Introduction

In February of 2023, the family of actor Bruce Willis revealed that he has a form of cognitive impairment called “frontotemporal dementia.” While not the same condition as Alzheimer’s Disease, proper, the sad announcement provoked a flurry of increased traffic to the Alzheimer’s Association’s website. In other words, the disclosures started a renewed conversation about aging – and its attendant illnesses.

For me, this is not simply an academic matter. My dad, Jim, died from Alzheimer’s Disease in 2016 after a decade-long struggle with that dreaded condition. 

Going through the experiences of trying to care for him and, later, getting him situated in – and visiting – a nursing home, I often felt that we were alone. Of course, and unfortunately, that is far from the case.

But, frequently, it’s not exactly public knowledge that a person has Alzheimer’s (or some other form of dementia).

One reason is the (pretty straightforward) consideration that families of all sorts usually wish to maintain their privacy in such matters.

Another is that Alzheimer’s is an insidious ailment whose presence may not be obvious until it is fairly advanced.

Finally, we don’t all have celebrity status! But, for those who – enviably or not – have achieved some measure of fame, it may be a different matter.

So, in this video, I will run through some of the “stars” of the stage or screen who are known to have had the misfortune of an Alzheimer’s diagnosis – and the ensuing cognitive decline and debilitation.

Caveats

I do not mean for this to be lurid or sensational. On the contrary, one chief purpose is to remind viewers that dementia is no respecter of persons, as it were. As far as we know, and notwithstanding various hypothesized predispositions and risk factors, Alzheimer’s Disease can strike almost anyone. So, for those who are dealing with this terrible affliction, let this serve as a tragic reminder that you’re not alone.

A further purpose is more practical. I’m trying to get back into the swing of making videos for this channel! And, yes, I have plenty more practical content planned. So…stay tuned!

The Top Ten

10. Joanne Woodward

At 93 as of this writing, Joanne Woodward is the only entrant on this list to be alive at time of recording. 

Getting her start in television in the early 1950s, she broke into a major movie rôle in the 1956 crime drama A Kiss Before Dying, with Robert Wagner.

Indisputably, her breakout performance came the following year in the psychological drama The Three Faces of Eve, for which she won the Academy Award for Best Actress in 1958.

She would be nominated for further recognition for the 1968 drama Rachel Rachel, directed by her longtime collaborator and late husband, Paul Newman. 

Her critical acclaim extended into the 1970s, where she performed in Gilbert Cate’s 1973 Summer Wishes, Winter Dreams.

As the decade progressed, she transitioned back into t.v., where – among other accolades – she won an Emmy Award for the 1978 production See How She Runs.

Sadly, in an article that appeared in the Los Angeles Times in 2022, we read: “Diagnosed with Alzheimer’s disease in 2007, Woodward has retreated from public life.”

9. Robert Loggia

Born Salvatore Loggia on January 3, 1930, he studied journalism in college. But the man who would become known as Robert Loggia rose to fame primarily playing “tough-guy” rôles. For example, he played the lead in Walt Disney Presents 1958 television series “The Nine Lives of Elfego Baca.” 

Loggia’s face seemed ever-present especially during the 1980s, where he made notable appearances in several widely distributed films, including 1982’s An Officer and a Gentleman with Richard Gere.

The following year, he starred alongside Anthony Perkins in Universal Picture’s sequel to Alfred Hitchcock’s groundbreaking 1960 horror film, Psycho.

But frequently, Loggia was cast to play mobster-type characters. For example, he was a Miami-based cocaine smuggler and “drug lord” in Brian de Palma’s 1983 Scarface, which also featured Al Pacino. 

Or, again, he was cast as sleazebag smut producer “Mr. Eddy” (also called “Dick Laurent”) in David Lynch’s 1997 abstract, psychological thriller, Lost Highway.

Occasionally, these secondary parts garnered him critical acclaim. For instance, Loggia was nominated for an Academy Award for Best Supporting Actor for his portrayal of private investigator Sam Ransom in the 1985 crime mystery, Jagged Edge.

And he won a Saturn Award in 1990 for his rôle as a toy-company owner in the 1988 “dramedy” Big, starring Tom Hanks.

Robert Loggia was diagnosed with Alzheimer’s disease in 2010. He passed away from its complications on December 4, 2015, at the age of 85, at his home in Brentwood, Los Angeles. 

8. Burgess Meredith

Born in Cleveland, Ohio in 1907 (November 16), Oliver Burgess Meredith began his acting career in the 1930s on Broadway.

His early cinematic work includes, with Lon Chaney Jr., a 1939 adaptation of John Steinbeck’s Of Mice and Men and, …

…with Robert Mitchum, a starring rôle in 1945’s The Story of G. I. Joe.

Meredith was lauded for his acting in John Schlesinger’s 1975 historical satire, The Day of the Locust. 

He was also well known to popular audiences for his work on television. During the 1960s, Meredith made a handful of appearances on Rod Serling’s The Twilight Zone, …

…and, as the villain the “Penguin,” on Batman, alongside Adam West and Burt Ward.

During the late 1970s and early 1980s, Meredith was a fixture in Sylvester Stalone’s blockbuster Rocky franchise, where he portrayed the gravelly voiced trainer, Mickey Goldmill.

After over fifty years of memorably quirky performances, in 1997, Meredith passed away. CNN reported his death, noting that Meredith “had been suffering from melanoma and Alzheimer’s disease”. He was 89.

7. Eddie Albert

The man who would attain celebrity under the name “Eddie Albert” was born Edward Albert Heimberger in Illinois in 1906.

He was successful both on television and on the “big screen.” Though, for a while, it seemed that his career would end prematurely. At one time, and (incidentally) similarly to Burgess Meredith, Albert’s name was associated with Hollywood’s so-called “blacklist.” 

This was primarily because of his wife Margo’s suspected left-leaning political sympathies and her alleged acquaintance with members of the Communist Party. 

However, Albert’s stellar record during World War Two, helped salvage his career. He was regarded as a hero because, as a naval steersman, he rescued 47 marines that were pinned down with gunfire.

Albert subsequently appeared in William Wyler’s 1953 comedy, Roman Holiday, for which he received a nomination for the Academy Award for Best Supporting Actor.

For six seasons, between 1965 and 1971, he starred with Eva Gabor in the once-popular “sitcom” Green Acres. Albert played the character Oliver Wendell Douglas, a lawyer who gave up his practice to become a farmer. 

He was again nominated for Best Supporting Actor for the 1972 comedy The Heartbreak Kid, which is now ranked #91 in the American Film Institute’s list of 100 all-time funniest movies.

During the 1980s, he was also featured on the prime-time CBS series Falcon Crest, a soap opera revolving around a prestigious vintner played by Jane Wyman.

When he died at home near California’s Pacific Palisades, it came out that Eddie Albert had been diagnosed with Alzheimer’s Disease around 1995. 

Though, according to his son, he had continued to be active right up to his death. The official cause of death was said to be pneumonia. Albert was 99 years old.

6. Charles Bronson

Born Charles Dennis Buchinsky in Pennsylvania in 1921, he forged himself into “Charles Bronson,” a personality that – in many ways – exuded gritty toughness onscreen and off.

The name change, by the way, was suggested by his talent agent. The supplied reason will sound familiar by now. Specifically, “Buchinsky” was thought to be a little too Eastern-European-sounding for a nation currently conducting House Un-American Activities Committee proceedings trying to ferret out Communist infiltrators. Bronson appears to have come through the period unscathed. 

Among the most successful action movies to his credit are the titular rôle in so-called “B-Movie King” Roger Corman’s 1958 Machine Gun Kelly,

John Sturges’s 1960 production, The Magnificent Seven, …

…and the same director’s 1963 film, The Great Escape, …both of which starred Steve McQueen.

…Robert Aldrich’s 1967 war picture, The Dirty Dozen, … 

…and Sergio Leone’s 1968 “spaghetti western,” Once Upon a Time in the West, …

But, Bronson’s most recognizable character was as “Paul Kersey,” a once mild-mannered professional who turns to vigilantism when his wife is slain after a home burglary.

The original franchise – known as the Death Wish series – consisted of some five installments over twenty years.

It was remade in 2018 by Eli Roth, with Bronson’s rôle played by Bruce Willis, whom we mentioned in our introduction. This has added poignancy given that both actors have been associated with dementia.

In Bronson’s case, news outlets revealed in 2001 that he was “battling Alzheimer’s.”

Charles Bronson died August 30, 2003 at the age of 81.

Sidelight

Although I may devote a dedicated video to the topic, I’d like to acknowledge that numerous individuals have suffered from other forms of dementia besides Alzheimer’s Disease.

Of course, we have already registered this point in reference to Bruce Willis, who is said to suffer from Frontotemporal Dementia. But, there are a number of others who could be mentioned here as well. I’ll simply list three.

The first was actor George Sanders. A highlight of his career was winning the Academy Award for Best Supporting Actor in 1951 for his performance in Joseph L. Mankiewicz’s 1950 drama, All About Eve. 

Sanders’ apparent suicide in 1972 was – perhaps – at least partially attributable to his dementia (which was, as far as I can tell, of an unspecified sort).

Or, again, we have actress Estelle Gettleman. Born Estelle Scher, she is better known by her stage name Estelle Getty. She had sporadic, odd rôles early in her life. But her main claim to fame came as the character Sophia Petrillo on NBC’s hit comedy series The Golden Girls, which ran from 1985 to 1992.

Getty died in 2008 from complications arising from Lewy-Body Dementia.

Finally, I’ll quickly mention comedy icon Robin Williams. Known for his wacky and improvisational style, his film and television credits are too numerous to relate exhaustively. But standouts include Aladdin (1992), Good Morning, Vietnam (1987), and Mrs. Doubtfire (1993).

Williams also “starred” in many noteworthy dramas – albeit, frequently with a touch of Williams’ characteristic humor – including Dead Poets Society (1989), Fisher King (1991), Good Will Hunting (1997), and What Dreams May Come (1998).

But, a darker side emerged in such movies as The Secret Agent (1997), based on Joseph Conrad’s 1907 novel, and Christopher Nolan’s Insomnia (2002).

Like Estelle Getty, Robin Williams may have had Lewy-Body Dementia – although, this fact was not disclosed until autopsy results were made public after Williams’ death.

And, of course – tragically – like George Sanders, Robin Williams was said to have taken his own life.

5. Peter Falk

Peter Michael Falk was born September 16, 1927 in New York City. His identifying squint was caused by the artificial eye he was forced to use after his natural eye had to be removed because of cancer when he was three years old.

Falk got his start in theater, but transitioned into the world of motion pictures. Among his credits are a disturbingly gritty portrayal of a mob-connected killer in the 1960 gangster film Murder Inc., …

…and Frank Capra’s 1961 comedy, A Pocketful of Miracles.

Much later, Falk appeared as both “grandpa” and narrator in Rob Reiner’s lighthearted 1987 The Princess Bride.

Still, there is little question but that Falk was most famous for his television work as the perceptive but self-effacing detective Columbo – which rôle he reprised over several broadcast seasons.

Following two successful “pilots” in 1968, the show ran from 1971 to 1978 and then continued from 1989 to the early 2000s. Falk is still instantly visually recognizable as Lieutenant Columbo. And he played the part with a humorous edge, as illustrated by his trademark line – “Just one more thing, …” – always delivered before the final mystery “reveal.”

In December of 2008, news outlets reported that the actor had been diagnosed with Alzheimer’s Disease. 

At a “conservatorship” hearing the following year, a physician testified that Falk had “slipped rapidly into dementia since a series of dental operations in late 2007” – at least, according to a summary from the Huffington Post. 

The article then went on to raise obliquely the possibility – underdetermined by the evidence at hand – that the Alzheimer’s had been brought on, or “worsened,” by the anesthesia.

In any event, he died at 83 on June 23, 2011. 

A gossip page asserted that Peter Falk’s “official cause of death was cardiorespiratory arrest, while pneumonia and Alzheimer’s Disease were both ‘underlying causes’ …”. 

4. Gene Wilder

Born Jerome Silberman in Milwaukee, Wisconsin on June 11, 1933, the boy who would eventually be known as “Gene Wilder” had humble beginnings. His father and maternal grandparents were Russian-Jewish immigrants.

Beginning his movie career in 1967 with Bonnie and Clyde, which featured Faye Dunaway and Warren Beatty in the titular roles, he moved onto a long-time and lucrative partnership with comedy director Mel Brooks.

Wilder performed in numerous films, including, in 1967, The Producers, as well as Blazing Saddles and Young Frankenstein, both in 1974. 

He married Saturday Night Live actress Gilda Radna. When she died at 42 from ovarian cancer, Wilder promoted cancer awareness.

But his most memorable rôle – not least through its generation of at least once persistent “meme” [Note: This remark will be elucidated via an onscreen image. – M.B.] –…

… might be as a quirky chocolatier in the 1971 movie Willy Wonka and the Chocolate Factory.

Gene Wilder died at the age of 83 in his home in Connecticut on August 29, 2016. 

The cause, not publicly disclosed until after his death, was Alzheimer’s Disease. 

Posthumous statements from relatives stated that he had been diagnosed in 2013, but that the star chose to keep the news from fans so as not to distress anyone.

Poignantly, in one press report, Wilder’s nephew was quoted as saying that his uncle “…simply couldn’t bear the idea of one less smile in the world.”

3. Charlton Heston

“Charlton Heston” was the well-known stage name of the man born John Charles Carter. 

As a movie star, he was especially recognizable for his portrayal of major religious figures in several prominent productions during the 1950s. For example, Heston was cast as the Biblical Moses in iconic director Cecil B. DeMille’s final – and most successful – films, The Ten Commandments, released in 1956. The part earned him a Golden Globe nomination.

Four years later, Heston won the Academy Award for Best Actor for his performance in William Wyler’s 1959 Christian-themed epic, Ben-Hur.

He is also remembered for several striking works of dystopian fiction, including the influential 1968 sci-fi movie Planet of the Apes, …

…and the 1973 horror “cult classic” Soylent Green.

Perhaps his most controversial rôles, however, were in the political sphere. Initially, his activism was in the service of left-leaning causes advanced by the Democratic Party. For instance, Heston spoke in favor of the Civil Rights Movement during the 1960s.

During the 1980s, he changed his allegiances and became a Republican. In this capacity, Heston served as a spokesman for, and president of (1998–2003), the gun-rights-advocacy group known as the National Rifle Association, for whom he popularized the slogan “I’ll give you my gun – when you pry it from my cold, dead hands.”

On August 9, 2002, it was widely reported that Heston had been diagnosed with “a neurological disorder whose symptoms are consistent with Alzheimer’s disease.”

Heston vowed that he was “neither giving up nor giving in”.

Roughly a year later, in what would prove to be his final public appearance, he was given the “Medal of Freedom” in 2003 by then-U.S. President, George W. Bush.

Despite this, his decline was rapid.

By 2005, Heston was apparently bed-ridden much of the time.

Ultimately, he passed away April 5, 2008 at the age of 84. The immediate cause was subsequently given as complications due to pneumonia.

2. Rita Hayworth

Rita Hayworth was born Margarita Carmen Cansio on October 17, 1918 in Brooklyn, New York. 

In the 1940s, along with Betty Grable, Veronica Lake, Carole Landis, Marie McDonald, Jane Russell, and others, Hayworth became a popular “pin-up girl” for many U.S. soldiers. 

Given this, it’s not a surprise that she was cast alongside Gene Kelly in the popular wartime musical Cover Girl (1944).

Hayworth got her “start” on the silver screen appearing in B-movies, such as the 1937 mystery, The Shadow.

But her first major dramatic role – and possibly her most enduring – was as the lead femme-fatale character in the 1946 movie Gilda. 

Other of her numerous film credits include: Only Angels Have Wings (1939), The Lady from Shanghai (1947), and Pal Joey (1957).

The American Film Institute ranks her 19th in their list of the top fifty actresses of all time.

Among her many love interests and husbands were the famed director Orson Welles and the Ismaili Prince Aly Khan.

Tragically, Rita Hayworth was diagnosed with Alzheimer’s Disease in 1980. In her case, this is now relayed as a case of so-called “Early-Onset” Alzheimer’s.

This comports with the comments of Hayworth’s daughter Yasmin Aga Khan, who once asserted that her mother had had dementia-like symptoms for “two decades” prior – which, doing the simple math, would have been around 1960, when the actress was in her 40s.

Some researchers now suspect that some forms of Alzheimer’s may be precipitated by various chronic nutritional and vitamin deficiencies. For Hayworth, these may have been bound up with – or at least exacerbated by – habitual alcohol abuse.

She lived with the illness for about seven years after diagnosis, succumbing May 14, 1987 at her home in New York. 

Reportedly, she had been in a semi-comatose state since February.  

Hayworth’s renown called wide attention to the disease that had been largely ignored or unknown before her diagnosis and death.

Runners Up

Other actors who suffered – or died – from Alzheimer’s Disease include: Raymond Bailey, remembered as Mr. Drysdale, from the popular Beverly Hillbillies t.v. series; 1930s actor Thomas Beck; David Birney, remembered for the 1970s sitcom “Bridget Loves Bernie,” and his relationship with actress Meredith Baxter-Birney; James Doohan, best-known as “Scotty” from the Star Trek franchise; English actress Jill Gascoine, known for the police-themed television show The Gentle Touch; British actor Tony Haygarth; actor Leonard Jackson; lesser-known actor John Kellogg; Jack Lord, best known for his part in the long-running television series Hawaii Five-O; William Marshall, star of the first horror movie (Blacula, 1972) to feature an African-American actor; Simon Scott, known for his rôle in the series Trapper John, M.D.; and film and television actress Stella Stevens.

1. Ronald Reagan

Ronald Wilson Reagan was born in Tampico, Illinois on February 6, 1911. With fifty-three films to his credit, he had modest success on the silver screen.

He was featured in such movies as the 1940 western Santa Fe Trail, with Errol Flynn, …

…and Sam Woods’ 1942 King’s Row – both of which are acknowledged for his respectable acting.

“Ronnie’s” most memorable performance, which earned him the alternate nickname “the Gipper,” was portraying ill-fated college footballer George Gipp in the 1940 biographical film, Knute Rockne, All American.

For the most part, however, Reagan is remembered as a B-movie actor who occasionally veered over into goofball territory, such as with the 1951 comedy Bedtime for Bonzo, where he plays a psychology professor trying to raise and teach a chimpanzee.

Fairly obviously, he is now far more important for his political involvement, which culminated (in 1980) with his election as the 40th president of the United States, than for anything he did while in Hollywood.

That said, it is noteworthy that Reagan transitioned into this phase of his life via two main channels. One was his activity with the Screen Actors Guild, for which he twice served as president.

In fact, when he testified before Congress’s House Un-American Activities Committee, Reagan denounced certain members of the Guild as “Communists.” According to Time Magazine, reporting in 1985, Regean also functioned “…as a secret FBI informant…”.

As the Chicago Tribune stated: “…he and his first wife, actress Jane Wyman, gave the FBI the names of actors who they believed were members of a clique with a pro-Communist line.”

Of course, we previously encountered several actors – including Eddie Albert – who were on the receiving end of such accusations. Mention of Wyman is therefore especially interesting, since you’ll recall that Albert and Wyman worked together on Falcon Crest. 

Reagan’s political ambitions were also evident – and probably advanced – in his capacity as spokesman for the multinational behemoth General Electric.

Through his shrewd networking, he became the 33rd governor of California in 1966 (a position he occupied between the powerful family duo of Pat and Jerry Brown). Reagan moved into the White House a few years after his gubernatorial term ended.

During his presidency, Reagan – whether justifiably or not – was credited with reversing the inflation and unemployment (or “stagflation”) that took hold during the 1970s. His laissez faire policies, characterized by reduction of taxes, were collectively called “Reaganomics.”

His ideas – or, at least, those attributed to him – were also termed “trickle-down” theory. The idea was that stimulating large corporations would boost the economy for everyone.

Reagan also increased defense spending and signed an historic treaty with then-Soviet leader Mikhail Gorbachev. The agreement provided that the two large “superpowers” – the United States of America and the Union of Soviet Socialist Republics (or, U.S.S.R.) – would begin to scale back their collections of nuclear weapons.

Reagan’s tenure as president has been cited as priming the U.S.S.R.’s collapse, which unfolded roughly between 1989 and 1992.

In 1994, Ronald Reagan released a dramatic statement beginning with the words: “My Fellow Americans, I have recently been told that I am one of the millions of Americans who will be afflicted with Alzheimer’s Disease.”

Over the next decade, the former “Great Communicator’s” cognitive and physical abilities faded until, June 5, 2004, he succumbed to pneumonia – a common Alzheimer’s-related complication – in his Bel Air home in California. 

As a coda, we note that Ronald Reagan had done much during his time as U.S. president to raise public awareness of Alzheimer’s Disease. For example, in 1982, he issued Proclamation 4996, creating a “National Alzheimer’s Disease Week.”

Then, in 1985, Reagan expanded on this with Proclamation 5405, making November “National Alzheimer’s Disease Month” – a commemoration that has continued to the present day.

I have an old video on this topic. 

Looking Ahead

Statistical reports suggest that, at present, there are over six million Alzheimer’s sufferers in the United States alone.

According to Alzheimer’s Association projections, that figure is expected to double by the year 2050. Of course, if the number of Alzheimer’s patients increases in the general population, we would expect the same to occur in subgroups. In other words, the number of actors with Alzheimer’s will be going up as well. We’re already seeing indications of this.

Prominent, here, is the Australian-born actor Christopher “Chris” Hemsworth, best known for portraying the Norse demigod Thor in numerous Marvel Cinematic Universe superhero movies.

Recently the press reported that Hemsworth underwent genetic testing as part of a “docudrama” on various aspects of the aging process.

Ultimately, Hemsworth revealed that he possesses two copies of the so-called “Alzheimer’s gene” – one from each side of his family.

Known as the APOE4 gene, it is present in around “in four people. …[B]ut only 2 to 3% of the population have [two copies]…”.

For some context, see the presentation that I did concerning my own test results.

Once again, stay tuned for additional material – both practical and theoretical – that is more central to the channel’s overall theme, which is Alzheimer’s Proofing both your home and your lifestyle.

But if you found something of interest in this video, I ask that you like it. And, if you haven’t already, consider clicking “Subscribe.” Don’t forget to turn on your notifications to be alerted to new content as it becomes available.

Thank you for watching!

The post 10 Famous Actors With Alzheimer’s Disease appeared first on Alzheimer's Proof.

Alzheimer’s – and other forms of dementia – are menacing and oppressive diseases. 

First and foremost, they take their toll on those who are directly afflicted. 

But they can – and do – cause much wider-spread devastation. 

Those who have seen it “up close and personal,” know this can include financial, physical, relational, and – for those so-inclined – even spiritual fallout.

I have gotten – and will get further – into those angles in other videos.

But among the myriad negative effects are the various emotional and psychological consequences associated with Alzheimer’s – and with dementia caregiving.

Some of these are widely discussed. At least… they’re addressed in general terms, abstractly.

But there’s an issue that tormented me, personally. Reading comments on some of my videos – especially “When Is It Time For a Nursing Home?” – it seems that I’m far from the only one. 

So, in this video, I want to talk about what to do when your caregiving efforts drive you to agonize over the question: Does this make me an awful person?

Caveats

I am not a counselor, psychologist, therapist, or anything close to these. And I am not a healthcare provider or medical practitioner of any kind. Therefore, I cannot diagnose mental- or physical-health conditions, and I am unable to give specific personal advice. If you have depression or thoughts about self-harming or anything in those vicinities, you need to seek professional help. This video is intended for general educational or informational purposes only. I am speaking solely from my own experiences and reflection. And my aim is to raise awareness of these issues as well as foster feelings of solidarity among other caregivers and sufferers. The message is: You’re not alone if you feel this way or have these concerns and doubts. 

Ten Reasons Why Being a Caretaker Can Make You Feel Like a Terrible Person

This will be rough-going. I’m going to try (!) not to linger on any point – but just sketch them. As always, your comments are welcomed, especially since it’s a good bet that I missed something.

#1 Missing the Signs of Dementia

If you’re like me, you may have a tendency to punish yourself for not having recognized the evidence of Alzheimer’s, or for misinterpreting the signs that you did see. This may or not be the first thing that prompts you to feel rotten. But, thinking back over my caregiving experience, it was the first thing that I thought of. 

As I have explained in several videos, my mom seems not to have recognized my dad’s dementia at all. When I came into the picture, I knew immediately that something was wrong. 

But I didn’t understand what I was witnessing. Frankly, I thought my dad had turned into a jerk.

It’s easy to feel bad for thinking ill of him. In retrospect, the temptation is strong to regret not being more intuitive or perceptive or for lack of knowledge.

But REALIZE: Alzheimer’s is a tricky disease. And (as I explained in a past video), even doctors can fail to see the writing on the wall. So don’t beat yourself up! We’re not omniscient, after all.

# 2 Being Unable to Help Them

A major and continual problem is our seeming inability to provide meaningful assistance.

When your loved one is struggling to remember an event or name, you may be unable to convince them of an answer that you know to be correct. And you’ll feel like a failure.

REALIZE: It’s not like helping a non-afflicted person remember something they’ve temporarily forgotten. A normally functioning person can know they’ve forgotten something and, after it’s been brought back to their attention, they can remember what they’re forgotten. Alzheimer’s Disease literally destroys the brain. At some point, a cognitively impaired person may no longer have the forgotten memory or any means to retrieve it.

Even more, we’re powerless to stop the advance of dementia. This is obviously a deeply distressing fact. And even though Alzheimer’s is only one of numerous terminal illnesses, it – and cognitive disorders like it – don’t just kill the body. They kill the mind and the personality.

It’s gut-wrenching when your loved one doesn’t recognize you, or repeats over and over that they wanna go home, when you’ve gone above and beyond to give them a caring environment. 

FURTHER REALIZE: That just your calming voice or loving touch is helping them at some level. Yes, you feel terrible when you make a loving home-care environment, but it goes unacknowledged. And, it’s true, once their impairment is far-enough advanced, they probably won’t be able to appreciate your efforts. The most important thing, however, is that you provide an objectively loving, safe, and secured space for them – not that they are aware of your efforts. 

#3 Calling in ‘Authorities’

Alzheimer’s sufferers may have outbursts. Some might sob uncontrollably. Others may laugh inappropriately. It’s easy to become distraught when you’re unable to calm or comfort them. 

My dad was at the opposite end of the emotional spectrum. He frequently exploded in anger. I had to physically restrain him on one occasion. Just what do you do when things get heated? 

I once called a well-known dementia-care support group (that’ll remain nameless). And I asked them this question. Believe it or not, the advice I was given was: Call the police! 

…which – after my dad’s next nasty outburst – I actually did.

I’ve no clue whether this suggestion reflected an organizational policy or was just the quirky opinion of the person who happened to answer the phone that day. And I’m not saying the step is never warranted!

But, in my case, the ensuing encounter was thoroughly discouraging – and the intervention was revealed to be obviously unsustainable.

Oh, sure, dad settled down at that moment. But I was made to understand – in no uncertain terms – that the police department had neither the manpower nor the training to be home-care “orderlies.” And it’s not like my dad “learned some lesson” or would even remember the episode.

REALIZE: You do what you can with the data you have. I like to draw an analogy with the daily forecast. If you plan your activities around the expectation of sunny skies – and you did your due diligence: checking the radar and weather report, etc. – and it ends up raining, it’s not your fault. Sometimes the best information available to you is just plain wrong.

Another aspect of this isn’t quite as dramatic. It has to do with your loved-one’s doctor.

As I noted elsewhere, physicians often depend on family members to know that something is wrong with a loved one. In my case, I wrote to my dad’s primary doctor letting him know that my mom, my sister, and I were all extremely worried – especially about the issue of his driving.

Specifically, I had to push the doctor to write a report that resulted in dad’s license being revoked. And that felt really lousy. – like I was going behind my dad’s back and betraying him.

What I had to REALIZE, there, was that other people’s lives and wellbeing were at stake. It wasn’t simply about my dad and his autonomy.

What if he confused the brake and the gas pedal while at our local park? – with families walking everywhere and little kids bike riding, playing, and running all over the place?

No. I felt that – as unfortunate as it was – it had to be done. And, ultimately, it wasn’t me doing anything to my dad; it was the Alzheimer’s Disease that was to blame.

#4 Being Embarrassed by Them

But, of course, when your loved one loses their mobility – or has their autonomy restricted, that doesn’t necessarily mean they simply become homebound shut-ins. – At least, not until the dementia becomes really physically debilitating. 

It probably means that you have to pick up the transportational “slack.” And this may not simply range over doctor’s appointments.

If you’re in the position of having to assume caretaking all by yourself – and see my recent video – then you might have to cart them along: As you go shopping and run other household-related or personal errands.

And even if you’ve got help on those fronts, your afflicted loved one will need haircuts. Maybe they gain or lose weight and need to try on new clothes. 

You might even want to include them in enrichment or leisure activities. My dad always enjoyed outdoor theater during the summer. My mom and dad had their favorite restaurants. And so on.

But, this can give rise to awkward situations. For instance, I was present at a church service during which my dad caused an obscenity-laced disruption. Several times, he caused a “scene” at local stores. He even picked a fight with a relative during a family reunion over some slight – whether real or imagined – that apparently went back decades. 

These sorts of experiences can make you not want to be seen with them in public or take them outside at all. 

REALIZE that your loved one may benefit from interpersonal interactions. But, sometimes, events are too busy or loud for a person with dementia. They may easily become overstimulated or overwhelmed. So, if possible, choose events and places that are calm and relaxing. 

But what can you do about feeling embarrassed? Firstly, it’s totally understandable. Just ask parents of unruly kids.

Something else that I wish I had done more frequently was to alert people around me about my dad’s cognitive problems. There is one way to do this without making a fuss – and without having to say anything out loud that your loved one might not take well.

Namely, there are little business-card-sized announcements displaying text such as: “The Person I’m With Has Dementia. Please be patient. Apologies for any inconvenience.”

In my experience, most of the time, when bystanders react negatively, it’s because they think that a person who is behaving badly is freely choosing their actions. If you can alert people around that something is wrong, they are often much more forgiving.

#5 Losing Patience With Them

Speaking of this, it’s not always easy for caretakers to remain calm, either. And there’s certainly no shortage of composure-testing situations that can arise in a home-care context. 

Providing daily care – including supervision – can become monotonous and tedious. Depending on your demeanor, one of your constant struggles might be losing your temper.

It’s easy to become impatient when you have to say the same things over and over. 

Again, child rearing is similar in this regard. But, with kids, at least they’re small and are acquiring the capacities to learn and remember. – Not so with a dementia-afflicted adult.

REALIZE that you might not be able to handle caretaking all by yourself. At some point, you might need to seek assistance. This might mean that you have a heart-to-heart with relatives and ask them to step in – whether temporarily or on an ongoing basis.

But it might also require that you consider professional-care options. As I’ve discussed elsewhere, respite facilities exist to offer family caregivers “breaks” on a short-term basis. And, of course, nursing homes may be the only viable long-term alternatives to home care.

#6 Feeling Your Loved One Is a Burden

Another way to say this might be that you find yourself resenting their decline. I mean…

It’s justifiable, and natural to lament your loved one’s cognitive and physical deterioration. 

But what I have in mind is different. It’s that you might find yourself becoming bitter at all the time you have to spend attending to their needs. Or you may develop a “grudge” over the fact that your loved one is unable to appreciate – or understand – your predicament and sacrifices.

Relatedly, you might get depressed – or panicky – at the emotional, financial, or physical strain. This may well include having to take leave from a job and, essentially, to put your life on hold.

REALIZE that you’re only human. Your capabilities and your resources are finite. It’s important – vital even – not to make rash choices. If you find yourself down in the dumps after an especially trying week – or month – then try to give yourself a bit of space.

That’s easier said than done, of course. But, as I have discussed in past videos…

…most recently, the one titled “Is It Possible to Be a Caretaker All By Yourself?” …

…there are a few options available to help you. I’ll defer to some of my other presentations for the details. But you may be able to secure what is called “Respite Care.” This is short-term assistance designed for the sole purpose of giving primary caretakers a much-needed break.

Sidelight: Know (Or Discover) Your Limits

At a certain point in time – it does no good for you to press too far beyond your reasonable limits. I choose my words very carefully. There are three key phrases or terms, there.

“A certain point in time,” “too far beyond,” and “your reasonable limits.” 

At the end of the day, only you (and your family) can determine, hopefully in consultation with each other, with friends, and with trusted advisers – like doctors, financial advisers, lawyers, etc. – what these points and limits actually are.

But the flip side of making a hasty decision when you’re temporarily or uncharacteristically emotionally low, is disregarding – or refusing to think about – your limits.

And that can land you in extremely dangerous territory. One sign of this might be, …

#7 Wishing Your Loved One Would Die.

Or wishing that they were already dead. Let’s draw a few distinctions.

Number one, there’s a difference between (on the one hand) lamenting that your loved one is suffering – focusing on their pain for their sake – …

…and (on the other hand)  worrying about their pain because of how upsetting it is for you. – whether for you to deal with, or for you to witness at all, or… whatever.

My dad wasn’t diagnosed with Alzheimer’s Disease until the summer of 2009. Immediately preceding that diagnosis, my dad had had two major surgeries just a couple months apart. 

On the eve of the first – a triple bypass – my dad was literally on death’s door. Those surgeries prolonged his life for seven years, as it turned out.

But, it’s easy to ask: For what?! Those years were dominated by cognitive decline. I spent four of them caring for him at home, and he spent his last three in a nursing home.

I regularly found myself wishing, or at least, wondering: If only he had died in 2009! 

Don’t get me wrong: On my better days, what I was mainly thinking was: If only he had died of a heart attack, his death would have been relatively quick (in theory)… and he would have been spared a near-decade of slowly wasting away – both mentally and physically. 

There is space, here, for a discussion of various spiritual perspectives. I’ll leave that complicated topic for a possible, future video. But REALIZE: You can’t control what life gives you; you can only control how you react or respond to it. 

Granted, it’s easy to say and hard to do. And I confess: not every thought I had was “altruistic.” 

So, number two, we also want to distinguish between a fleeting “bad” thought and an all-consuming idea. Admittedly, there’s a vast middle ground between the two extremes.

Anyone might be susceptible to having the occasional selfish desire. You want to guard against obsessing over such thoughts. For me, this came when my dad was in the nursing home.

Towards the midpoint of dad’s nursing-home stay, we had our first dealings with hospice.

“Hospice” is end-of-life, palliative care for terminally-ill patients. Every time we’d get a call that dad was being “put on hospice,” the news hit us as if he’d just been handed a death sentence. Obviously, I’m speaking loosely. The late-stage Alzheimer’s itself was the real death sentence.

We just didn’t realize that a person can see-saw on and off hospice. Roughly half the time dad was in a nursing home, my family was on edge, expecting that his death might come any day.

That is exhausting, to say the least. Your emotions are like a yo-yo. And it can be both financially and physically demanding.

For example, the first time you think your loved one is at the point of death, you cancel appointments, you take off work, and you otherwise bend over backward to be present as much as possible. If and when they recover, you’re relieved – and not a little surprised, frankly.

But then it happens again. And again. And again. Finally, you worry how you can keep doing this. And you’re basically stuck. If you do react to every wave of hospice as if it were going to be your loved one’s last minutes on earth, then you can place an ever-increasing burden on your family – depending on how many cycles they go through. 

After all, it’s not easy to set aside a year, two years, or whatever to be a part of some protracted, open-ended hospice scenario. Sad, but true.

But if you don’t respond, then you risk not being there when your loved one actually passes. You don’t want them to die alone. So, more than once, I wished he would just die. Because I’m here this time. Or my mom is with him right now. Or my sister is visiting from out of town. If he pulls through again, I don’t know which of us will be present next time. 

The thing to REALIZE, here, is that we’re only human. The best you can do sometimes, is to take things one day at a time. Have an honest and open dialogue with the hospice and medical staff about your loved one’s situation. And try to plan (as best you can) for rainy-day scenarios.

Regardless of what stage of care you’re in, and where that care is being delivered, try to nip any selfish thoughts in the bud as soon as they pop into your head. Again… easier said than done. 

It may help to focus on why you’re doing this. Think about positives – like happy memories. Try to “reframe” the situation, or look at the end-of-life process as a series of opportunities to spend a few more precious moments with your loved one than you thought you’d get.

If you’re in a home-care situation, then consider whether these thoughts – especially if they’re preoccupying you – might be signs of an impending breakdown. Be honest with yourself.

That includes reaching out for help if and when it’s necessary. It might mean that you seek counseling or arrange for respite or hospice care for your loved one.

It doesn’t do any good to simply bury or deny your feelings. The overall caregiving may suffer – which would be bad for your loved one and for you. And that leads to the next consideration.

#8 Regretting Your Caretaking Decisions

It’s an understatement to say it, but …the caretaking road is tiring. 

It may also be long and winding. You may feel like you’re wandering lost with no clue how long it will take you to arrive anywhere – or to get back. 

You may have mounting debt or expenses. You yourself may be developing age-related physical problems at the same time your loved one is declining. These – and other – factors can lead you to wonder: Can I do this at all? Or …Can I keep doing it? 

You can get the distinct impression you’ve bitten off more than you can chew.

And that can lead you to think you made the wrong choice – or a bunch of wrong choices – somewhere along the way. I want to tackle that worry head-on in another video.

But if you start thinking that it was a mistake to take your loved one in, or to assume caregiving responsibilities in the first place, then it can throw you into a spiral of self-doubt. 

REALIZE: You’re not alone. Probably every caretaker will harbor similar concerns if they are at it long enough. While this won’t necessarily allay fears that you took a wrong turn, I say it because it’s arguably never clear to anyone what the “correct” path is. You consider your loved one’s well-being of paramount importance, you gather information, you talk your options over with trusted friends and advisers, and you try to do the best you can with the hand you’re dealt.

If, ultimately, things become unmanageable, that may lead to you having to course-correct.

#9 Having to Institutionalize Your Loved One.

And that leads me to this next item. Let me come at this by way of a recent comment. Let’s just say that the opinion was acerbic.

The commenter wrote, in part: “ …I cared for my wife on my own… It did not occur to me to farm her out to await death to make my life more comfortable. …”

Honestly, I doubt that the commenter watched my video. Instead, it seems that he was merely reacting to the title. It’s possible that he misconstrued “When Is It Time for a Nursing Home?” as me saying that – eventually – every caretaking scenario will end with institutionalization. – Which, of course, I don’t believe is true and never said.

Either that, or else he objected that anyone would ever admit their loved one into a nursing home. It’s a view that treats the nursing-home option as tantamount to throwing in the towel (at best) or seeking the easy way out (at worst). 

For our purposes, I’m highlighting this because it might easily be taken to heart as an indictment of a caretaker’s commitment to his or her loved one. – As if the only way to show love is to assume full caregiving duties – and stick to them – come hell or high water. Since I turned to professional care, that makes me a bad son.

REALIZE that no one has walked in your shoes. No one should impugn someone’s else’s familial love on the sole basis of their having to utilize a nursing home. 

If we didn’t care, we wouldn’t be anguishing over the decision. 

But not only is a comment like this uncharitable, it’s really incomprehensible. It half-implies that nursing homes should never be an option. 

As many of you know all too well, it’s not always possible – emotionally, financially, physically, or whatever – for family members to be at-home caretakers. In fact, if a better, more complete, kind of care can be delivered in a skilled-nursing facility than in a home, then you could turn the poster’s allegation around and say it would be unloving not to use the nursing home.

Personally, I believe that things are often much more complex and nuanced than either of these dismissive reactions would suggest. For one thing, nursing homes may (or may not) offer quality care. This is just to say that the way forward is not always obvious. In fact, I’d be hard pressed to find a case where the “right decision” is obvious! 

No …If there’s certainty in any of this at all, it’s that there is no one-size-fits-all approach. 

Thankfully, though, you and I have nothing to prove to anyone else. At the end of the day, it’s for you – in consultation with your support network – to make the best decision you can for your loved one and for your entire family.

#10 Finding That You Don’t Feel Anything at All

Up to now, we’ve been trying to come to terms with various experiences that can make you feel miserable. And that unhappiness can make you wonder if you’re an awful person.

But what happens if you don’t think you’re feeling anything at all? 

Someone might hear me explaining how I was tortured over things like the decision to admit my dad into a nursing home or how I was periodically embarrassed by him in public, and so on.

And it’s perfectly imaginable that somebody might think: I’ve never felt anything like that. Does that mean I’m a horrible person?

REALIZE that people deal with adversity differently. I tend to be a reactive, volatile person. I can get worked-up easily.

So, don’t compare – and certainly don’t judge – your emotional reactions to mine or anyone else’s. 

But also REALIZE that not feeling anything can mean a lot of different things. For example, it might mean that you’ve become emotionally numb. Caretaker burnout is a real danger. 

Remember, also, emotional flatness can be bound up with the so-called “denial stage” of grief processing. So, as I stated earlier, just be willing to be honest with yourself. You might need to take a break. Or you may need professional help – whether for your own mental or physical well-being or for assistance with the day-to-day business of caretaking.

Concluding Remarks

Being a caregiver for someone with dementia can make you feel a lot like Sisyphus. You’ll recall that in the Greek myth, Sisyphus is fated to push a rock uphill for all eternity. Every time he manages to reach the summit, the rock rolls back down the mountain and he has to do it again. 

It’s frustrating. It can feel altogether absurd and futile. Additionally, some of the caretaking measures you may need to implement can feel like betrayals. That can be depressing. And it may lead you to feel inadequate, unworthy, and even wretched. 

Recently, I realized how many times in past videos I say something like “it sounds bad, but…”.

Why install double-keyed deadbolts on the entry doors? It sounds bad, but… it’s so your loved one can’t easily get out of the house.

How hard is it to care for someone with middle-stage dementia? It sounds bad, but… caretaking can be more manageable if they’re also physically disabled.

I was racked with guilt after having my dad admitted into a care facility. I had nightmares for years afterwards. And it sounds bad, but… the worst were bad dreams in which my dad came back to the house and I was once again thrown into a stomach-churning hopelessness. 

You love your afflicted dad, mom, grandparent, spouse, …or child! They’re not actively doing anything to you. They’re not intentionally making you miserable or “oppressing” you. 

And you know they’re suffering, too. As my sister said to me during one heart-wrenching exchange in which we discussed institutionalization: Dad is himself in a really bad place.  

That’s an understatement, of course.

Trying to imagine what it was like for him is, frankly, sickening. You’re “stuck” inside a body and with a brain that can’t or doesn’t or won’t cooperate with you?! I picture being locked in a windowless room – cut off from others and, eventually, from myself. It’s horrible, hellish, in fact.

Deep down, we know all this “full well,” as the saying goes. That’s the point. The enormity of the pain – on all sides – can be terrifying. Even so, you want so badly to continue to believe that – in their “heart of hearts” – your loved one cares about you, still remembers you, still loves you.

In a sense, it’s precisely that belief – and that hope – that adds insult to injury. 

Because… You desperately want to help them. But when they’re cursing you out and throwing things around the house; or when they don’t recognize you and they react to your caretaking as if you were an intruder; or when they refuse to bathe or toilet and you’re routinely cleaning feces off the carpet; you are thoroughly demoralized.

The situation creates an almost impossible tension. You’re sick over the prospect of nursing-home confinement. At the same time, you can feel like you can’t go on and on like this – or you will literally go insane or totally break down physically yourself.   

This psychic pressure can build to the point where your mind goes in really dark places.

I’ve been there.

I don’t want to leave this on a negative note. 

Please know that I truly, truly, truly empathize. 

If you’re presently going through a hard time, then I invite you to share your experiences and thoughts in the comments. 

And if you went through a similarly harrowing journey in the past, then I’d ask that you share as well. I have seen really beautiful exchanges in the comments. And I sincerely believe that people who are experiencing self-doubt – or loathing – can benefit from reading about what other people have undergone – and survived.

I hope that – if nothing else – this video encourages you that you’re not alone. And, sometimes, knowing that is about all that keeps you going. I wish you all the best. Thank you for watching.

The post When Dementia Caregiving Makes You Feel Like an Awful Person appeared first on Alzheimer's Proof.

After all, anything is supposed to be possible. Right?

But what we’re really asking is: Can I manage it? Will it work in my situation?

And the frustrating reality is, I don’t know.

What I can do is speak from my own experience and research.

But after it’s all said and done, you’ll have to look at this picture, talk it over with family and trusted advisers, and decide whether it would be feasible and realistic for you.

Perhaps the least useless thing I can do is to try to paint a picture of what solo caretaking might look like in the hope that it will give you a framework for your own decision making.

So, strap in, and we’ll start to think through the question: Can you be a caretaker all by yourself?

Preface

I’ll be speaking broadly. I’ll talk about a way solo caretaking could look, drawn from when I was the at-home caregiver for my dad, who died from Alzheimer’s Disease in 2016. I started caring for him in 2008. But we’ll also talk about caregiving variations, based on my research. 

The main thing I want to do is to provide you with a blueprint for having a conversation. You will want to talk about possible caregiving scenarios – and pitfalls – with family, friends, and trusted advisers. So, my hope and expectation is that you’ll take what you find useful and leave the rest. 

As an “assist,” I’ve prepared a step-by-step guide that you can feel free to download. It’s possible that you can simply Google “Alzheimer’s Proof Caretaker’s Guide.” 

But, search engines can be a bit dicey sometimes. So, you can always just point your web browser to AlzheimersProof.com and navigate to it that way.

Introduction

This video was prompted by a viewer-submitted question. As I reflected on the viewer’s situation, one thing I realized is that it is extraordinarily difficult – bordering on being practically impossible – to be entirely solo as a caretaker. 

As we move along, it’ll become apparent why I say this. But, what I sincerely hope is that you may also discover, upon reflection, that you’re not actually all by yourself. Or, at least, if you are genuinely alone, then I hope you may come to a deeper understanding of the challenges that lay ahead of you. Not to compound your worries! But simply to enable you to better plan for, and adapt to, circumstances as they arise.

Caretaking Rôle vs. Household Composition

First thing’s first. We should try to clarify what we’re talking about. You’d think that “solo caregiver” is fairly self-explanatory. But I think there are subtleties that need to be made explicit.

What does it mean to be “solo”? There are at least two senses. 

‘Solo’ in a Caretaking Sense

Firstly, there’s a caretaking sense. By “caretaking,” I mean assisting your loved one with the Activities of Daily Living (ADLs) – which I explain in a dedicated video – or supervising a cognitively impaired individual, or both. 

Just for reference, the basic “ADLs” are: bathing, dressing, eating, maintaining continence, toileting, and transferring (e.g., in and out of bed). 

Under the category of “caretaking,” we can further distinguish a primary caretaker from a solo caretaker. Taking the latter first, if you’re a solo caregiver – in a strong sense – then you are the only game in town (or the only player, as it were). It’s entirely and totally up to you – and absolutely no one else – to implement every aspect of your loved one’s care plan.

If you’re a primary caretaker, by contrast, then you have some people in relieving or supportive roles – even if only minimally. Consider a few examples.

Let’s say you have four siblings. One of your siblings drives mom to the doctor’s office. Another buys and delivers her diet-specific groceries and medicine. A third takes her to church on Sunday and spends the day with her. And a fourth can usually be relied upon to fill in for you if you have something come up.

Even so, mom lives in your house. You administer her medicines, prepare her meals, and otherwise tend to her daily needs. You watch her for the majority of the week. The bulk of caretaking duties fall upon you. We might say that you are mom’s primary caretaker. 

On the other hand, suppose three of your four siblings live out of state. The other one declines or refuses to help you with any facet of mom’s care. Here, you’re more of a solo caretaker.

Granted, there are cases that are harder to classify. More on that in a moment.

But… it’s not as important to classify the cases as it is simply to recognize that there are different levels of expected responsibility falling on you in each case.

Questions

One of the most pressing questions is: Which case is – or would be – closest to your situation?

Can you expect help with the actual caretaking responsibilities?

At this point, I’m thinking about unpaid help: assistance you’d get from family and (possibly) friends. We’ll consider the role of professionals in a few minutes.

If you’re closer to a primary caretaker, then your questions are things like the following.

How dependable are the secondary caregivers?

Do you have someone who can step in for you in an emergency?

When you get sick, for example, is someone willing to come into your place?

Bear in mind that an Alzheimer’s sufferer may have difficulty adjusting to a new environment. Often, they have enough trouble getting around a familiar place. If the place is comparatively strange, they can be especially difficult to manage.

Do you have a family member willing to be around you when you might be contagious?

Will someone take your loved one to their place for a week? 

Remember that the care environment may need to be safeguarded and secured in various ways. I’ve spoken in other videos about many aspects of this. You may need to install childproof locks on cabinets (to prevent your loved one from accessing dangerous chemicals or objects), change thumb-turn locks to double-keyed deadbolts (to reduce the risk of “elopement,” which is the caregiver’s term for when your loved one wanders away from the care environment), install closed-circuit cameras (to monitor them while you do other, necessary work), etc.

Even if you do have a family member who is willing to take dad for a week, it may be necessary for them to prepare their home for this eventuality well in advance. 

And if you have no one, how will you function as a caretaker if you are not feeling 100%? What if you become disabled? Etc.

For that matter, how will you sleep? Many of you may realize that Alzheimer’s, and other forms of cognitive impairment and dementia, often interrupt normal sleeping patterns. Usually, this results in an insomnia-type situation at night. Your loved one may have difficulty falling – and remaining – asleep. Sufferers who wake up in the middle of the night may wander. And, unless their environment is entirely free of potential hazards, this nighttime wandering can’t be ignored. 

Related questions include: How will you cook or otherwise prepare meals? Similar problems with wandering may appear during the day. If you need time in the kitchen, it may be possible to entice your loved one to join you – possibly by assigning them an easily accomplished or harmless task. But if they refuse to cooperate, or if they start to walk away, you’ll need to make sure they’re not getting into anything dangerous. And that can be easier said than done – especially if the timer’s going off and that dish in the oven is about to burn.

Now… some of these problems lead into another topic.

‘Solo’ in a Housekeeping Sense

Remember I said that there were two relevant senses of the word “solo.” The first was the caretaking sense. The second sense is related – and possibly overlapping.

And that’s the general question of whether you’re alone in your household. Apart from your afflicted loved one, are you literally the only other person in the home?

From this standpoint, we’re talking about whether you’re single, married, or otherwise “partnered”; whether you have kids; whether you have a roommate; or even, in some cases, whether there’s another aging adult that you care for already. 

The basic questions, here, are: Are you being helped in running the household? And do you have other people – besides your afflicted loved one – for whom you are responsible?

I want to keep the phrase “running the household” a little vague. After all, this is not a channel about good housekeeping. But, just so we’re on roughly the same page, I have in mind anything – and everything – that goes into making sure the house isn’t condemned and the people inside it don’t starve. Doing chores, paying bills, performing maintenance, and …whatever else.

There are too many household variations to list them all. But we can gesture toward four (4) broad types, under two overarching factors: whether the other people are helping you, or if they’re needing help from you.

Of course, there’s a sense in which any group of people thrown together under the same roof will sometimes help one another and sometimes need help from one another. 

But, for this exercise, what you want to ask yourself is: Are the other people in the household helping you in a consistent and meaningful way? Relatedly, you want to ask: Are the other people in the house needing substantial help from you on a regular basis?

We’re going to assume simple “yes” and “no” answers can be given. Real-life cases may involve “maybe” and “sometimes” answers. But… this uncertainty may help you decide what to do.

After all, if your household is already a “question mark” – before you bring in an Alzheimer’s-afflicted loved one – then you might have serious concerns about the viability of a plan that complicates your living situation further.

Ignoring those complexities for the time being, we can arrange the following possible answers. 

1. One case is where you both give help to – and can expect help from – the people in your house. We might think, here, of two married or “partnered” people, for example.
2. Another is where you provide help, but can’t expect or rely on any in return. An example of this would be a case where you also have young children in the house.
3. A third is where you don’t really need to provide help, but you still get help. Maybe it’s your house, but one of your grown children lives with you. They pay their own way, as it were, but also do the dishes, maintain your car, mow the grass, etc.
4. Finally, we can imagine a case where you don’t need to provide much help, but you don’t get much back either. Perhaps you have teenagers. Maybe they’re in college and working part time. They’re starting to pay for necessities and you don’t have to do much for them day to day. But they’re not around much. And they aren’t really contributing to the household. 

Some of this will dovetail with financial considerations, which I will say something about in a moment. But, for the time being, and at the risk of harping on the obvious, we can expect that it would be much easier to take on caregiving responsibilities in a household where you’re getting help than one where you’re not getting help.

Likewise, it would be harder to be a caretaker for someone with dementia if you’re also having to provide help to other people already (for example, children). 

Still, for all that, it may be possible to add an Alzheimer’s-afflicted loved one into any of the four scenarios. And this is because there are so many factors at play. 

For instance, it would make a huge difference if your afflicted loved one presently is in an early-stage – or has a mild form – of dementia as opposed to something more severe. 

‘Early’ vs ‘Middle’ vs ‘Late’ Stages

I don’t want this to be a video about Alzheimer’s various stages. I’ve gotten into that topic before – and it may be good to do so again in the future.

At the same time, we can’t avoid touching on the subject, here. But my remarks will be cursory and shouldn’t be taken as a detailed accounting of the progression of dementia.

What I want to highlight is that caretaking challenges are not static. They can and do change – sometimes dramatically, frequently, and unpredictably. 

Caveats notwithstanding, we can say that so-called “Early-Stage” Alzheimer’s is characterized by mild difficulties. Memory and reasoning are beginning to be impaired. But this impairment may go unnoticed – even by family and trained physicians. 

Possible “comorbidities” aside, your loved one may be able to maintain a large amount of independence. For example, they might be able to cook for themselves, handle basic finances, maintain good hygiene, etc. They might even still be able to drive. Though, this poses special problems and carries risks, as I discuss elsewhere.

From a caregiving perspective, it may not pose insurmountable or even especially difficult challenges to take in a loved one who is in an early stage of cognitive decline. In other words, caregiving – even solo – could potentially be sustained throughout the early stage of dementia.

That said, there are important qualifications. Firstly, given the subtlety of the symptoms, Alzheimer’s may not be diagnosed in its earliest stage. So, families may not be presented with the question of home care until after the dementia becomes more advanced.

I didn’t come in until my dad – by all accounts – was already in Middle-Stage Alzheimer’s.

Secondly, given the current state of the medicine – and enough time – the disease will (unfortunately) progress. This has numerous consequences. Chief among them, for this discussion is that, even if you are able to be a solo caretaker for a while – while symptoms are mild – you have to understand that symptoms will not be mild forever.

If you have a good reason for suspecting that your loved one’s dementia will not become more complicated, that’s one thing. For example, let’s say that your mom is simultaneously (and tragically) diagnosed both with Early-Stage Alzheimer’s and some form of advanced, inoperable cancer. Suppose that her physicians expect her death within 12 to 24 months and they think it likely that she’d still be suffering from only mild dementia during that interval. In that specific case, you’d have good medical reasons for worrying less about how to handle advanced Alzheimer’s than about how best to deliver so-called “palliative care.” 

Even so, you may feel more comfortable with a backup plan. After all, the exact progression of the cancer and the dementia are, to some extent, left to the educated guesswork of the doctors. And they are not all-knowing or inerrant.

One final word, here. If Alzheimer’s (or some other dementia) is recognized in an early stage, it may provide a prime opportunity to involve the afflicted loved one in the development of a sustainable, long-range plan for their care. If you simply take them in – and figure you’ll deal with any worsening of their condition later – you may foreclose on that possibility. 

Not only this, but if they do live long enough for the dementia to progress, then caregiving will become more complicated. And that is what you can expect by “Middle Stage.” 

It’s arguable that Middle Stage is the most difficult, from the standpoint of caregiving in general, and at-home caregiving in particular. Be that as it may, Middle Stage is characterized by a worsening of the pertinent condition. You’ll be dealing with a person who may still be mobile, but who is no longer reliable in terms of decision-making, memory, reasoning, etc.

To put it bluntly: It can be a bit like dealing with a child who has the physical abilities of an adult. 

Middle Stage is also often the longest stage. Possibly this is due to the fact that Early Stage may not be detected immediately. Bear in mind that the beginning of “Middle Stage” may not be much worse than the end of “Early Stage.” This might point to the clumsiness or inadequacy of the three-stage view. But my point is that the relevant degeneration and transition can be gradual. The home situation could be fine and manageable until… it’s not. 

And – especially if you’re all by yourself – you need to have some awareness of this progression so you can plan accordingly. After all, if it became necessary for you to look into nursing homes, it’s not clear how you would be able to manage visiting and applying to facilities while you’re buried in daily caretaking tasks. And nursing homes almost always have waiting lists.

And while the progression of dementia is somewhat predictable, there are numerous variations. 

For instance, Early Stage is usually said to last 1 to 2 years. Fair enough. But you should know that, occasionally, people report a precipitous decline in their loved-one’s cognitive function. 

This might occur after a major surgery, for example. My dad took a significant turn for the worse following a triple bypass and a colectomy (spaced out by several months). I’ve seen comments where other people have shared similar stories. It may happen that your loved one is compliant or reasonable one day; then – almost suddenly – they’re obstinate or uncontrollable.

If you can make it all the way to “Late Stage,” you might find that a lot of the Middle-Stage difficulties have subsided.  For example, your loved one’s mobility will be drastically diminished. And at a certain point, they will have a near-total impoverishment of their communication ability.

The huge caveat, here, is that Late Stage comes with brand new difficulties. Dealing with a bed- or wheelchair bound person is by no means effortless. They have to be bathed or wiped, changed, fed, hydrated, turned to prevent bed sores. Etc. 

When you imagine having to lift an immobile person and help them transfer, you may see why this stage can be extremely physically demanding. 

And speaking of those challenges, let’s talk about another set of considerations. 

Able-Bodied vs Disabled

Let’s go back to the beginning of the home-care-decision process. Whether the cognitively impaired adult is able-bodied will also matter. Although, this consideration cuts in two directions.

If your loved one has mild-cognitive impairment, then – all other things being equal – it would probably be easier to care for them if they were able-bodied rather than disabled. As stated, many early-stage Alzheimer’s sufferers can perform a lot of daily activities on their own. And while they will need some measure of monitoring and reminding, these kinds of assistance may be “low-impact” and might be manageable by a caretaker who has many other responsibilities.

On the other hand, if your loved one has more severe dementia, then – somewhat paradoxically – it might be easier to care for them (overall) if they were also physically disabled. This sounds bad, but it’s to say that an able-bodied person with significant dementia may be an elopement risk (meaning that they have a tendency to leave the safety of the care environment without the knowledge of the caretaker); or they may otherwise require constant supervision. 

I’ve told many stories – in other videos – of times that my dad created messes or safety hazards (whether for himself, for others, or both) in virtue of the fact that he was still ambulatory and mobile, but had lost his ability to recognize perils or to make good decisions.

That said, a severely impaired person who is also disabled may be at increased risk for other things – such as falling. They might fall out of bed, out of a chair or wheelchair, or – God forbid – down a flight of stairs or off the front porch.

To make all this even more complicated, it’s also predictable that – again, all things being equal – a physically disabled person would be more difficult to care for than one who is able-bodied. This is due to the obvious point that a person who is physically disabled will require help getting around, whether to the bath, shower, or toilet; in and out of chairs or bed; or whatever. 

Support Network

You also need to consider your – or your loved one’s – support network. And, here, let’s further develop the point – made earlier – that some cases are difficult to classify.

For example, let’s say you’re caring for mom or dad in your home, but that you have siblings who live in the same city. Suppose that they don’t usually assume caretaking responsibilities. 

Still, if they could or would assume some responsibilities in the event that you had a personal emergency, you would want to know this – and get that commitment – in advance of needing it. 

Is this a case where you’re a primary caregiving, or solo? Once again, and obviously, it doesn’t really matter what you call it. What matters is what help you can rely upon!

I am working on a separate video on talking and planning with family. The best practice is to have hard conversations before emergencies arise. Try to agree on a workable plan in advance.

See, again, the “Caretaking Guide” at AlzheimersProof.com.

Paid vs Unpaid Support

Family can be – and often is – a valuable resource. However, it has its limitations. 

What happens if your sister is out of town when you fall ill? She promised to help in the case of an emergency, but she’s just not around.

In such cases, you may need to augment your family network by paying for professional services. So, let’s round out our discussion by picking up the thread I laid down earlier.

There are numerous types of paid services. There may be home-care providers in your area. Some of these may require applications and approvals in advance. This is especially likely if your loved one requires skilled-nursing care, or if you will be – wholly or partially – relying on long-term-care insurance, medicaid, or medicare. 

I have a few videos sketching the basics of these. If you would be interested in more, please leave me a comment.

Of course, other options might include changing the care environment altogether. On this wavelength, there are Assisted-Living Facilities and Nursing Homes. 

A somewhat middle-of-the-road option would be an Adult Daycare. This is a facility you might be able to utilize alongside home care. For example, maybe you take your loved one to a nine-to-five daycare program Mondays, Wednesdays, and Fridays, but care for them at home the remainder of the week.

A final recourse (still thinking about maintaining homecare) is called Respite Care. Respite Care is designed to give the primary caregiving a short break. But, if the respite provider comes to the home, this may only be for a day or so. If you take your loved one to a respite facility, the respite interval may be a week at most. 

For some of the differences in care environments, see my dedicated video. Admittedly, it’s an older video. It might be time to remake it. Feel free to share your opinion in the comments.

Nursing Home 

The thrust of this presentation is the feasibility of solo, at-home caregiving. But, what if you determine that it’s simply not feasible? 

We should say, emphatically, that it’s not necessary to look at it as an either-or situation.

What I mean is, you shouldn’t think that either you care for your loved one in the home, or else you’re just not involved at all.

When my family made the decision to get my dad admitted to a nursing home, we saw – up close – the level of involvement that he and other patients received from the families.

And it was definitely a spectrum. On the tragic end were those people who received no visits from loved ones. Whether this was because they had no living relatives or because their relatives were unable or unwilling to come, I can’t say. And it probably depended on the case.

In the middle were those people who received regular visits from family members. Maybe it was the same day every week, or always on weekends, or whatever. But these patients had family members who remained involved in their lives.

On the other extreme, there were family members who – barring emergencies and illnesses – came to the nursing home every single day. These devoted folks – whether children, spouses, or whatever – maintained their role as caretakers, despite the change of care environments.

And here’s the crux. You may not be able to accommodate your loved one in your home (or in their home) all by yourself. But you could potentially still be involved as a caregiver – even daily.

I say “potentially,” because (as always) there are complications. For example, it would be an obstacle to daily visits if you had to make a four-hour drive to get to the nursing home. Obviously, all the income-specific considerations are still pertinent, here.

And there are ancillary factors as well. Unless you trust the staff implicitly, or you’re on site frequently, it’s a good idea to vary the days and times of your visits. I will have to get into more detail in another video.

But, in the same vicinity, nursing homes are often understaffed. What staff there is, may be overworked. This may lead to a situation – usually unspoken – where the staff depend upon you to deliver basic care to your loved one. And, well… there’s no delicate way to say this, but: You pay the same for the nursing home whether you are performing caretaking duties or the staff is. 

It may come down to the question of whether it matters more to you that your loved one is properly cared for, or whether you get what you (or someone) is paying for. 

Financial Considerations

Of course, professional home care, Adult Daycare, Respite Care and the like are not free services. Daycare and homecare can cost several thousands of dollars every month. And if you admit your loved one into a nursing home, the average expected monthly costs start at $4,000. 

You or your loved one might qualify – or be able to qualify – for Medicaid. But you should know that not all nursing homes accept Medicaid. Of those they do accept Medicaid, they may not accept it for every available bed in the facility. That is, Medicaid beds may be in short supply.

So the prospect of having – or electing – to pay for care (of any kind) leads immediately into a discussion of finances. …For which – once again – I have dedicated videos.

But… At the most basic level, the question is: What is your financial situation? Among the prominent “sub” questions, here, would be: What is your source of income?

We’d be at it all day if I tried to list all the possible combinations. So, let’s just make a few obvious, summary remarks. If you have to leave the house to go to a 9-to-5 job, then assuming caretaking responsibilities may not be sustainable for you in the long run. 

Things might be fine as long as your loved one has mild impairment, is in an early stage, or does not require constant physical assistance or supervision.

But what happens when the dementia advances and becomes more severe? What happens if a fall around the house confines them to a wheelchair? Would you be around them enough every day to notice the sometimes-subtle signs of worsening dementia?

Financially speaking: Could you manage to keep your current job and still be a caretaker?

If your income depends on you commuting to a business, then necessary in-home caregiving will have to be provided by someone else when the time for that comes. Either that or you will have to change your job, take an extended “leave,” or utilize some care facility. As mentioned, Adult Daycare could come into play. 

But, what would you do if your loved one is ill and can’t be taken to daycare? Or, what happens if (or when) their dementia advances and they become hard to control or they become ineligible for daycare? Or, what would you do if, as my dad did, your loved one flat refuses to go?

You may be able to cover limited periods of time with paid time off or family medical leave. But at a certain point, your employer may become less understanding. Or corporate policies might demand your termination – regardless of the good will of your immediate supervisor.

If your job is more flexible, or if you work from home, you might have an easier time in some respects. However, even here: How will you ensure that you can devote the necessary time to your job? How will you make sure you have a sufficiently quiet environment in which to work? 

It’s not always as simple as giving your loved one an arts-and-crafts project, or hoping they find something to do for a couple hours. What if they become agitated? Would you notice if they wandered off? Do you have some way of monitoring them? – All questions for “9-to-5’ers.”

Finally, a problem may arise more broadly for anyone thinking of taking an extended leave or quitting their current job to be a caretaker. If you’re not actively employed, you might find that some of your benefits – such as your health insurance – will be canceled or suspended. And if you ever found it necessary to rejoin the workforce or to try to get your previous job back, you might find that the position has been eliminated or filled. You might lose seniority. If you have access to a pension, its calculation might be negatively affected by the “lost” years.

There are cases where income may not be an issue for you. One might be if your partner or spouse is the primary breadwinner. Assuming they’re on board with the decision to take in your loved one, then – the idea is – you’d continue relying on their income. No changes. In theory. 

Of course, you’ll want to consider whether home care would negatively – and predictably – affect your spouse’s ability to earn a living. If your partner works from home but mom or dad’s raucousness keeps your partner from being able to uphold their job obligations, then things could get messy. What if your loved one has chronic insomnia and their nightly wanderings disturb the whole household? Would your spouse find it difficult to get to the office on time?

Even if things started off “okay,” you’ll want to ask: What happens if the home care starts to interfere with the day job? Will you err on the side of continuing care? Or preserving the job?

These are all genuinely difficult questions. 

Other cases of stable income might be ones in which you are able to live off a truly passive income stream – such as guaranteed pensions, royalties, or trust funds.

However, not all “passive income streams” are equal. Some may require periodic tending. Could devote enough time to this maintenance if you were also an at-home caretaker? 

Probably the most common case where you may have quasi-dependable income is if you’re fully (not “partly”) retired, and you have unfettered access to all relevant funds (including distributions from 401ks, IRAs, Roth IRAs, dividends, and Social Security). 

These can have complications of their own. And it’s beyond the scope of this video to tease out every aspect of relevance. But, if you’re not at least 59 ½, then you likely do not have unrestricted access to retirement funds. And if you’re not at least 62, then you wouldn’t be able to collect Social Security – assuming you’ve qualified for SSA retirement benefits. 

Even if you can withdraw money from retirement funds without penalty, you still have to keep an eye on your tax situation. And if distributions from your retirement account depend at all on market performance, then the next economic downturn could upend your ship. 

Eventually, if you’re not already doing so, you’ll be forced to take money out of qualified retirement plan accounts by way of the so-called “Required Minimum Distribution.” 

The point is that even if you think your finances are “taken care of,” it may not be best thought of as a case of “set it and forget it.” 

If you’re living off government assistance, you’ll want to be careful about altering the number of people in the household. Sometimes this can jeopardize your eligibility for some programs.

I can’t and won’t speak to this in any detail, here. Except, I will say that you should consult with experts before finalizing or implementing any changes. And you can see some of my other videos for basic overviews of some relevant programs like Medicaid and Medicare.

It’s worth pointing out that there are a few programs under which you might qualify for government subsidies as a family caretaker. I believe that Medicaid has such a program, sometimes falling under the umbrella of “Consumer Direction.” 

Once again, it’s beyond the present scope to detail such a program.

And, of course, eligibility for government programs isn’t the only concern. The amount of assistance you qualify for may change depending on your household’s total financial picture. In some cases, if you change the makeup of the household, you’ll also change that picture.

Obviously, the amount of income is also important for you to reflect on, regardless of its source.

A question would be: Is your current income level sufficient to pay for home-care services – on top of the other, usual household expenses? If not, then it will probably need to be augmented.

Now you might think that if you’re living – or thinking about living – in the same house as your afflicted loved one, then you would have access to their income as well as your own.

And sometimes this is true. But, there are complexities.

I don’t want to make this a video about the relevant ins and outs. However, I could do so if there’s interest. I’m simply trying to bring to the surface issues that may be of relevance.

In that vein, let me just gesture toward some big considerations. As mentioned a moment ago…

Firstly, if your loved one’s income partly consists of government assistance, and is predicated on their living situation, then changing the situation could change the level of assistance. (Boldface, italicize, and underline the word “could.”)

Secondly, be aware that most financial institutions – for example, banks, brokerages, insurance companies, investment houses, retirement-management firms, etc. – are on the lookout for anything that smacks of elder abuse.

If dad’s social-security check suddenly starts getting deposited into daughter’s account; or if mom’s financial adviser or life-insurance agent gets an out-of-the-blue request to “cash out” this or that account or policy; you will probably have to answer some questions before your request or transaction is executed.

This isn’t to say that you’re trying to do anything questionable! Nor is it to say that these kinds of financial requests can’t be honored. But you should be aware that there are levels of legislative protection that have been built into financial regulations over recent decades. And these result in legal “hoops” that sometimes have to be cleared before you can “pool” resources.

Best-case scenario? You’re able to involve your loved one in making all necessary – or desired – changes before their legal or mental competence is undermined (or even called into question).

This might include cashing out or closing some types of account, filling out beneficiary-designation forms, giving you durable or “springing” powers of attorney, opening joint accounts, transferring control or ownership of a financial holding or instrument, and so on.

Once your loved one loses his or her ability to make sound financial decisions, then many – even most (or all!) – of the necessary financial moves you would need to make wouldn’t be advisable (or realizable) without outside authorization. The chief avenue for this would be a conservatorship hearing in a court of proper jurisdiction.

However, appointment as conservator will almost certainly carry restrictions and require reporting to the court. At a basic level, this means that separate bank accounts will have to be maintained, funds shouldn’t be “comingled,” assets can’t be disposed of without court approval, etc. Additionally, conservatorship generally terminates upon the death of the person who was subject to it – so… your loved one. (The subject would be called a “conservatee” or “ward.”) 

If your loved one is still able – right now – to converse, decide, and think lucidly on these matters, then you could look into trying to arrange the asset picture in advance of any worsening of their condition. For example, if it is their wish that their financial resources be pooled with yours or otherwise used at your discretion then there is not a moment to lose.

Extremely important caveat! If your loved one is no longer legally or mentally competent, then they are unable to consent to changes to their financial situation. You might face serious – even criminal – consequences even if your loved one’s competency is questionable. All this is beyond me. You’d be wise to consult with legal and medical professionals to ensure that everything is above board. Just to be clear: What I’m saying is for general informational purposes only and should not be construed as any kind of advice. 

Suffice it to say… You still do need to be careful with any consolidating moves. 

Another point, here. If it’s even possible (that is, conceivable) that your loved one would eventually need Medicaid to help pay for the cost of care, then you have to take great care when assigning, disposing of, gifting, pooling, retitling, selling, or otherwise transferring assets. Because, once again, there are severe repercussions for not following Medicaid’s requirements to a “T.” It took me three dedicated videos just to scratch the surface of Medicaid-related issues. 

A Word on Emotions

I’ve been ignoring emotional factors because these are sometimes especially difficult to describe or quantify – partly because they are so bound up with who we are as unique individuals. But, they’re no less an important part of our lives. 

You need to consider the emotional impact on – and emotional makeup of – everyone involved. 

On the one hand, this means your loved one’s emotions. A diagnosis of dementia would be depressing to anyone with the wherewithal to understand it. It can also be bound up with or give rise to anger, hostility, and resentment.

Alzheimer’s is a mysterious disease. The effects that it can have on emotions are sometimes as puzzling as they are devastating. There is no formula that I am aware of that will predict exactly what you’ll get.

Before his decline, my dad was friendly, likable, and somewhat extroverted. He was also easygoing and, to a large extent, unflappable.

As his cognitive faculties eroded, he became aggressive, belligerent, and combative – with everyone around him. It’s not exactly clear how to understand what occurred. 

Did the dementia – so to speak – cause his emotions to “invert”? Did it cause an awakening and overemphasis of dormant negativity? Or did it destroy who he was and, in effect, leave us with someone new? 

The other side of the coin, in a solo-caretaking situation, is your emotional tendencies. 

If you are mellow and don’t get your feathers ruffled easily, you might be able to take caretaking challenges in stride. On the other hand, if you’re irritable and impatient – like I can be, for sure – then you’re in for an especially tough time.

These considerations need not be determinative or final. Alzheimer’s is always a wild card. And we’re often capable of rising to a challenge. So don’t sell yourself short. Don’t “ostrich” either. 

For those who are interested, I dive more into emotional factors in the companion video “Is It Hard to Be a Caretaker?”

Summary Remarks

Okay… this has been a long and bumpy road. Let’s try to take stock.

We started by thinking about what it means to be a “solo” caretaker. We distinguished being a primary caregiver, where others – whether family members or professionals – assist you in backup, respite, and various secondary roles; and being truly solo, where you’re literally handling all caretaking duties by yourself. 

But we also noticed that being a solo caretaker doesn’t necessarily mean you’re alone in your home – not counting your afflicted loved one, of course.

It’s difficult to be a caretaker at any level of involvement. It could be a challenge to take dad or grandma for the afternoon, let alone invite them into your house 24/7/365.

If you’re truly going it alone – both as a care provider and as a homemaker – then you’re in for major difficulties. Assuming you have your financial bases covered, however, and you just have to focus on caretaking, I don’t want to say it’s impossible. 

Still, you’ll need to have a plan for necessities like cooking, sleeping, and showering – just for yourself. And you’ll probably want to have some sort of lifeline in place if (for instance) you fall ill or become injured. This highlights the need for a viable short-term back-up plan.

This includes numbers for prospective, in-home professional caregivers, Adult Daycares, etc.

Looking farther into the future, you’ll want to have a plan – even if only provisional – for finding a nursing home should that route become unavoidable. This is part of a long-term backup plan.

If you’re more in the primary-caretaker camp, then some pressure might be off of you. But, even so, emotional, medical, and other factors might arise that make it infeasible (or ill-advised) to continue with in-home care. 

Additionally, worsening of your loved one’s dementia is, for all intents and purposes, inescapable. Though, of course, it’s possible that a comorbidity might arise and further complicate an already complex situation.

Regardless of your circumstances, you’ll almost certainly run into a situation – probably many – where you’ll need or want professional advice. This could be legal, medical, nutritional, psychological, whatever. You’d be well-served by trying to develop a network of connnexions before your need for expert guidance becomes urgent.

Okay. As difficult as it was to make this video, the really hard part is up to you. You have to reflect on these factors and make the decision. Then you have to put that choice into effect.

Please understand that the Alzheimer’s Proof project – both this channel and the associated website – were designed and intended to help you.

I hope you can turn to some of my resources and find some assistance and value in them.

Finally, let me remind you that I have a second video – written in tandem with this one – which you might find a useful supplement. And don’t forget to check out and download the free workbook that I prepared to walk you through reflecting and choosing a path for your family.

If you’d like to ask follow-ups to me, personally, you can type your comments below or email me at AlzheimersProof@gmail.com.

For legal reasons, I cannot give specific advice. But if there are general concerns, I may be able to speak to them in a future presentation.

Please know that I wish you all the best in this confusing and painful process. Thank you for watching. 

The post Can You Be a Solo Caregiver? Is It Possible to Do It Alone? appeared first on Alzheimer's Proof.

So far, most of my content has dealt with Alzheimer’s proofing in home-modification scenarios and other long-term-care conversations.

But, today, I thought I would venture off the beaten path just a little bit.

Alzheimer’s also has a number of interesting theoretical implications as well. My academic background is partly in philosophy and so these theoretical questions are also of interest to me personally.

There are a great number of these cognitive impairments and dementia might surface in a number of different contexts. Ethics is going to be one. Metaphysics is another. Philosophy of mind has obvious relevance. So, I thought I would just pick one of those issues and I decided upon the question of the existence of the soul; that this is an issue that has been debated for thousands of years, so I am under no illusions about trying to resolve the issue in the space of a short web article.

In fact, I am not even going to take sides on the issue, what I want to do instead is just trying to present an accessible introduction to the range of issues, or if you are already familiar with these then call it a refresher course.

The question that is going to be somewhat in focus here is:

Does Alzheimer’s disease disprove the existence of the soul?

What I am going to do is assume the role of the person who says that Alzheimer’s does disprove the soul and then, on the other side of the fence, I’ll play the person who says it does not. I’ll go back and forth like this through five (5) considerations.

But, without further ado, let me present both sides!

Pro and Con Arguments

Against Soul #1: Alzheimer’s is a brain disease that can destroy someone’s personality. That’s the key point.

Alzheimer’s destroys personality by destroying the brain. So, take away the brain, and you take away the personality. A soul simply does not fit into that picture anywhere.

The brain is necessary for personality.

For Soul #1: The brain is necessary for personality. There is no real question about that. So yeah, if you take away the brain, you take away the personality.

But think of a Philly-Cheese-Steak sandwich. If you take away the cheese, you take away the Philly cheese steak sandwich. That does not show that there is nothing to a Philly cheese steak sandwich other than cheese.

The cheese is necessary, just like the brain is necessary. But arguing that the necessity of the brain shows the nonexistence of the soul is like arguing that the necessity of the cheese shows the nonexistence of …bread rolls.

Against Soul #2: Not really, because we already know that bread rolls exist, and we know the full recipe for a Philly cheese steak. It is part of our background information.

But, here, we’re trying to figure out what the full recipe for personality is, based on empirical evidence.

Personality is made up of brain states. Think of it as like how a team is made up of players and coaches. There is nothing more to a team than the people who make it up, and there is nothing more to a personality than the brain states that make it up.

For Soul #2: Well, wait a minute!

The evidence shows dependence. Personality depends on the brain. But dependence is not the same thing as identity.

A team may be identical to the people that make it up. But, then, a team is not a good analogy.

A better analogy would be to think of a musician. A musician depends on a working, well-tuned instrument in order to make music. If the instrument is broken, or out of tune, then the quality of the music is either dramatically lowered, or the musician may not be able to make any music at all. But this dependence of the musician on a working instrument certainly does not imply that music is identical to a good instrument.

Similarly, the fact that personality is dependent on the brain does not mean the two are identical. The brain is an instrument of the soul.

Against Soul #3: But we can experience both musicians and musical instruments. We know they are two separate things because we can have dealings with both of them.

Again, in this case, were trying to figure out how many things there are.

Just because there could be something more than the physical brain does not mean that there is.

Number one, it’s not clear how a nonphysical thing like a soul could use a physical brain as a tool.

And, number two, the principal known as “Occam’s Razor” tells us not to multiply causes, and to prefer simpler explanations.

So, in this case, saying that personality is due to one thing – a physical brain – is simpler than saying that it is due to two things – a physical brain plus some mysterious “soul.”

For Soul #3: There’s a saying, sometimes attributed to the famed physicist Albert Einstein: “Make everything as simple as possible, but not simpler.”

Simplicity is great, but it is not always a matter of just counting proposed causes.

Suppose someone is investigating a house fire, and they notice that the wiring is faulty, and that there were oily rags strewn about the entire place.

Now, it would, of course, be simpler to explain the house fire only by talking about the faulty wiring, and not mentioning the oily rags at all. But, if the house fire was in fact caused by faulty wiring and the rags together, then any explanation that leaves one of those factors out is not a good explanation.

Occam’s Razor says we should not multiply causes beyond necessity. Sometimes multiplying causes is necessary.

Against Soul #4: In the case of your fire example, the multiplication of causes is necessary because the scientist, or in that case, the fire investigator, concludes from the evidence that having more than one cause is necessary to give a full explanation.

In the case of personality, the investigators, for example, neuroscientists, have not concluded that we need to appeal to more than the physical brain in order to have an adequate explanation.

So, appealing to anything else simply goes beyond what is needed.

For Soul #4: Fire investigators and neuroscientists are both scientists of nature.

Natural science deals with what is physically measurable and physically detectable.

So, natural scientists can tell you all about the physical causes of physical things, but they cannot tell you about nonphysical things. For example, the fire investigator can tell you about faulty wiring and oily rags but cannot tell you that the fire was a tragedy.

Things like tragedies, or indeed souls, are nonphysical things. But, being nonphysical does not mean that they are not real parts of human experience. They are; they just go beyond what natural science can talk about.

Against Soul #4: We do not need the fire investigator to tell us that the fire was a tragedy. That’s obvious. But having a soul is not obvious.

For Soul #4: Here is what’s obvious: I have a rich inner experience – a private mental life – that goes beyond what neuroscientists can image, or test, or quantify in physical experiments.

Against Soul #5: We are getting off track. Here is the bottom line.

My dad got Alzheimer’s disease and progressively forgot more and more, and got worse and worse until, eventually, somebody could have looked at him and said he was a completely different person.

And that horrible decline was due to a brain disease.

So, at the end of the day, who my dad was, and who we all are, is dependent on, caused by, or explained in terms of the brain.

If something like Alzheimer’s disease comes along and damages our brains enough, it can literally change who we are.

And this is not at all what we would expect if we had, or if we were, something other than, a physical brain.

Therefore, Alzheimer’s disease shows: Probably, there is no such thing as a nonphysical soul.

For Soul #5: Well, my dad went through Alzheimer’s disease, too.

Notice how we both said that.

“My dad developed Alzheimer’s disease.” “My dad got progressively worse.” “My dad forgot who he was.”

But all that happened to the same person: My dad.

Yes, his personality was dramatically and tragically changed, because we know – from science – that you have to have a working brain in order to be a healthy and recognizable version of yourself.

But my dad never literally became someone else. If he had, why would the family have continued to care about him at all?

See, that is really the point. If, as I think, he was still numerically one and the same person, even after his brain and his personality were destroyed, then the question is: What was it about them that stayed the same the whole time? What continuous, existing thing explains that identity over time?

It wasn’t his brain, or his memories, or his personality. All those things were destroyed by the Alzheimer’s!

Therefore, I say that the thing that stayed the same was something the Alzheimer’s could not destroy: It was his soul.

Conclusion

These are heavy, theoretical topics! Bear in mind that I have left out quite a lot!

Philosophical reflections on questions regarding the soul may spill over into discussions of personal identity, memory, and so on – each of which on their own fill countless pages and extend back hundreds and even thousands of years.

Conversations of this kind often invoke obscure words and forbidding terminology. You may hear talk of “aboutness” and “intentionality.” You may be exposed to ponderous phrases like “mind-body dualism” and “reductive versus non-reductive physicalism.” You might hear great-big words like “supervenience.”

In the above presentation (and accompanying video!), what I have tried to do is to give a presentation of the issues without any of that jargon.

I have, however, bumped up against some of the deeper concepts. For example, there is an underlying discussion of necessary and sufficient conditions. I touched on this a little bit, without naming it specifically.

But, there are other important issues that I simply haven’t gotten into at all. For instance, there are questions about identity and what is sometimes called “Leibniz’s Law.” I did not really get into those at all.

And the conversation can easily turn into a subset of philosophy called “modality,” where the discussion is about concepts like contingency, possibility, and necessity.

Suffice it to say that there is plenty of room to expand a conversation like this!

So… if you feel like I have left out your favorite argument or your favorite consideration, please understand that I have not done it to purposely weaken one side of the argument or another, or to play favorites. I have simply done it because I felt that introducing another concept might have made the article a little bit less accessible.

And bear in mind that all of that is simply keeping the conversation in the realm of what you might call “philosophy.” The conversation could easily be further expanded to include religious doctrines, theological opinions, etc., and that could be an entire presentation all on its own.

What I did present was simply designed to be an introduction to the issues.

Although I may certainly get into further theoretical issues in the future, understand that this website is mostly about some very practical concerns about how to Alzheimer’s Proof your care environment. Or, indeed, I get into how to Alzheimer’s Proof your own diet and lifestyle to reduce your own risk of developing diseases like Alzheimer’s and other forms of dementia.

Of course, I have further content along those lines planned. So, I invite you to bookmark the page and check back!

Thank you for reading or watching!

Feel free to leave your thoughts in the comments, below.

The post Does Alzheimer’s Disease Disprove the Existence of a ‘Soul’? appeared first on Alzheimer's Proof.

There are really only three (3) ways to pay for long-term care expenses and nursing costs.

The first general way is with the proceeds from insurance policies. These might be long-term care policies, whether they are qualified policies or non-tax-qualified policies. It could be through short-term care policies; it might even be through hybrid, life-insurance / long-term care combinations.

For people who do not have insurance policies to cover their long-term care costs, the remaining payment options are, second, privately paying from your own income and assets and – for people who do have insufficient income or assets to pay for their care – the final option, third, is applying for government aid. Of course, the most relevant government-aid program is Medicaid.

So, the questions then become: How does one specifically qualify for Medicaid? Or, to put it another way: How does Medicaid determine eligibility?

Caveats

It is important to bear in mind that this is a complex conversation, in part because Medicaid-eligibility requirements are going to vary slightly (and, in some cases, significantly) from state to state. Because of this, you’re going to want to consult with an expert who is knowledgeable about your particular state.

Note: This post tracks along with a YouTube video I have on the same subject.

Medicaid Eligibility

There are two overarching considerations.

Number one, there are financial qualifications.

Number two, there are medical-eligibility requirements.

Most of what I’m going to say is going to have to do with the financial eligibility requirements (because they are so complicated). But let me say a bit about the medical requirements just right off the bat.

Medical Requirements

Generally speaking, Alzheimer’s-level cognitive impairments are going to be enough to qualify you – provided, of course, that they are sufficiently advanced in their severity.

In some literature, you will encounter phrases like “nursing-home-level care.”

The specifics of this are going to vary from state to state. So, once again, you need to seek advice.

However, often, this nursing-home level of care is going to be calibrated to the type of supervision that a person requires, if they have cognitive impairments. Or, it may be calibrated to the various Activities of Daily Living (ADLs) that they are lacking.

Financial Requirements

But what I’m mainly going to be concerned with is going to be the financial eligibility. That’s essentially determined by two (2) calculations or “tests”: an asset test, and an income test.

The question of assets is going to preoccupy us in this article. In a subsequent article, I’ll talk about the income test. (They are both intricate conversations, and so it is probably best to break the conversation up into two pieces.)

Why Are There Financial Qualifications?

The basic reason that these tests exist at all hearkens back to the stated purpose of Medicaid – as I sketched, previously. (For my written article, see HERE; for the companion YouTube video, see HERE.)

In a nutshell, Medicaid provides financial assistance, to help pay medical expenses for people who are impoverished.

And so, the obvious follow-up question is: Who qualifies as “impoverished”?

The answer to that question is determined by these two tests. Basically, the idea is if a person’s assets fall below a certain level, and their income falls below a certain level, then they count as impoverished.

So, as I said: Let’s now consider assets.

Medicaid Asset Requirements

Quick Answer

Essentially, a person has to have $2000 or less in order to qualify for Medicaid, from an asset standpoint.

Two Types of Assets

Now assets themselves are classified into two (2) categories.

The first are “countable assets,” or those that are nonexempt. The second are exempt assets, or those that are not “countable.”

The precise scope of the exemptions and countability will vary from state to state. So, once again, this underscores the need for you to have a conservation with an expert in your area.

Typical Exempt (Non-Countable) Assets

But, usually, an exempt asset is going to be something like these: basic pieces of property, such as the Medicaid recipient’s primary residence,[1] a car, and so on.

Another Caveat

You have to bear in mind that Medicaid can cover people of various ages; it’s not just for people who have Alzheimer’s Disease, dementia, and other cognitive impairments. Medicaid is more broadly applicable than that.

So, for example, it might happen that a 30-year-old Medicaid recipient has a primary residence, has a car, and can get around with no problem.

Now, while it is unlikely – not to say, ill-advised – for a person with advanced Alzheimer’s to be living alone or have a car, those restrictions are not imposed by Medicaid. They are simply result of the advancement of their disease.

What About the Non–Afflicted Spouse?

But the real question occurs when an Alzheimer’s afflicted individual has a spouse who has no affliction. What happens with the assets in that case?

The answer is that the non-afflicted spouse – sometimes referred to as the “noninstitutional spouse,” or the “community spouse” – will also have some assets that are usually going to be exempt.

Those exempt assets will be similar to what was just surveyed for the recipient him- or herself and will usually include a primary residence[2] and a single vehicle.

Medicaid May Seek ‘Recovery’

You should be mindful of the fact that Medicaid will sometimes claim reimbursement for the sale of the home after the Medicaid recipient has died.

You should also be aware that Medicaid is supposed to seek recovery from money that it spends on a recipient’s care.

Because of its strict monetary eligibility requirements, a Medicaid recipient is unlikely to have had any property apart from a home. For this reason, Medicaid often becomes a lien holder against the primary residence, and it may seek to collect money that was generated from the sale of the home.

In a few cases, a home may be required to be sold in order to settle with Medicaid.

However, there are many exceptions to this. In some cases where the noninstitutional spouse or minor child or some other dependent is still living in the home, Medicaid may either be unable or unwilling to seek recovery.

This is complicated territory and, not to sound like a broken record, but you will need to discuss your situation with licensed professionals who are familiar with these kinds of cases.

Countable (Non-Exempt) Assets

For the most part, assets beyond personal effects – like furniture and clothing – will be counted. This includes cash and banking assets, whether they are liquid or “semi-liquid.”

For example, it will include unsettled annuities, bank accounts (like checking accounts, money markets, and savings accounts), as well as certificates of deposit, (or CDs).

Countable assets will also include brokerage and other investment accounts as well as myriad “funds” (such as ETFs, hedge funds, mutual funds, and so on).

It will include cash-value life insurance (whether adjustable life, universal life, whole life, variable life, etc.).

And, importantly, it will include retirement accounts – including 401(k)s and other employer-sponsored defined contribution plans like 403(b)s, 457(b)s, and other employer-sponsored, defined-contribution-type plans. But it will also include Individual Retirement Accounts / Annuities – such as the Traditional IRA and the Roth IRA.

Real-estate and other property, beyond the primary residence and the main vehicle, are also generally non-exempt.

For example, if you have a family cabin or vacation home, then that would be a countable asset.

If you have a boat or a recreational vehicle (RV), then these would be countable assets as well in most cases.

$2,000 Limit

And as I said before, a person having more than $2000 in countable assets will usually be considered (asset) ineligible for Medicaid – although some states like New York have set other asset limits.

What About Property Owned Jointly?

How does it work if assets are shared in common with the spouse?

There are two (2) sorts of state: a “50%” state and a “100%” state.

Each of these types of estates handles assets a little bit differently and I will run through each of these, in turn.

My unofficial count was that approximately 35 states are of the 50-percent type. So, I’ll start with that.

‘50-Percent’ (50%) States

Although the details vary, usually, it happens something like this: All the countable assets are totaled.

So, consider a married couple. Let’s call them “John and Jane.”

The couple’s countable assets will include (1) those that are owned entirely by John, (2) assets owned entirely by Jane, as well as (3) assets that they own together.

The current values or Fair Market Values (FMVs) for these are summed, and then the result is divided by two – hence the name, “50-percent state.”

In general, the non-Afflicted spouse is going to be able to keep half – that is, 50% – of the total, within certain limits.

Two (2) limits are of greatest pertinence: a lower asset limit (or, minimum amount), and the upper asset limit (or, maximum amount).

Minimum & Maximum Asset Limits

These amounts are likely to vary year to year, just like the Internal Revenue Service (IRS) varies the amount of tax deductions, or varies the amount of retirement contributions that you can make.

In 2020, the lower limit was $25,728, and the upper limit was $128,640.[3]

In theory, a person could ask Medicaid to keep an amount outside of those limits. This would be established through a Medicaid “Fair Hearing.” But, in practice, the stated limits are usually final.

50%-State Examples

Case #1

This is complicated stuff, so an example or two might be helpful. I will run through three different scenarios, just for illustration purposes.[4]

Let’s take a middle-of-the-road example to begin.

Step One

Total the assets. Let’s suppose that John’s assets and Jane’s assets, together, are worth $100,000.

Step Two

In a 50% state, we just learned that we take that total and divide it by 2 which (of course) gives us $50,000.

Step Three

Compare the answer to that division problem (the quotient) to the lower and upper limits.

Results

Since our quotient – $50,000 – falls somewhere between the lower limit of $25,xxx, and the upper limit of $128,xxx, in this case, the noninstitutional spouse would get to keep all $50,000.

(This is because $50,000 is less than the maximum-allowable amount, and more than the statutory minimum.)

On the other hand, the institutional spouse, can only have $2000. So, he or she would need to “spend down” $48,000 (on this example), in order to qualify for Medicaid.

(Warning: This is only considering assets! There’s also an income test, as well.)

Case #2

Let’s consider a case now where the assets are a little bit more substantial.

Step One

Let’s suppose that Jane and John both together have $300,000 in assets.

Step Two

Once again, applying the 50% calculation we would take $300,000 and divide it by two. The resultant amount is $150,000.

Step Three

Comparing $150,000 to our stated limits, we notice that it exceeds the 2020 upper limit of $128,640.

Results

This means that, in our second example, the noninstitutionalized spouse will only be able to keep up to the limit, or $128,640.

As always, the institutionalized spouse can only keep $2000. So, once again, the institutional spouse must spend down the rest of his or her “half.” So… that’s $148,000 (or, $150,000 – $2,000).

But, all the money that is over the limit must be spent down.

In this case, even the noninstitutional spouse was not permitted to keep the entirety of his or her “half” of the money. So, the noninstitutional spouse must also spend down the remainder of his or her share of the couple’s assets. Here, that amounts to $21,360 (or, $150,000 – $128,640).

Therefore, in this second case, the total spend-down amount is $169,360.

($148,000 from the institutional spouse plus $21,360 from the noninstitutional one).

Case #3

For our third example, let’s consider a case where the assets are far less significant.

Step One

Suppose that Jane and John have a total of $30,000 to their names.

Step Two

When we divide that number by two, we get $15,000.

Step Three

Comparing it to our limits, we observe that $15,000 is less than the minimum amount of $25,728.

Results

That means, in a 50% state, the noninstitutional spouse will get to keep all $25,728, despite the fact that that amount exceeds 50% of the asset total.

On the other hand, since the institutional spouse can only keep $2000, the remaining $2,272 would have to be spent down.

($30,000 of total assets minus $25,728 kept by the noninstitutional spouse minus $2,000 kept by the institutional spouse.)

Takeaway

We see that there is an asset “spend down” that occurs when one’s countable assets exceeds the allowable amounts.

100% States

As I said, not all states operate on a 50% basis. Some are what are called “100% states.” In these states, the noninstitutional spouse may keep all the assets, up to the prescribed limit.

100%-State Examples

In some cases, the practical difference is very slight.

Case #4

Step One

For example, again suppose that Jane and John have $300,000 of total assets.

Step Two

Compare the total assts to stated limits.

Results

In a 100% state, the noninstitutional spouse keeps up to the maximum-allowable amount. In 2020, this is $128,640.

Therefore, the noninstitutional spouse will keep $128,640. This is the same amount that the noninstitutional spouse got to keep in the comparable 50%-state example.

As always, the institutional spouse keeps $2,000, and the rest is spent down.

Case #5

On the other hand, if the assets are less significant, the 100% state approach starts to make a bigger difference.

Step One

So, suppose that Jane and John had a total of $100,000 of assets.

Step Two

$100,000 is less than the 2020 limit of $128,640.

Result

Therefore, in a 100% state, the noninstitutional spouse would keep all $100,000.[5]

Case #6

Step One

Similarly, suppose the assets totaled $30,000.

Step Two

$30,000 is less than the $128,640 limit.

Result

In a 100% state, the noninstitutional spouse would keep all $30,000.

Takeaway

Essentially, in a 100% state, the noninstitutional spouse gets to keep all the assets up to the limit, which is $128,640 in the year 2020.

‘Spend Down’ Doesn’t Mean ‘Give Away’!

Here we run into a potential pitfall.

Upon learning about Medicaid’s austere requirements, and upon surveying their financial situation, couples might be tempted to start giving away assets – whether it be to relatives, to friends or to charities.

This would be a bad idea and very dangerous course of action!

Medicaid’s ‘Penalty Period’

We’ll need to be exceptionally careful.

Medicaid asset transfer rules are every bit as stringent as its other requirements.

Running afoul of Medicaid asset transfer regulations can result in the imposition of what is termed a “penalty.” This is a period of time when the applicant would be ineligible for Medicaid because of procedural violations.

You should also be aware that the penalty period only begins once the applicant would otherwise qualify for Medicaid and often once the applicant is already in a long-term care environment and receiving care.

That means that the Medicaid applicant would be in need of the assistance but would be unable to get it because they are being penalized. In other words, you would be up a creek without a paddle!

The ‘Look-Back Period’

In general, at least for long-term-care scenarios, Medicaid can – and will – review an applicant’s financial history and financial reports going back a full 60 months, or five years.

This “scrutinizing interval” is referred to as the “Medicaid look back.”

What are they looking for?

Medicaid is looking for transfers that are inadmissible from the standpoint of its regulations.

Improper Gifting

Illicit transfers might include things that you might call “improper gifting” and also inappropriate sales.

Illicit gifting would be giving gifts apart from what would be reasonable to celebrate usual occasions (like birthdays and anniversaries) or beyond what would be expected and reasonable in terms of holidays (that is, holidays that your family normally observes).

So, for example, giving little Johnny $50 on his birthday, or buying him a video game might not raise any red flags. (Although, if you are in the process of Medicaid planning, you need to consult with an attorney about every move that you make!)

On the other hand, giving the family cabin to your brother and calling it “an Arbor-Day gift” will almost certainly land you in hot water.

So, don’t make that kind of a mistake!

But, seriously, even inadvertent violations of asset-transfer requirements can be penalized severely.

Your best bet is to consult with an attorney who is knowledgeable about Medicaid transfers.

Firstly, lawyers are liable for the advice that they give to you.

And secondly, it’s against federal law to advise anybody to make asset transfers in such ways to try and hide assets or to cheat Medicaid. If a person’s advice results in the imposition of a penalty, the person giving the advice can be criminally liable.

Caveat

Naturally, this article is not intended to be construed as advice of any kind. It is for general informational, or entertainment, purposes only. You need to consult with experts in your area – perhaps more in this case than others. This is because qualifying for Medicaid is serious business.

Improper Selling

You can get in a lot of trouble, even if you aren’t gifting assets, but if you’re selling them incorrectly.

This is especially the case if the sale price is below the fair market value (FMV) of whatever the item is.

For example, if your car’s blue book value is $10,000. You sell it to your granddaughter for 25 bucks.

This is going to do more than just raise eyebrows. It could get you into a lot of trouble!

Is Every Asset Transfer Illicit?

Now, that isn’t to say that no asset transfers or sales are permissible.

This is an important point because it’s to be expected that a person is transitioning into a new era of their life when going into a long-term care facility, or a nursing home, and they are going to be downsizing, and they’re going to be getting rid of some of their property almost for sure.

The point is that you would be far better getting competent advice when you make these changes, than you would be otherwise.

Permissible asset transfers might include: retitling the home in the name of a spouse or in the name of a caretaking child, or selling items at their fair market value – provided, of course, that the proceeds from the sales are duly noted, tracked, and then reported as part of the countable asset calculation.

Once again, asset transfer rules are state specific, and any Medicaid planning and preparation should be done only under the express advice of an attorney.

Life Insurance

The real difficulty with life insurance is the cash value.

Not every life-insurance policy has cash value. This is going to apply (mainly) to policies that are built on a whole-life or universal-life chassis.

Most term-life policies[6] have no cash value and can (generally) be retained at any face amount.

The “face amount” is the big dollar amount written on the front page of most life-insurance policies. It’s the amount that you would expect to the beneficiary to receive in the event of the insured person’s death.

On the other hand, permanent policies are usually the ones that have cash values. These policies must be limited to $1,500 face values.

That means they can pay out $1,500, at most, in the event that the insured dies. If the face value is $1500, then the cash value is expected to be less than that.

Any contract exceeding these values most likely will need to be “surrendered,” or “cashed out.” (But do not do anything without consulting a competent Medicaid expert or planner!)

Cash-value policies also need to be tracked carefully, even if they are retained.

So, if a policy falls under that $1,500 threshold, it is still going to need to be carefully tracked because: (1) the cash value is still part of the countable assets, and (2) if the policy’s cash value increases or changes year to year, or if the face value goes up, then the policy may qualify this year but not qualify next year.

Final Words

Take a deep breathe.

Because… the income requirements are every bit as complex as the asset requirements!

We’ll tackle those next time.[7]

(Featured-image credit: ‘Robbie Owen-Wahl’ Link: animalaidunlimited.org
https://images.freeimages.com/images/large-previews/916/calculator-and-pen-indicating-work-study-1632106.jpg.)

Notes:

[1] You should also be aware that there are sometimes limits imposed in terms of how much equity can be inside the house and whether this is applicable or not often depends on whether it is the Medicaid recipient him or herself, who is in the home or whether it is the noninstitutional spouse where equity limits do apply. They tend to vary year to year. In 2020, the amount of allowable equity in a home is about $600,000. Technically about $595,000. In some states it can go all the way up to closer to $900,000 or about $893,000 in 2020.

Intuitively, the reason for the equity limit is so that a person sitting on a $2 million mansion could not qualify for Medicaid when the sale of the home would be enough to discharge both their medical expenses and more modest housing costs. Cases where the spouse is willing in the home equity.

Limits may or may not apply. Consult your Medicaid planner.

[2] See, again, the previous footnote.

[3] These limits may have changed, though; so, don’t too get too hung up on the specific amounts. Just try to get a grasp of the concepts. Your trusted Medicaid expert or planner will be “up” on the relevant limits.

[4] My numbers are entirely hypothetical.

[5] Conceivably, the institutional spouse could keep $2,000 and the noninstitutional could retain $98,000. Consult your Medicaid planner.

[6] Term insurance is usually regarded as “temporary,” since it is purchased for intervals called “terms.” Intervals may be 1 year, 10 years, 20 years, 30 years, etc. The insurance expires if the insured hasn’t died during the interval.

[7] I want to stress that this has been my good-faith effort to provide people with an accessible summary of the contours of Medicaid asset eligibility. However, I make no claims to completeness or expertise. I do not warrant that this information is accurate, error-free, or up to date. So, please, consult with a qualified expert to help you!

The post Medicaid & Private Assets: Look-Backs, Spend Downs & Tests appeared first on Alzheimer's Proof.

I want to survey the antioxidant potential of sixteen (16) herbs that you might have on your spice rack at home.

The Relevance of Oxidation

Oxidative stress dovetails with Alzheimer’s disease in several respects.

Firstly, patients who already have Alzheimer’s disease have problems with accelerated oxidation. They have more oxidative stress in their brains.

Secondly, many readers may also be aware that one of the primary characteristics of Alzheimer’s disease is that there is an abnormal accumulation of beta-amyloid and tau protein deposits, which aggregate between – and inside of – nerve cells, gumming up the neural “works.” Well, this abnormal deposition of protein has been speculated either to be the result of an increase in “free radicals” or a decrease in antioxidant defenses inside of some people’s bodies. In other words, it’s the result of oxidation.

But that raises the question: Are antioxidant therapies for Alzheimer’s disease viable?

In attempting to answer this question, we should be mindful of the fact that herbs can be excellent sources for antioxidant. And, as I mentioned at the outset, many of these versatile plants can be found in your kitchen.

In this article, I’ll list sixteen of the most common. (In a follow-up post, I’ll provide a further sixteen that, while less common, are still available.)

Caveats

Obviously, I’m not guaranteeing that you will have all – or even any of – these on your spice rack. Various starter sets will likely include some elements that I don’t write about. Contrariwise, your set may fail to have some component that I do discuss.

Additionally, these profiles are not exhaustive. Moreover, not every example of these herbs will have exactly the same chemical constituents or in the same amounts. It often depends on how the plants are grown, what weather conditions were like, how they were harvested, how the extract was harvested, how was stored, etc. Numerous peer-reviewed scientific journals contain more detailed information on herbs, in general, and on their antioxidant constituents, specifically.

16 Common Antioxidant Herbs You Have on Your Kitchen Spice Rack

Spice #1: Basil[1] (Ocimum basilicum)

Like most of the herbs surveyed here, basil is a good source of vitamins – many of which actually are antioxidants, themselves. But what I’m going to be concerned with is some of the other antioxidant chemicals that are found in these plants.

Basil’s Antioxidant Profile

I have come up with these little graphics with a list of antioxidants. I’m calling these the “antioxidant profile.”

In some cases, an herb’s antioxidant activity can’t be explained solely by the presence of any single compound on the list. In other words, following this line of thinking, it’s not just eugenol, but it’s eugenol in conjunction with all of the other chemicals contained in basil.

(Note: eugenol is more abundantly present in oil of clove. See Part 2.)

This propensity of antioxidants to complement and mutually amplify one another is referred to as “synergism.”

In addition to basil’s significant antioxidants, the herb has also been shown to increase both “memory retention” and “memory retrieval” in experiments on mice.[2]

Spice #2: Bay Laurel Leaves (Laurus nobilis)

Bay Laurel’s Antioxidant Profile

You can see that my list for bay leaves is a little bit less expansive than it was for basil. sale being the primary one.

Nevertheless, bay laurel essential oil is a rich source of natural antioxidants. In fact, the anti-inflammatory and antioxidant potential of “laurel extracts is very significant,” particularly in relation to pathologies such as “Parkinson’s disease, Alzheimer’s disease, and atherosclerosis.”[3]

Spice #3: Black Pepper (Piper nigrum)

Black Pepper’s Antioxidant Profile

This one is really interesting to me. I’m fascinated that this is on the list because even people who don’t have a “collection” of herbs and spices probably have a salt and pepper shaker!

So, it’s amazing that pepper – regular pepper – may have many health-promoting qualities. And it may be highly relevant to Alzheimer’s prevention and treatment.[4]

For example, it’s full of antioxidants.

Piper nigrum’s signature component is something termed “piperine.” You don’t have to go further than the title of one Food-and-Chemical-Toxicology article to get a sense of why this is constituent is so exciting. “Piperine, the main alkaloid of …black pepper, protects against neurodegeneration and cognitive impairment in animal model[s] of cognitive deficit[s] like …Alzheimer’s disease.”[5]

It might be worthwhile to develop a taste for black pepper – if you don’t have one already! Sprinkle a little on your food next dinnertime.

Not only is a good antioxidant, in general, but it actually helps reduce high-fat-intake-induced oxidative stress, specifically.[6] Obesity, and consumption of high-fat diets are both known to be risk factors – that is, increase risk – for Alzheimer’s.

I get into this further in Part 1 of my YouTube-video series on sugar and dementia. (Watch Part 1, HERE.)

But, since black pepper is also purported to have acetylcholinesterase activity,[7] Piper nigrum is also an excellent and promising candidate for multi-target Alzheimer’s-disease therapies.

(And… if you want to get more into acetylcholinesterase inhibitors, I have separate YouTube videos on that subject. For a rudimentary explanation of how acetylcholinesterase inhibitors are supposed to work, see HERE. On the perhaps far-fetched and – as far as I know – merely theoretical possibility that a natural “acetylcholinesterase deficiency” might be beneficial in avoiding Alzheimer’s, see HERE. Finally, on the six, Food-and-Drug-Administration-approved Alzheimer’s drugs – five of which have acetylcholinesterase-inhibiting functions – see HERE.)

It’s worth observing that it’s not just black pepper that is reported to deliver positive health effects. The Piper genus has some 2,000 species of plants.[8] It is plausible to think that at least some of these will have effects similar to those of black pepper just rehearsed.

Spice #4: Cayenne / Paprika (Capsicum annuum)

Cayenne / Paprika’s Antioxidant Profile

Speaking of varieties of pepper, cayenne is another one commonly locatable on kitchen spice racks.

Rich in antioxidants, Cayenne’s main constituents include ascorbic acid, which is (of course) the more “sciency” name for Vitamin C. (By the way, for more on Vitamin C, glance see further down in this article.)

Vitamin C isn’t this pepper’s only arrow in its nutritional quiver. Cayenne also contains a healthy quantity of calciferol, that is, Vitamin D.[9]

Cayenne is known, in part, for is its antidiabetic effect.[10] Of course, diabetes may increase a person’s risk of Alzheimer’s.[11]

I’ll add that some people might have a cannister labeled paprika in their herbal starter packs. Now, I am not a chef, so this is not a culinary observation, but… cayenne and paprika are very similar. In fact, they’re similar enough that, from our standpoint, they can be considered readily interchangeable.[12]

So, for example, paprika is an antioxidant. It contains a variety of compounds, including Vitamin A – or “retinol” – and some other carotenoids, similarly to cayenne. It’s rich in antioxidants.[13]

You can see some validation of this in the article with the somewhat forbidding title, “Binding Antioxidant and Antiproliferative Properties of Sweet Paprika.”[14]

I’ll presently toss in a little caveat. Weather conditions as well as the various, possible ripening stages of individual peppers are going to impact the chemical constituents of these herbs. In the article cited in my footnote, you can see this point in reference to paprika.[15] However, as hinted at in my “disclaimers,” similar statements considerations apply to any of the herbs surveyed.

Spice #5: Cinnamon (Cinnamomum verum)[16]

Cinnamon’s Antioxidant Profile

Cinnamon is loaded with antioxidants, according to the commonly cited website Healthline.[17]

In some ways, cinnamon’s antioxidant effects are similar to those of black cardamom (Amomum subulatum),[18] which I’ll get into in Part 2. (Again, to see this presentation in a YouTube-video format, see HERE.)

Spice #6: Coriander Seeds [19] (Coriandrum sativum)

Coriander Seed’s Antioxidant Profile

Coriander seeds have potential as natural antioxidants.[20] In fact, in addition to coriander’s ability to counteract oxidative stress, the seeds also show antihyperglycemic activity.[21] This makes Coriandrum sativum yet another potential herbal prophylaxis against diabetes. (And this, in turn, may help to reduce a person’s risk of dementia.[22])

Beyond these properties, “Coriandrum sativum seed extract” appears directly relevant to Alzheimer’s and other forms of dementia (for example, Multi-Infarct Dementia, also called “Vascular Dementia”) in virtue of its observed “ameliorative effects on memory impairment in… mice.”[23]

To put it slightly differently, it can possibly “[repair] memory deficits”[24] – which is cause for excitement!

Spice #7: Cumin (Cuminum cyminum)

Cumin’s Antioxidant Profile

“…[C]umin is a potent antioxidant.”[25]

Its constituents include beta-carotene, cineole, and limonene.

According to an article in the peer-reviewed journal Pharmaceutical Biology, cumin also has antistress potential. But, interestingly, especially for the focus of this website, the authors enthuse that cumin also has “memory-enhancing activity.”[26]

They wrote: “This study provides scientific support for the antistress, antioxidant, and memory-enhancing activities of cumin extract and substantiates that its traditional use as a culinary spice in foods is beneficial and scientific in combating stress and related disorders.”[27]

It happens to be an excellent stand-in for coriander. So, if you don’t have coriander seeds, but you do have cumin, you’re in luck. Not only can you expect that cumin is substitutable from a culinary standpoint, but – as alluded to – it also can be used as a stand-in from the standpoint of antioxidant profiles.

Spice #8: Garlic (Allium sativum)

Garlic’s Antioxidant Profile

Speaking of those antioxidant profiles, garlic has a unique one.

Among its noteworthy chemical parts, garlic’s “signature” antioxidant is something called allicin.

Firstly, allicin is being investigated for its possible dual ability to “reduce neuronal death and ameliorate …spatial memory impairment in Alzheimer’s disease models.”[28]

Additionally, allicin also holds promise as an acetylcholinesterase inhibitor[29] – which is the main therapeutic action of the majority of Alzheimer’s drugs – including the preeminent donepezil (sold as Aricept) – currently prescribed.

We already touched on this a bit with black pepper (see above). And we’ll get into it again when we talk about sage (see below), which is also reported to have exceptional acetylcholinesterase-inhibiting activity.[30]

(For my YouTube video on how acetylcholinesterase-inhibiting pharmaceuticals work, click HERE. For my presentation on the six FDA-approved for Alzheimer’s, see HERE.)

In addition to its own antioxidant constituents, Aged Garlic Extract (AGE) has “the ability …to increase the levels of some antioxidant enzymes.”[31]

Among other things, garlic also has a storied history as an antibacterial agent. For more on the herb that, before Alexander Fleming arrived on the scene, was referred to “Russian Penicillin,” see, for example, the article “Extracts From the History and Medical Properties of Garlic.”[32]

Spice #9: Ginger (Zingiber officinale)

Ginger’s Antioxidant Profile

“Ginger is loaded with antioxidants…”.[33]

Recalling from our discussions of cayenne and cinnamon that diabetes is an Alzheimer’s risk factor, it’s also notable that “[g]inger has been shown to possess anti-diabetic activity in a variety of studies.”[34]

It also turns out that ginger has health-giving properties that are particularly relevant to females of the species. According to the peer-reviewed journal Evidence-Based Complementary and Alternative Medicine: “[G]inger is a potential cognitive enhancer for middle-aged women.”[35]

Finally, for Alzheimer’s, in particular, “Z. officinale may be a promising source of AChE [i.e., acetylcholinesterase – editor] inhibitors for Alzheimer’s disease.”[36] Indeed, some researchers think ginger may spark new insights into multi-targeted pharmaceutical approaches.[37]

Spice #10: Mustard (Brassica nigra)

Mustard’s Antioxidant Profile

It’s easy to dismiss mustard as a mere condiment. But, in fact, “Brassica nigra” is a remarkable “natural food source for antioxidants.”[38]

Healthline elaborates, stating: “Mustard contains antioxidants and other beneficial plant compounds thought to help protect your body against damage and disease. [i]t’s a great source of glucosinolates, a group of sulfur-containing compounds found in all cruciferous vegetables, including broccoli, cabbage, Brussels sprouts, and mustard.”[39]

Its antioxidant profile includes carotenes and kaempferol.

In the article titled “Kaempferol Attenuates Cognitive Deficit Via Regulating Oxidative Stress and Neuroinflammation…,”[40] appearing in the scientific journal Neural Regeneration Research, investigators report “that [kaempferol] may be a potential neuroprotective agent against cognitive deficit in [Alzheimer’s Disease].

As one of the most popular and widely used spices in the world, mustard is readily incorporated into a wide variety of dishes, recipes, and other culinary applications.

That said, however, bear in mind that various mustard-based preparations may include other ingredients besides the bare mustard seeds. Though, admittedly, some of these – for example, turmeric (see my YouTube videos HERE and HERE) and vinegar – may have salubrious properties of their own.

Spice #11: Nutmeg (Myristica fragrans)

Nutmeg’s Antioxidant Profile

Nutmeg is an interesting entrant to this list. First, let’s look at its “pluses.”

Predictably, the stuff “[c]ontains powerful antioxidants.”[41] As Healthline puts it: “Nutmeg contains an abundance of antioxidants, including plant pigments like cyanidins, essential oils, such as phenylpropanoids and terpenes, and phenolic compounds, including protocatechuic, ferulic, and caffeic acids.”[42]

Among its various “catechins,” and other assorted constituents – which together give it a free-radical-scavenging efficiency – is a unique chemical called “myristic acid.”

In one experiment, which involved feeding mice a “ketogenic diet …rich in myristic acid,” the studied diet “…significantly reduced total brain Aβ levels by approximately 25%.”[43]

Of course, the phrase “brain Aβ levels” refers to the pathological accumulation of junk, known as “beta-amyloid protein,” in the brains of Alzheimer’s suffers. These protein deposits are believed by some researchers to be the at-bottom cause of the dread disease. But, the jury is still out.

(For my own discussions of candidate Alzheimer’s-Disease causes, I invite you to see my WRITTEN ARTICLE elsewhere on this website or, if you’d prefer, view one of my early YOUTUBE-VIDEO efforts.)

Now… onto a few significant “minuses.”

In a New York Times article titled “A Warning on Nutmeg,” the author points us to the historical fact that, “[i]n the Middle Ages, it was used to end unwanted pregnancies.”[44]

This past employment as an herbal abortifacient would probably be little more than a footnote, were it not for the fact, reported by the Journal of Medical Toxicology, that there is such a thing as “nutmeg poisoning.”[45]

And this leads us to the somewhat darker side of nutmeg’s properties: myristicin’s potentially toxic effects.[46]

The concern shouldn’t be overstated, however. These poisoning cases are rare. They tend to involve teenagers horsing around. So, you don’t necessarily have to worry – for example, if you’re following quantity information in a tried-and-true recipe.

Still, interested persons should proceed with caution, since there’s little to go on in terms of precise information regarding how much nutmeg may be needed to cause some of the nastier effects (like hallucinations, nausea, and vomiting).

The New York Times says: “It takes a fair amount of nutmeg — two tablespoons or more — before people start exhibiting symptoms.”[47] That quantities of this sort (two tablespoons or more) are required is underscored by some of the poisoning reports available.[48]

Healthline suggests that doses can be less and still result in adverse events. In the article “High on Nutmeg,” writer Eleesha Lockett tell us: “According to the case studies from the Illinois Poison Center, even 10 grams (approximately 2 teaspoons) of nutmeg is enough to cause symptoms of toxicity. At doses of 50 grams or more, those symptoms become more severe. Like any other drugs, the dangers of nutmeg overdose can occur no matter the method of delivery.”[49]

(For more on this, see my YouTube video, HERE.)

Just handle nutmeg with care. For example, use only as directed by trusted recipes, and keep it out of reach of kids, teenagers, and the cognitively impaired.[50]

Spice #12: Oregano (Origanum vulgare)

Oregano’s Antioxidant Profile

“Oregano is rich in antioxidants…”.[51]

A glance at my “profile” for oregano reveals a plethora of powerful, constituent antioxidants, including rosmarinic acid – a compound also found in lemon balm (Melissa officinalis), peppermint (Mentha × piperita), rosemary (Rosmarinus officinalis), sage (Salvia officinalis), and thyme (Thymus vulgaris) – and which, in addition to its antioxidant capabilities, “…possesses many biological activities including …anti-inflammatory, anticancer, antiviral, antibacterial, and neuroprotective effects.”[52]

“Dietary intake of oregano oil has been reported to significantly delay lipid oxidation in animal models…”.[53]

One Science Daily post humorously puts things this way: “In what may be good news for pizza lovers and Italian-food connoisseurs everywhere, the herbs with the highest antioxidant activity belonged to the oregano family. In general, oregano had 3 to 20 times higher antioxidant activity than the other herbs studied,” according to at least one American-Chemical-Society investigation.[54]

Spice #13: Rosemary (Salvia rosmarinus / Rosmarinus officinalis)

Rosemary’s Antioxidant Profile

Rosemary has “potent antioxidant properties” which “have been mainly attributed to its major diterpenes, carnosol and carnosic acid, as well as to the essential oil components”[55] – names for some of which you can read on the “dossier” that I have prepared.

We looked at another, characteristic antioxidant component – namely, rosmarinic acid – when we covered oregano, above.

Rosemary is quite noteworthy. In fact, I have two video presentations dedicated to it (viewable HERE and HERE), including one (ßthe second link!) where I (unofficially!) name it my pick for the second-best “Alzheimer’s herb” – just behind Gingko biloba.

Suffice it to say that rosemary is one of those “powerhouse” herbs that appears to be capable of attacking Alzheimer’s from multiple angles, including: providing “…general antioxidant-mediated neuronal protection,” guarding against “brain inflammation,” and even possibly hindering “amyloid-beta (Aβ) formation.”[56]

(Recall that nutmeg was alleged to have a similar, Aβ-inhibiting action. For a review, see the relevant section, above. And, for similar remarks about sage, continue, below!)

Spice #14: Sage (Salvia officinalis)

Sage’s Antioxidant Profile

As Healthline puts it: Sage is “Loaded With Antioxidants”![57] In fact, the herb reportedly “…contains over 160 distinct polyphenols, which are plant-based …antioxidants…”.[58]

Like oregano and rosemary before it, sage also contains nonnegligible quantities of rosmarinic acid (see the writeup on oregano for details). But it also has salvianolic acid, a chemical that is somewhat unique to Salvia plants.

The widely studied Red-Sage species, Salvia miltiorrhiza, for example, has “Salvianolic acid B (Sal B),” a “major and …active anti-oxidant …[that] protects diverse kinds of cells from damage caused by a variety of toxic stimuli.”[59]

Though, I hasten to add that “…salvianolic acid” shows up as one of the “major components” in “…analyzed samples of S. officinalis…,” or garden-variety sage, as well.

The remarks made in one scientific article are worth quoting at length.

“Amongst many herbal extracts, Salvia species are known for the beneficial effects on memory disorders… S. officinalis (common sage), Salvia lavandulaefolia (Spanish sage), and Salvia miltiorrhiza (Chinese sage) have been used for centuries as restoratives of lost or declining mental functions such as in Alzheimer’s disease (AD).

“…In AD, the enzyme acetyl cholinesterase (AChE) is responsible for degrading and inactivating acetylcholine, which is a neurotransmitter substance involved in the signal transferring between the synapses. AChE inhibitor drugs act by counteracting the acetylcholine deficit and enhancing the acetylcholine in the brain. …Essential oil of S. officinalis has been shown to inhibit 46% of AChE activity at a concentration of 0.5 mg/ml.

“…A study shows that S. officinalis improves the memory and cognition… A randomized, double-blind clinical study has shown that an ethanolic extract from common sage (S. officinalis) as well as Spanish sage (S. lavandulaefolia) is effective in the management of mild to moderate AD…”

“…The cytoprotective effect of sage against Aβ (amyloid-beta plaques) toxicity in neuronal cells has also been proven by …a study which provides the pharmacological basis for the traditional use of sage in the treatment of AD.”[60]

Therefore, sage – along with other plants like gingko, rosemary, and saffron – belongs high on any list of possible herbal Alzheimer’s interventions.

Let me interject, at this point, that if you want more detailed information on or about any of these herbs, then I would invite you to do a little bit of research yourself on PubMed.

First of all, many articles specify more of the antioxidant constituents than I do.

Secondly, as just illustrated by the previous, long quotation, numerous scholarly articles excavate the therapeutic potential of these spices much more completely – and expertly – than I can do in this space.

(However, for a nontechnical introduction, I invite you to check out my own treatment of sage on YouTube, HERE.)

(For a refresher regarding the significance of this activity for Alzheimer’s Disease, see the entries for black pepper and garlic, above. See also: my YouTube presentations on the function of acetylcholinesterase inhibitors, HERE; hypothetical “acetylcholinesterase deficiency,” HERE; and FDA-approved Alzheimer’s drugs which have acetylcholinesterase-inhibiting functions, HERE.)

Spice #15: Thyme (Thymus vulgaris)

Thyme’s Antioxidant Profile

Regarding thyme, one website reports: “It turns out that this useful kitchen herb is also a high-antioxidant food.”[61]

In fact, thyme – or, at least, its essential oil – is arguably one of the most potent herbal antioxidants. One set of authors reports: “The best antioxidant[62] was T. vulgaris oil.”[63]

And among thyme’s most important constituents – a summary of which you can see in the “profile” that I prepared – is thymol, itself one candidate (on a short list) for the title most powerful antioxidant.

One journal states: “Thymol, carvacrol, and eugenol are the most powerful antioxidants…”.[64]

Thymol is so potent that even “waste thyme extract can… be used as an antioxidant either in food or pharmaceutical emulsions…”.[65]

In terms of Alzheimer’s-Disease relevance, I note that “…thymol decreased the effects of Aβ on memory and could be considered as neuroprotective.”[66]

On top of all this, thyme also displays antimicrobial properties.[67]

(For more on thyme, including a segment on borneol (a constituent that is able to improve the transportation of other therapeutic compounds into the brain) see the YouTube version of this presentation, HERE.)

Spice #16: Turmeric (Curcuma longa)

Turmeric’s Antioxidant Profile

This herb is more widely known – and regarded – for its potent anti-inflammatory properties.[68]

But, make no mistake, “[t]urmeric is a powerful antioxidant,” also.[69]

The key component is something called “curcumin.” Now, the relationship between curcumin and turmeric is a bit tricky, especially when it comes to supplements. Curcumin has been thoroughly studied for its health benefits – which are numerous.

But, by itself, curcumin does not have the same health benefits from a practical standpoint, because it doesn’t get absorbed well in the digestive tract.

An article in USA Today makes the point.

“Curcumin is a nutritional compound located within the rhizome, or rootstalk, of the turmeric plant. An average turmeric rhizome is about 2% to 5% curcumin. …[I]t’s the curcumin …that has the powerful health benefits. …You would have to take hundreds of [turmeric] capsules to get a clinically studied amount of curcumin. …[But p]lain curcumin extracts are poorly absorbed in the intestinal tract.”[70]

Synergy

One possible workaround arguably depends upon the concept of synergism – mentioned earlier. Recall that this has to do with the idea of “combining” or “pooling” potencies.

So, for example, curcumin can be taken with another of turmeric’s constituents, namely, aromatic turmerone, sometimes abbreviated as “ar-turmerone.”[71]

Another possibility is a combination of curcumin and black pepper, the common spice discussed earlier in this article. “[P]iperine is the major active component of black pepper and, when combined in a complex with curcumin, has been shown to increase bioavailability by 2000%.”[72]

A further illustration of the power of synergy is offered by the Journal of Agricultural Food Chemistry, where we read the following. When sage and thyme are combined, antioxidant constituents, including “[c]arnosol, rosmanol, epirosmanol, isorosmanol, galdosol, and carnosic acid” together “exhibited remarkably strong activity, which was comparable to that of alpha-tocopherol.”[73]

“Alpha-tocopherol is the most active form of vitamin E in humans.[74] It is also a powerful biological antioxidant. Vitamin E supplements are usually sold as alpha-tocopheryl acetate, a form that protects its ability to function as an antioxidant.”[75]

Blends

And… don’t forget about spice blends! Many blends provide you with these common herbs in combination.

For instance, curry powder frequently includes ingredients such as coriander, fenugreek, ginger, and – of course – turmeric.

Chili powder might have garlic in addition to cayenne or paprika.

Italian-seasoning blends are typically going to include basil, garlic powder, oregano, Rosemary, thyme, and so on. Sometimes there’s an assist from things like marjoram or parsley – both of which I get into in part 2. (See HERE.)

There are a number of other blends, of course. For example, there’s poultry seasoning, which can have oregano, sage, and rosemary, but also secondary constituents like black pepper and marjoram.

My point in mentioning blends in these cursory comments is simply this.

Even if you look at your spice rack see discover that you don’t have most – or any – of the sixteen herbs expressly named on my list, if you have a few blends, you might find that you have more than you think you do.

Vitamin C

As a coda, I’ll add that many – in fact, nearly all – of these herbs also include vitamins. In conversations about antioxidants, one of the most significant vitamins is Vitamin C, or ascorbic acid.

Take thyme, for example. Thyme is frequently touted as a significant source of vitamin C. In its article “20 Foods That Are High in Vitamin C,” Healthline reports that “[o]ne ounce (28 grams) of fresh thyme provides 45 mg of vitamin C, which is 50% of the D[aily]V[alue].”[76]

Of course, you’re probably unlikely to consume that much thyme at one sitting.

Moreover, note that the article in question specifically mentions fresh thyme – as opposed to the dried stuff. It’s arguable that fresh herbs are often higher than their dried counterparts in terms of vitamin content, but lower in terms of other antioxidants – or, at least, in terms of measured, overall antioxidant potency.[77]

(I plan on tackling the vexed topic of “ORAC values” in another place.)

Bottom line: just be aware that many of these herbs can deliver some vitamin content. In fact, every one of the herbs that I survey, here, is reported to have some Vitamin-C content.

For More Information

Where can you go for more?

• PubMed is a publicly searchable database of scholarly articles, many of which (though, not all) are posted in full-text format. Just use search strings such as <“antioxidant” + [your favorite herb]>. PubMed is accessible, HERE.
• Among the numerous, informative articles that you may find is an offering like this: “Antioxidant Activity of Spices and Their Impact on Human Health: A Review.”[78]
• That article is actually published by the international, peer-reviewed, academic journal Antioxidants – located HERE – which, as its name suggests, focuses on the topic that has occupied us in this post.
• Additionally, though, my website and YouTube channel are sources for basic introductions to many topics in the vicinity. Some of the titles that readers may find interesting include:
  1. “Antioxidants on Your Kitchen Spice Rack, Part 1” (16 Common Herbs)
  2. “Antioxidants on Your Kitchen Spice Rack, Part 2” (16 Less-Common Herbs)
  3. Alzheimer’s Herbs, Part 1: “Top 10 Ayurvedic Herbs” (except for turmeric!)
  4. Alzheimer’s Herbs, Part 2: “10 Miscellaneous Brain-Health Herbs” (including sage)
  5. Alzheimer’s Herbs, Part 3: “Top 5 Herbs for Alzheimer’s Disease” (turmeric is in this one!)
  6. All 25 of the herbs in the three installments just mentioned appear in a written article on my website, available HERE.
  7. Finally, I’ll mention my YouTube presentation on “Rosemary” (a dedicated, early video I made on this spice)

[By Matthew Bell]

Notes:

[1] Basil is sometimes referred to as “Sweet Basil.”

[2] Shadi Sarahroodi, Somayyeh Esmaeili, Peyman Mikaili, Zahra Hemmati, and Yousof Saberi, “The effects of green Ocimum basilicum hydroalcoholic extract on retention and retrieval of memory in mice,” Ancient Science of Life, vol. 31, no. 4, Apr.-Jun. 2012, pp. 185-189, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3644756/>.

[3] According to: Biljana Kaurinovic, Mira Popovic, and Sanja Vlaisavljevic, “In Vitro and in Vivo Effects of Laurus nobilis L. Leaf Extracts,” Molecules, vol. 15, no. 5, May 2010, pp. 3,378-3,390, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6263372/>.

[4] For just one hint of this, see: Lokraj Subedee, R. Suresh, M. Jayanthi, H. Kalabharathi, A. Satish, and V. Pushpa, “Preventive Role of Indian Black Pepper in Animal Models of Alzheimer’s Disease,” Journal of Clinical and Diagnostic Research, vol. 9, no. 4, Apr. 2015, pp. FF01-FF04, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4437082/>.

[5] Pennapa Chonpathompikunlert, Jintanaporn Wattanathorn, and Supaporn Muchimapura, “Piperine, the main alkaloid of Thai black pepper, protects against neurodegeneration and cognitive impairment in animal model of cognitive deficit like condition of Alzheimer’s disease [sic],” Food Chem. Toxicol., vol. 48, no. 3, Mar. 2010, pp. 798-802, < https://pubmed.ncbi.nlm.nih.gov/20034530/>.

[6] BrahmaNaidu Parim, Nemani Harishankar, Meriga Balaji, Sailaja Pothana, and Ramgopal Rao Sajjalaguddam, “Effects of Piper nigrum extracts: Restorative perspectives of high-fat diet-induced changes on lipid profile, body composition, and hormones in Sprague-Dawley rats,” Pharmaceutical Biology, vol. 53, no. 9, Apr. 9, 2015, pp. 1,318-1,328, <https://pubmed.ncbi.nlm.nih.gov/25856709/>.

[7] Kazuya Murata, Shinichi Matsumura, Yuri Yoshioka, Yoshihiro Ueno, and Hideaki Matsuda, “Screening of β-secretase and acetylcholinesterase inhibitors from plant resources,” Journal of Natural Medicines, vol. 69, no. 1, Aug. 15, 2014, pp. 123-129, <https://pubmed.ncbi.nlm.nih.gov/25119528/>.

[8] J.D.D. Tamokou, et al., “Antimicrobial Activities of African Medicinal Spices and Vegetables,” Victor Kuete, ed., Medicinal Spices and Vegetables from Africa: Therapeutic Potential against Metabolic, Inflammatory, Infectious and Systemic Diseases, London: Academic Press; Elsevier, 2017, p. 223, <https://books.google.com/books?id=SHjUDAAAQBAJ&pg=223>.

[9] Cholecalciferol, also known as Vitamin D3, is a particularly highly regarded variety.

[10] Setareh Sanati, et al., “A Review of the Effects of Capsicum annuum L. and Its Constituent, Capsaicin, in Metabolic Syndrome,” Iranian Journal of Basic Medical Sciences, vol. 21, no. 5, May 2018, pp. 439-448, <https://pubmed.ncbi.nlm.nih.gov/29922422/>.

[11] “Diabetes and Alzheimer’s linked,” Mayo Clinic, May 22, 2019, <https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/in-depth/diabetes-and-alzheimers/art-20046987>.

[12] Arguably, they’re literally identical. At least, in some preparations, they seem to be the same herb. But, since I am not experienced enough to know whether this is the usual state of affairs, I’ll stick to the more reserved word, and simply say that they’re similar.

[13] Lizzie Streit, “8 Science-Backed Benefits of Paprika,” Healthline, Aug. 20, 2019, <https://www.healthline.com/nutrition/paprika-benefits>.

[14] Hong-Gi Kim, et al., “Binding, Antioxidant and Anti-proliferative Properties of Bioactive Compounds of Sweet Paprika (Capsicum annuum L.),” Plant Foods for Human Nutrition, vol 71, no. 2, Jun. 2016, pp. 129-136, <https://pubmed.ncbi.nlm.nih.gov/27184000/>.

[15] F. Márkus, H. Daood, J. Kapitány, and P. Biacs, “Change in the carotenoid and antioxidant content of spice red pepper (paprika) as a function of ripening and some technological factors,” Journal of Agricultural Food Chemistry, vol. 47, no. 1, Jan. 1999, pp. 100-107, <https://pubmed.ncbi.nlm.nih.gov/10563856/>.

[16] Cinnamomum verum is sometimes designated “Ceylon Cinnamon.” It is a close cousin to the Chinese variety, Cinnamomum cassia, which is more commonly found on grocery-store shelves. According to an article in the Wall Street Journal, C. verum is considered safer than C. cassia – at least in high doses. Additionally, C. verum is assumed to share many of the same salubrious properties of C. cassia, which latter has (admittedly) been more thoroughly studied in scientific experiments. See Laura Johannes, “Little Bit of Spice for Health, but Which One? While Ceylon Cinnamon Is Milder Than Grocery-Store Variety, There Are Few Studies on Its Benefits,” Wall Street Journal, Oct. 14, 2013, <https://www.wsj.com/articles/little-bit-of-spice-for-health-but-which-one-1381786452>.

[17] Joe Leech, “10 Evidence-Based Health Benefits of Cinnamon,” Healthline, July 5, 2018, <https://www.healthline.com/nutrition/10-proven-benefits-of-cinnamon>.

[18] J. Dhuley, “Anti-Oxidant Effects of Cinnamon (Cinnamomum verum) Bark and Greater Cardamom (Amomum subulatum) Seeds in Rats Fed High-Fat Diet,” Indian Journal of Experimental Biology, vol. 37, no. 3, Mar. 1999, pp. 238-242, <https://pubmed.ncbi.nlm.nih.gov/10641152/>.

[19] Just a terminological note: Coriander and cilantro are the same plant, Coriandrum sativum. Some people, in some contexts, probably use the words “coriander” and “cilantro” as synonyms. But the way I’m using these words is this. “Coriander” refers to the seeds of the plant, whereas, “cilantro” refers to the aerial parts (leaves, etc.).

[20] Helle Wangensteen, Anne Samuelsen, and Karl Malterud, “Antioxidant activity in extracts from coriander,” Food Chemistry, vol.88, no. 2, Nov. 2004, pp. 293-297, <https://www.sciencedirect.com/science/article/abs/pii/S0308814604001219>.

[21] B. Deepa, C. Anuradha, “Antioxidant potential of Coriandrum sativum L. seed extract,” Indian Journal of Experimental Biology, vol. 49, no. 1, Jan. 2011, pp. 30-38, <https://pubmed.ncbi.nlm.nih.gov/21365993/>.

[22] For just one report on this, see: Ramit Ravona-Springer and Michal Schnaider-Beeri, “The association of diabetes and dementia and possible implications for nondiabetic populations,” Expert Review of Neurotherapeutics, vol. 11, no. 11, Nov. 2011, pp. 1,609-1,617, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3240939/>.

[23] Yurina Mima, Nobuo Izumo, Jiun-Rong Chen, Suh-Ching Yang, Megumi Furukawa, and Yasuo Watanabe, “Effects of Coriandrum sativum Seed Extract on Aging-Induced Memory Impairment in Samp8 Mice,” Nutrients, vol. 12, no. 2, Feb. 11, 2020, pp. 455ff, <https://pubmed.ncbi.nlm.nih.gov/20848667/>.

[24] Ibid.

[25] N. Thippeswamy and K. Naidu, “Antioxidant potency of cumin varieties—cumin, black cumin and bitter cumin—on antioxidant systems,” European Food Research and Technology, Jan. 12, 2005, vol. 220, pp. 472-476, <https://link.springer.com/article/10.1007/s00217-004-1087-y>.

[26] Sushruta Koppula and Dong Kug Choi, “Cuminum cyminum extract attenuates scopolamine-induced memory loss and stress-induced urinary biochemical changes in rats: a noninvasive biochemical approach,” Pharm. Biol., vol. 49, no. 7, Jul. 2011, pp. 702-708, <https://pubmed.ncbi.nlm.nih.gov/21639683/>.

[27] Ibid.

[28] Xian-Hui Li, Chun-Yan Li, Zhi-Gang Xiang, Fei Zhong, Zheng-Ying Chen, and Jiang-Ming Lu, “Allicin can reduce neuronal death and ameliorate the spatial memory impairment in Alzheimer’s disease models,” Neurosciences (Riyadh, Saudi Arabia), vol. 15, no. 4, Oct. 2010, pp. 237-243, <https://pubmed.ncbi.nlm.nih.gov/20956919/>.

[29] Suresh Kumar, “Dual inhibition of acetylcholinesterase and butyrylcholinesterase enzymes by allicin,” Indian Journal of Pharmacology, vol. 47, no. 4, Jul.-Aug. 2015, pp. 444-446, <https://pubmed.ncbi.nlm.nih.gov/26288480/>.

[30] See: Agatonovic-Kustrin, et al., <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334595/>, op. cit.

[31] Ana L. Colín-González, Ricardo Santana, Carlos Silva-Islas, Maria Chánez-Cárdenas, Abel Santamaría, and Perla Maldonado, “The Antioxidant Mechanisms Underlying the Aged Garlic Extract- and S-Allylcysteine-Induced Protection,” Oxidative Medicine and Cellular Longevity, vol. 2012, 2012, p. 907,162, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363007/>.

[32] Biljana Petrovska and Svetlana Cekovska, “Extracts from the history and medical properties of garlic,” Pharmacognosy Review, vol. 4, no. 7, Jan.-Jun. 2010, pp. 106-110, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249897/>.

[33] “Health Benefits of Ginger,” WebMD, Melinda Ratini, reviewer, Nov. 6, 2020, <https://www.webmd.com/diet/ss/slideshow-health-benefits-ginger>.

[34] Nafiseh Khandouzi, Farzad Shidfar, Asadollah Rajab, Tayebeh Rahideh, Payam Hosseini, and Mohsen Mir Taherif, “The Effects of Ginger on Fasting Blood Sugar, Hemoglobin A1c, Apolipoprotein B, Apolipoprotein A-I and Malondialdehyde in Type 2 Diabetic Patients,” Iranian Journal of Pharmaceutical Research, vol. 14, no. 1, Winter 2015, pp. 131–140, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4277626/>.

[35] Naritsara Saenghong, et al., “Zingiber officinale Improves Cognitive Function of the Middle-Aged Healthy Women,” Evid. Based Complement Alternat. Med., vol. 2012, Dec. 22, 2011, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3253463/>.

[36] Bui Thanh Tung, Dang Kim Thu, Nguyen Thi Kim Thu, and Nguyen Thanh Hai, “Antioxidant and acetylcholinesterase inhibitory activities of ginger root (Zingiber officinale Roscoe) extract,” Journal Complementary and Integrative Medicine, vol. 14, no. 4, May 4, 2017, <https://pubmed.ncbi.nlm.nih.gov/29345437/>.

[37] See: Faizul Azam, Abdualrahman Amer, Abdullah Abulifa, and Mustafa Elzwawi, “Ginger components as new leads for the design and development of novel multi-targeted anti-Alzheimer’s drugs: a computational investigation,” Drug Design, Development and Therapy, vol. 8, 2014, pp. 2,045-2,059, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211852/>.

[38] R. Rajamuruganab, N. Selvaganabathyc, S. Kumaraveld, C. Ramamurthyc, V. Sujathae, and C. Thirunavukkarasu, “Polyphenol contents and antioxidant activity of Brassica nigra (L.) Koch. leaf extract,” Natural Product Research, vol. 26, no. 23, Dec. 2012, pp. 2,208-2,210, <https://www.researchgate.net/profile/Dr_Chinnasamy_Thirunavukkarasu/publication/51818527_Polyphenol_contents_and_antioxidant_activity_of_Brassica_nigra_L_Koch_leaf_extract/links/55ca502608aeca747d69e63f/Polyphenol-contents-and-antioxidant-activity-of-Brassica-nigra-L-Koch-leaf-extract.pdf>.

[39] Alina Petre, “Is Mustard Good for You?” Healthline, Jan. 10, 2020, <https://www.healthline.com/nutrition/is-mustard-good-for-you>.

[40] Somayeh Kouhestani, Adele Jafari, and Parvin Babaei, “Kaempferol attenuates cognitive deficit via regulating oxidative stress and neuroinflammation in an ovariectomized rat model of sporadic dementia,” Neural. Regen. Res., vol. 13, no. 10, Oct. 2018, pp. 1,827-1,832, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128063/>.

[41] Jillian Kubala, “8 Science-Backed Benefits of Nutmeg,” Healthline, Jun. 12, 2019, <https://www.healthline.com/nutrition/nutmeg-benefits>.

[42] Ibid.

[43] Milad Iranshahy and Behjat Javadi, “Diet therapy for the treatment of Alzheimer’s disease in view of traditional Persian medicine: A review,” Iranian Journal of Basic Medical Sciences, vol. 22, no. 10, Oct. 2019, pp. 1,102-1,117, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6885391/>.

[44] Deborah Blum, “A Warning on Nutmeg,” New York Times, Nov. 25, 2014, <https://well.blogs.nytimes.com/2014/11/25/a-warning-on-nutmeg/>.

[45] See: Jamie Ehrenpreis, Carol DesLauriers, Patrick Lank, P. Keelan Armstrong, and Jerrold Leikin, “Nutmeg Poisonings: A Retrospective Review of 10-Years Experience from the Illinois Poison Center, 2001–2011,” J. Med. Toxicol., vol. 10, no. 2, Jun. 2014, pp. 148-151, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057546/>.

[46] Note: Beside the fact that “[m]yristicin is present in nutmeg” – and the related “mace” – it’s also present in “…black pepper, parsley, celery, dill, and carrots.” This is according to the chapter titled “Toxins in Food: Naturally Occurring,” by D. Hwang and T. Chen, contributors to the academic volume Encyclopedia of Food and Health (Oxford and Waltham, Mass: Academic Press; Elsevier, 2016), edited by Benjamin Caballero, Paul Finglas, and Fidel Toldrá (text excerpted at <https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/myristicin>). However, I am reporting on myristicin in relation to nutmeg – and not in relation to other of the named plants – because the quantities are orders of magnitude higher in nutmeg, resulting in the fact that “…nutmeg and mace induce greater narcotic and psychotomimetic activity than” some other herbs, or even of “…an equivalent amount of myristicin or elemicin, also a component of nutmeg” separately. Ibid.

[47] Blum, loc. cit.

[48] Ehrenpreis, et al., op. cit. In fact, one report involved “…ten tablespoons of nutmeg.” Ibid.

[49] Eleesha Lockett, “Can You Get High on Nutmeg? Why This Isn’t a Good Idea,” Gerhard Whitworth, reviewer, Healthline, Aug. 31, 2018, <https://www.healthline.com/health/high-on-nutmeg>. Note that in a Google snippet, the article’s title displays as “High on Nutmeg: The Effects of Too Much and the Dangers”; whereas, on the actual Healthline website, the title reads “Can You Get High on Nutmeg? Why This Isn’t a Good Idea.” Presumably, the difference has to do with Search-Engine-Optimization (SEO) settings, which is an esoteric conversation that would implicate technical terms like “metadata” and “metatags,” and lies far afield from anything I’ll be delving into, presently.

[50] Of course, the focus of my work is on people with Alzheimer’s Disease and other forms of dementia. These conditions negatively affect memory and reasoning. Confused sufferers can sometimes expose themselves (or others) to dangers – whether advertently or inadvertently. For instance, one journal article reports on the case of one woman whose cognitively afflicted “…husband put nutmeg on his steak instead of pepper.” Els van Wijngaarden, et al., “Entangled in uncertainty: The experience of living with dementia from the perspective of family caregivers,” PLoS One (Public Library of Science), vol. 13, no. 6, Jun. 13, 2018, p. e0198034, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5999274/>.

[51] Rachael Link, “6 Science-Based Health Benefits of Oregano,” Healthline, Oct. 27, 2017, <https://www.healthline.com/nutrition/6-oregano-benefits>.

[52] Niloufar Ansari and Fariba Khodagholi, “Natural Products as Promising Drug Candidates for the Treatment of Alzheimer’s Disease: Molecular Mechanism Aspect,” Current Neuropharmacology, vol. 11, no. 4, Jul. 2013, pp. 414-429, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3744904/>.

[53] Muhammad Ayaz, Abdul Sadiq, Muhammad Junaid, Farhat Ullah, Fazal Subhan, and Jawad Ahmed, “Neuroprotective and Anti-Aging Potentials of Essential Oils from Aromatic and Medicinal Plants,” Frontiers in Aging Neuroscience, vol. 9, May 30, 2017, p. 168, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447774/>.

[54] “Researchers Call Herbs Rich Source of Healthy Antioxidants; Oregano Ranks Highest,” Science Daily, Jan. 8, 2002, <https://www.sciencedaily.com/releases/2002/01/020108075158.htm>; citing: American Chemical Society. On oregano outperforming other herbals in terms of its antioxidant abilities, see also: Snezana Agatonovic-Kustrin, Ella Kustrin, and David Morton, “Essential oils and functional herbs for healthy aging,” Neural Regeneration Research, vol. 14, no. 3, Mar. 2019, pp. 441-445, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334595/>.

[55] Aleksandar Rašković, Isidora Milanović, Nebojša Pavlović, Tatjana Ćebović, Saša Vukmirović, and Momir Mikov, “Antioxidant activity of rosemary (Rosmarinus officinalis L.) essential oil and its hepatoprotective potential,” BMC Complementary and Alternative Medicines (alternatively titled BMC Complementary Medicine and Therapies), vol. 14, Jul. 7, 2014, p. 225, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227022/>.

[56] As discussed in: Solomon Habtemariam, “The Therapeutic Potential of Rosemary (Rosmarinus officinalis) Diterpenes for Alzheimer’s Disease,” Evidence Based Complementary and Alternative Medicine, vol. 2016; Jan. 28, 2016, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4749867/>.

[57] Ryan Raman, “12 Health Benefits and Uses of Sage,” Healthline, Dec. 14, 2018, <https://www.healthline.com/nutrition/sage>.

[58] Ibid.

[59] Yan-Hua Lin, Ai-Hua Liu, Hong-Li Wu, Christel Westenbroek, Qian-Liu Song, He-Ming Yu, Gert Horst, and Xue-Jun Li, “Salvianolic acid B, an antioxidant from Salvia miltiorrhiza, prevents Abeta(25-35)-induced reduction in BPRP in PC12 cells,” Biochemical and Biophysical Research Communications, vol. 348, no. 2, Jul. 28, 2006 [online], Sept. 22, 2006 [print], pp. 593-609, <https://pubmed.ncbi.nlm.nih.gov/16890202/>.

[60] Mohsen Hamidpour, Rafie Hamidpour, Soheila Hamidpour, and Mina Shahlari, “Chemistry, Pharmacology, and Medicinal Property of Sage (Salvia) to Prevent and Cure Illnesses such as Obesity, Diabetes, Depression, Dementia, Lupus, Autism, Heart Disease, and Cancer,” Journal of Traditional and Complementary Medicine, vol. 4, no. 2, Apr.-Jun. 2014, pp. 82-88, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003706/>.

[61] Amanda Rose, “Antioxidants in Thyme,” Traditional Foods; The Antioxidant Project, Jun. 30, 2011, <http://www.traditional-foods.com/antioxidants/thyme/>.

[62] At least, it was the best among the five explicitly tested: bitter orange (Citrus aurantium), Fennel (Foeniculum vulgare), Mediterranean cypress (Cupressus sempervirens), Tasmanian blue gum (Eucalyptus globulus), and Thyme (Thymus vulgaris).

[63] Smail Aazza, Badiâ Lyoussi, and Maria Miguel, “Antioxidant and antiacetylcholinesterase activities of some commercial essential oils and their major compounds,” Molecules, vol. 16, no. 9, Sept. 7, 2011, pp. 7,672-7,690, <https://pubmed.ncbi.nlm.nih.gov/21900869/>.

[64] Yasiel Crespo, Luis Sánchez, Yudel Quintana, Andrea Cabrera, Abdel del Sol, and Dorys Mayanchaa, “Evaluation of the synergistic effects of antioxidant activity on mixtures of the essential oil from Apium graveolens L., Thymus vulgaris L. and Coriandrum sativum L. using simplex-lattice design,” Heliyon, Jun. 15, 2019, vol. 5, no. 6, p. e01942, <https://pubmed.ncbi.nlm.nih.gov/31245650/>.

[65] Soukaïna El-Guendouz, Smail Aazza, Susana Dandlen, Nessrine Majdoub, Badiaa Lyoussi, Sara Raposo, Maria Antunes, Vera Gomes, and Maria Miguel, “Antioxidant Activity of Thyme Waste Extract in O/W Emulsions,” Antioxidants (Basel, Switzerland), vol. 8, no. 8, Jul. 25, 2019[online], Aug. 2019 [print], pp. 243, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719112/>.

[66] Masoumeh Asadbegi, Parichehreh Yaghmaei, Iraj Salehi, Alireza Komaki, Azadeh Ebrahim-Habibi, “Investigation of thymol effect on learning and memory impairment induced by intrahippocampal injection of amyloid beta peptide in high fat diet- fed rats,” Metabolic Brain Disorder, vol. 32, no. 3, Mar. 2, 2017 [online], Jun. 2017, [print], pp. 827-839, <https://pubmed.ncbi.nlm.nih.gov/28255862/>.

[67] Monika Sienkiewicz, Monika Łysakowska, Paweł Denys, and Edward Kowalczyk, “The antimicrobial activity of thyme essential oil against multidrug resistant clinical bacterial strains,” Microbial Drug Resistance, vol. 18, no. 2, Nov. 21, 2011 [online], Apr. 2012 [print], pp. 137-148, <https://pubmed.ncbi.nlm.nih.gov/22103288/>.

[68] Julie Jurenka, “Anti-inflammatory properties of curcumin, a major constituent of Curcuma longa: a review of preclinical and clinical research,” Alternative Medicine Review, vol. 14, no. 2, Jun. 2009, pp. 141-153, <https://pubmed.ncbi.nlm.nih.gov/19594223/>.

[69] “The health benefits of turmeric,” Nuffield Health, Nov. 18, 2020, <https://www.nuffieldhealth.com/article/the-health-benefits-of-turmeric>.

[70] Terry Naturally, “The ways turmeric and curcumin differ might surprise you,” USA Today, May 1, 2019, <https://www.usatoday.com/story/sponsor-story/terry-naturally/2019/05/01/ways-turmeric-and-curcumin-differ-might-surprise-you/3541923002/>.

[71] Ibid.

[72] Susan Hewlings and Douglas Kalman, “Curcumin: A Review of Its’ Effects on Human Health,” Foods, vol. 6, no. 10, Oct. 22, 2017, p. 92, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664031/>. A similar extract is sometimes referred to as “bioperine.”

[73] Kayoko Miura, Hiroe Kikuzaki, and Nobuji Nakatani, “Antioxidant activity of chemical components from sage (Salvia officinalis L.) and thyme (Thymus vulgaris L.) measured by the oil stability index method,” J. Agric. Food Chem., vol. 50, no. 7, Mar. 27, 2002, pp. 1,845-1851, <https://pubmed.ncbi.nlm.nih.gov/11902922/>.

[74] Though, see my YouTube-video presentation Antioxidants, Part 2 to discover gamma-tocopherol, a form of Vitamin E more commonly found in seeds – such as sesame seeds, which are on my list.

[75] M. Saljoughian, “Natural Powerful Antioxidants,” U.S. Pharmacist, vol. 1, Jan. 23, 2007, p. HS38-HS42, <https://www.uspharmacist.com/article/natural-powerful-antioxidants>.

[76] Caroline Hill, Jun. 5, 2018, <https://www.healthline.com/nutrition/vitamin-c-foods>.

[77] Also, pasteurization or processing can cause the vitamin content (especially in the case of Vitamin C) to diminish.

[78] Alexander Yashin, Yakov Yashin, Xiaoyan Xia, and Boris Nemzer, Antioxidants (Basel, Switzerland), vol. 6, no. 3, Sept. 15, 2017, p. 70, <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5618098/>. Innumerable other articles could be given at this point, including many cited elsewhere in this post, or in any of the companion videos, but also: T. Alan Jiang, “Health Benefits of Culinary Herbs and Spices,” Journal of AOAC International, vol. 102, no. 2, Jan. 16, 2019 [online], Mar. 1, 2019 [print], pp. 395-411, <https://pubmed.ncbi.nlm.nih.gov/30651162/>.

The post 16 Antioxidant Herbs for Alzheimer’s on Your Spice Rack appeared first on Alzheimer's Proof.

In order to help pay for my dad’s nursing home care, my mom had to reduce her already modest assets as part of what is commonly referred to as a Medicaid spend-down.

But what is Medicaid? How do you qualify for it? Who is it designed to assist? And why do so many people have to expend their life savings in order to get it?

Let’s take a look at Medicaid.

In this introductory article, I’ll lay some basic groundwork – and provide a few essential definitions and concepts.

In two follow-up articles, we’ll discuss the all-important financial qualifications: first assets, then income. So… stay tuned!

(Also, be aware that this additional content is already available in the form of YouTube presentations and can be accessed HERE and HERE.)

Disclaimers

First of all, I need to give the usual disclaimers and in fact I want to amplify what I normally stay. I am not an attorney. I am not a financial advisor of any kind. You can consider the topics that I discuss to be research leads just to help you as you are thinking through these issues and hopefully help to shorten your learning curve in some of these important topics. But nothing that I say in this video should be construed as advice of any kind. If you need actual recommendations and evaluations, you need to consult with licensed professionals in your area. In this case, I am talking about attorneys who are knowledgeable about Medicaid, or other Medicaid experts.

The usual disclaimers are especially important in this case. That’s because Medicaid is just so complex; Medicaid’s rules and regulations are subject to amendment and modification; eligibility and other limits can be expected to change almost annually; Medicaid has as many different variations as there are US states.

So, you should meet with someone, not just is knowledgeable about the rough contours of the entire program, but somebody who knows the nitty-gritty of your local situation or state situation and how best to advise you.

What is Medicaid?

Medicaid is a United States government program that is designed to help impoverished people pay their medical expenses.

Sometimes, Medicaid is referred to as a joint federal and state program. Other times, Medicaid is referred to as a federal program that is administered by the U.S. states. And, sometimes, it is thought of mainly as a state program that has infusions of federal cash.

The federal government generally provides funding for benefits that are mandated at the federal level, which makes sense. The states, in turn, provide administrative services. They also pay for state-specific benefits.

However you think of it, or by whatever name you call it, Medicaid has a foot on the federal level government as well as on the state level.

This is one key reason for its (aforementioned) complexity. Namely, the particulars of how the plan is implemented and managed are going to vary according to the state that you are in.

Medicaid Isn’t Only for Long-Term Care

It is important to understand at the outset that Medicaid is a broad program and can cover many different medical services.

For example, it can cover routine doctor visits. It can cover hospital visits, long-term-care facilities, nursing homes and the like of that.

The long-term-care applications will be my focus in this series (since it’s the obvious concentration of the website). But Medicaid can cover a lot more than that.

And if you have need for additional services, for yourself or for your family, I am sure there are other resources that will expand my treatment.

Potential Pitfalls

Because of the complexity of the topic, there are certainly going to be a number of pitfalls.

Firstly, it’s easy to confuse Medicaid with Medicare. Not only are the two words similar, but both programs are overseen by the same government agency, the Centers for Medicare and Medicaid services, or CMS. CMS is a major division of the United States Executive Branch Department of Health and Human Services, with the cabinet-level Secretary of Health and Human Services at the helm of both programs.

However, these programs differ in terms of who is eligible and what services are covered.

Medicare is basically health insurance for seniors. Some of the premiums might vary in terms of the amount that is paid. But, otherwise, Medicare covers seniors of any income level.

Here, “senior” simply means a person who is 65 years of age or older.

There is an important caveat.

Medicare is called upon to deliver health coverage to people of any age, provided that they also are recipients of Social Security Disability Income (or SSDI), or if they suffer from end-stage renal failure (or kidney disease). Medicare itself is complex.

Medicare is a complex program itself. For my own YouTube-video treatment, see HERE.

In broad strokes, though, Medicare Parts A and B cover hospital and doctor visits, respectively. Part D was added to help provide prescription-drug coverage.

You can talk about something referred to as Medicare “Part C,” also known as “Medicare Advantage” plans. (These function something like Medicare HMOs)

And, to complicate matters further, Medicare Parts A, B and D can be further augmented with what are called “Medicare Supplement” (or “Medigap”) plans. (These, in turn, are also designated with letters like “Medicare-Supplement A,” “Medicare-Supplement F,” and so on.)

Medicare & Social Security

Historically, Medicare has a fairly tight relationship with Social Security.

For example, although it does have a deductible, Medicare Part A is usually delivered premium-free to people who are fully qualified to receive Social Security benefits. It is in this sense that Medicare Part A is often referred to as “automatic.”

It is important to note that if you are not eligible to receive Part A cost free, you may be able to purchase it.

Medicare has long had this close association with the Social-Security program

In fact, Medicare’s eligibility age, 65, once corresponded to the Full Retirement Age (or “FRA”)[1] for Social Security recipients. Even though the full-retirement age has been increased for most retirees, Medicare’s eligibility age has remained the same.

Medicare part B is never free. Though it’s actual premium cost will depend on many factors, including your income level.

Medicaid Will Be Our Focus

As stated from the outset, going forward, this series will be concerned with Medicaid (and its financial requirements), the government’s financial-assistance program for impoverished people – regardless of their age.

So, we come to one quick way of distinguishing Medicare and Medicaid.

Medicare has an age requirement,[2] but no income requirement. As long as you are 65 years of age, or older, you are eligible for Medicare.

On the other hand, Medicaid has no age requirement, but it does have an income requirement.

To rephrase: Medicare covers people 65+ years of age, of any income level; Medicaid covers any aged person, but only if they are of a low-income level.

Which Program Covers Long-Term-Care Costs?

“Medicaid also covers long-term care costs, both in a nursing home and at-home care. Medicare does not provide this coverage.”[3]

As noted by CNN, long-term care and nursing home costs are not generally covered by Medicare.

Medicare really only covers “curative,” skilled-nursing care – in a Medicare-approved facility. And, even then, it only covers skilled-nursing-home costs, provided that your entry into a qualifying facility followed a hospital stay of at least three days.

Additionally, Medicare coverage is calibrated to what are termed “episodes of care.” And each skilled-nursing-home visit is only covered up to 100 days per episode.

So, since Alzheimer’s and related dementias are not “episodic” in the relevant sense, we can basically say that Medicare is going to be irrelevant for the purposes of long-term care and nursing home care.

Another reason for this irrelevance is that long-term care is often bound up with what is called custodial care, and this is to be distinguished from skilled nursing care.

Basically, custodial care is help with the activities of daily living, whereas skilled nursing care is what you would normally think of in terms of medical care, medical testing, the administration of drugs, and the like.

(For my YouTube presentation explaining the difference between custodial and skilled nursing care, see HERE. For my written article on the same topic, see HERE.)

As if things weren’t confusing enough as it is, Medicaid is able to pay some of the expenses associated with Medicare. Examples of this would include the Parts B and D premiums, the Part-A premium (when it is applicable), and the various Medicare “co-pays” and deductibles.

Intro to Medicaid Eligibility

Each state sets its own guidelines for eligibility, within various limits.

For many states, Medicaid assistance is available to people who are below, at, or near the federal poverty level, or FPL.

Recipients cannot have incomes that exceed about 130-140% of the FPL, adjusted for household size. And these low-income requirements are very strict.

In addition, Medicaid recipients are not allowed to have much by way of assets or, in the Medicaid terminology, “resources.”

But, these two financial tests – one pertaining to assets, and one pertaining to income – are quite intricate. So much so, in fact, that I will be devoting a separate article to each of these.

So, I invite you to stay tuned for those posts.

And, in the meantime, feel free to view the companion YouTube videos. My discussion of Medicaid’s asset requirements can be found HERE, and my coverage of the relevant income requirements is HERE.

Notes:

[1] Note that, in some literature, this is instead termed the “Normal Retirement Age,” or NRA. Presumably, FRA is more common due to the fact that the letters “NRA” more commonly designate the National Rifle Association.

[2] For the exceptions to this, see the previous section.

[3] “What Does Medicaid Cover?” CNN, <https://money.cnn.com/retirement/guide/insurance_health.moneymag/index21.htm>.

The post Intro to Medicaid: Medicaid Vs. Medicare; Long-Term Care appeared first on Alzheimer's Proof.

A news item crossed my radar screen a couple weeks ago. This actually goes all the way back to August 2019, and was published in the Neurology, which is an academic journal, and subsequently was picked up by various news outlets.

I saw this through a press release from Washington University School of Medicine which is located in St. Louis, Missouri. The report focused on a new blood test that’s available for Alzheimer’s Disease.

Currently, it’s in testing phases. But, it has been developed, and researchers think that it holds great promise, and let me explain why that is.

So, first of all:

What does the test do?

I have both an ARTICLE and a YouTube VIDEO on some of the possible causes for Alzheimer’s disease. One of the causes that’s often referenced is the accumulation, in the brain, of various protein “gunk.”

There are two different types of protein that are implicated in this. The first is called beta-amyloid and the second is called tau. The two of these, together, account for the various “plaques and tangles” that Alzheimer’s patients’ brains seem to be riddled with.

The 100% definitive test for this is going to be an autopsy. (For these assortment of Alzheimer’s “tests,” see – again – either my other written work, e.g., HERE, or the companion, video presentation, HERE.)

There is very little use, obviously, for an autopsy to play in terms of preventative medicine or even in treatment, while somebody’s alive. It can give you the accurate cause of death only after the fact. But it’s not going to be too good for medicinal purposes.

Now comes a blood test that promises, or at leads holds the promise, of being able to detect levels of beta-amyloid in the blood during a person’s life.

Two kinds of beta-amyloid protein are being focused upon. And those are designated “Number 40” and “Number 42.”

My layman’s “take” on this is that there is an array of these beta-amyloid’s, but that 40 and 42 somehow play particularly important roles in the pathological accumulation of these deposits in an Alzheimer’s-afflicted brain.

I should say the test has actually been going on for couple years.

What researchers have hypothesized, and has since been borne out – at least, in early stages – is that levels of beta-amyloid in the blood suggest an accumulation of the beta-amyloid in the brain.

 Why is the test important?

I mentioned that autopsies are the definitive test for Alzheimer’s. But, of course, autopsies are no good for diagnostic purposes so long as the patient is alive.

So, the most accurate test a living person can get right now is a so-called “Pet Scan,” which is shorthand for the more forbidding “positron-emission-tomography scan.”

A pet scan is essentially the best test that’s available.

But… pet scans are both expensive and time-consuming to perform. Therefore, this blood test holds out the hope for being able to be administered on a much wider scale and at far less of a cost.

Those are two points in its favor.

In theory, a blood test of this kind would be able to be given in a doctor’s office – instead of, for example, having to send the patient to an imaging center.

How Accurate Is the Blood Test?

What researchers discovered, when they compared the blood-test results against the pet-scan results, was that the blood test was 88% correlated with the pet scan.

What this seems to suggest is that, if for every 100 pet scans displaying evidence of Alzheimer’s, a blood test would detect Alzheimer’s in 88 of those cases.

At least… that’s the way I’m reading the article. (Disclaimer: I am not a medical professional! This is simply my untutored commentary on the situation. For advice, seek a healthcare expert who is familiar with your personal history.)

So, the test was (provisionally) determined to be 88% effective, in the above respect.

What Other Risk Factors Were Considered?

It’s worth pointing out that when they coupled the blood test with a couple of other risk factors – for example, age – the effectiveness increased.

It’s widely accepted that a person’s Alzheimer’s risk goes up with age. In fact, it’s said that your risk actually doubles every five years after age 65.[1]

Also, they factored in genetic predisposition. So, if you have the APO-E4 variant gene in your genetic makeup – as I myself do (see my video testimony, HERE) – then you have a higher (3 to 5 times higher actually!) chance of developing Alzheimer’s sometime in your life.[2]

Another risk factor – believe it or not – is sex. We talked about this in other places. (My AlzheimersProof.com post is HERE and my video is HERE.) Sex may not be its own risk factor. It may simply be that women live longer and therefore are more likely to manifest symptoms of Alzheimer’s and other dementias because of their longevity. But it is sometimes said that two out of three Alzheimer’s sufferers are female.[3]

When researchers incorporated age and genetic predisposition, they found that the test was 94% effective in terms of matching up to the pet scan.

What’s the Practical Benefit of an Alzheimer’s Blood Test?

But what they found, in addition to that, was that when some of the blood tests came up positive for people who had not yest been pet scanned, those people eventually came up positive on the pet scan as well.

This suggested to researchers that the test might actually be even more accurate than the pet scan, and able to detect Alzheimer’s in its very earliest stages.

Recall, also, that Alzheimer’s disease manifests in symptoms. But researchers believe that the underlying brain changes may take place as far back as a decade or more prior to the onset of symptoms.

One of the benefits obviously of early detection is they want to be able to treat people in presymptomatic stages. They feel like once memory changes, and other changes manifest in the brain, then that brain is already so damaged that it is basically beyond help.

In possibly being able to find people in the earliest stages of Alzheimer’s, another potential benefit of the blood test is that it might help with constructing clinical trials for developing interventions.

An early version of this test goes back to 2017 or even 2016. At that time, some of the articles referenced “autoimmune antibodies,” also called “autoantibodies.” The idea was that the immune system’s response to the accumulation of beta-amyloid protein might be able to be gauged. But, upon closer inspection of these articles now, in retrospect, they also seem to be describing a blood test that focuses on some of these beta-amyloid protein variants.

The fundamental idea is to try to catch Alzheimer’s disease in its very earliest stages.

Sometimes this “preclinical” stage is referred to variously as Very Mild Cognitive Impairment (especially on the so-called 7-Stage-Dementia view – about which, see HERE and HERE) or Mild Cognitive Impairment, often better known simply by the abbreviation “MCI.”

Note, however, that not all cases of MCI develop into Alzheimer’s disease. For one thing, there are other sorts of dementia (e.g., Lewy-Body Dementia, Multi-Infarct Dementia, Parkinson’s Disease, etc.) and there are traumatic brain injuries and other conditions that also might be prefaced by mild cognitive impairment. (For the difference between “Alzheimer’s Disease” and “dementia,” see my video, HERE.)

“Mild Cognitive Impairment” is, in a sense, just a catchall phrase for a certain level of mental diminishment as well as for the impoverishment of other perceptual and reasoning capabilities.

Concluding Reflection

There’s little doubt, though, that this blood test is fascinating. Even though it still has some way to go before you can expect it at a physician’s office near you, it holds promise.

Number one, it’s less expensive than the pet scan. Number two, it is able to be administered more widely, and in more environments – like doctors’ offices, and other places (such as out-patient clinics and “urgent-care” centers) – whereas the pet scan is obviously limited to an imaging center. Number three, it’s possibly more accurate than the pet scan. And, number four, it’s certainly superior to the autopsy in the sense that it holds out promise for being able to help treat and diagnose people while they are still alive – which is, quite obviously, advantageous.

Notes:

(Featured image credit: Billy W., <https://images.freeimages.com/images/large-previews/97a/blood-test-1545982.jpg>.)

[1] See: “Causes and Risk Factors for Alzheimer’s Disease,” Alzheimer’s Association, <https://www.alz.org/alzheimers-dementia/what-is-alzheimers/causes-and-risk-factors>.

[2] Though, the risk really ramps up after age 75. See the video for details.

[3] Again, see the Alzheimer’s Association: “Women and Alzheimer’s,” <https://www.alz.org/alzheimers-dementia/what-is-alzheimers/women-and-alzheimer-s>.

The post New Alzheimer’s ‘Blood Test’ Detects Amyloid Deposits appeared first on Alzheimer's Proof.

When a resident retains his or her reason, then – in principle – he or she can “advocate” for themselves in the sense of communicating their desires and needs to facility administrators and staff. But what about cognitively impaired residents, such as those with Alzheimer’s Disease or some other form of dementia?

Such persons may require additional assistance. And this is where a Family Council can come in.

Long-Term-Care Resident Groups

Residents in long-term-care facilities, and families of people residing in such facilities, have the ability to form groups. These groups are often organized to facilitate discussions focused on resident needs and facility changes that may have to do with quality-of-care and quality-of-life issues.

As it happens, these groups, when formed, have tended to be referred to as “councils.” There are two main types of these councils that may be created: family councils and resident councils.

Resident Councils

The most basic variety of long-term-care group is going to be the resident council.

In general terms, a “resident council” is an association of individuals who live in a particular care facility and who wish to work together for the enhancement of their shared living experience.

When they exist, resident councils are independent of the care facility. To put it another way, the resident councils are not controlled or run by the facility administrators or staff.

I say that this sort of group is the “most basic” because it is natural for facility residents to provide feedback and input that pertains to their living conditions. They are interested in the facility, not simply in a psychological sense, but in an economic sense – that is, they have an interest in the policies and procedures of the relevant facility.

Family Councils

A related type of long-term-care group is the family council. As the name implies, “family councils” are groups organized and run by families (or close friends or representatives) of nursing home residents instead of the residents themselves. These family members then join with other families and speak for residents in advocating for policy and procedure changes that improve daily care and quality of life.

It should be said that nothing prevents residents from joining or participating in family councils.

Relatedly, I note that the point of the family council is not to compete with, replace, or supplant the resident council.

Rather, the point is to offer assistance to residents. And, the focus of this website being what it is – namely, Alzheimer’s Disease – it is important to observe that this assistance is especially necessary and valuable in cases where residents lack the ability to speak for themselves because of cognitive impairment, dementia, or similar conditions. (More on this, below.)

Brief Council-Related Questions and Answers (Q&A)

What Do Councils Do?

Both family and resident councils may bring to light issues surrounding care and living conditions. These may include, without limitation: the availability of food, medical equipment, silverware; the cleanliness of the facility; the functionality of things such as elevators; the reliability of internet access; and so on.

Essentially, any topic that impacts the quality of life of residents is fair game.

Once topics have been discussed, it is up to the individuals in the council as to how to proceed. Many facilities (see further on) are required to provide the council with a go-between or contact so that concerns can be delivered to the administration or staff without delay.

Councils may decide to bring their concerns to the facility orally or in writing – in a small group or via a designated council representative.

The first and preferable route would be to communicate with the facility.

However, if the facility is unreceptive for whatever reason, or if it somehow fails to satisfactorily address the expressed concerns, then councils may contemplate or undertake other actions.

Are Family Councils Only Allowed When Residents Have Dementia?

No. Family councils can be formed in order to support any person residing in a particular long-term-care facility, whether the resident is impaired or not.

However, it’s arguably even more important for a family council to be formed when resident loved ones do have cognitive impairments, since dementia sufferers may be unable to speak for themselves.

What Are Examples of Conditions That May Result in Cognitive Impairments?

Conditions may include: Alzheimer’s Disease, Creutzfeldt-Jakob Disease, Frontotemporal Dementia (Pick’s Disease), Huntington’s Chorea (Huntington’s Disease), Lewy-Body Dementia, Multi-Infarct (or Vascular) Dementia, Parkinson’s Disease, Wernicke-Korsakoff Syndrome, etc.

What If a Resident Has No Living (Or Interested) Family Members?

Residents may give permission to non-family members to participate in family councils on their behalf.[1] If a resident has a cognitive impairment, then things can get a little dicey. If you would like a non-family member to represent your interests in a family council, you may wish to record your wishes in writings prior to the manifestation of any condition that might call in question your mental fitness.

Are Long-Term-Care Facilities (Such as Nursing Homes) Required to Recognize Family Councils?

I will address this question at greater length in a forthcoming post.

But, for now, suffice it to say that Federal regulation (in Title 42 CFR 483.10) states that Medicare/Medicaid-participating nursing homes must recognize family and resident groups when they form.

Further, these facilities have to provide resident and family groups with private meeting spaces, and they need to take reasonable steps (with the approval of the groups) to make residents and family members aware of upcoming meetings in a timely manner.

Additionally, the facility must provide a designated staff person to act as a liaison to the group. This person will be responsible for providing assistance to the group and with delivering (though not necessarily writing) responses to formal requests that result from the group meetings.

Does the Long-Term-Care Facility Have to Respond to Council Requests?

The facility cannot ignore the group or suppress its ability to form. So, in this sense, yes, the facility must provide some sort of reply to a group when it is asked to do so.

This does not mean, however, that the facility is compelled to do precisely what the council requests.

Things are tricky. I will try to explore some of these issues at greater length in a future installment.

Six Characteristics of a Family Council

It may be helpful if I briefly sketch some of the qualities that a family council will have.

Autonomy

Autonomy refers to the fact that the group is self-led. Neither a family council nor a resident council is created or led by facility administrators or staff members. If the facility has started and controls a group, then it is not a family or resident council in the relevant sense – regardless of what the facility calls it.

Facilities are of course free to form their own groups; and residents or families are free to join these facility-created groups if they choose to do so. But the formation of a facility-led group is not a replacement for an autonomous family council, and joining a facility group does not bar a person from joining an autonomous group.

Facility Specificity

There may be groups that support anyone living at any nursing home. However, a family council is relative to a specific facility. The ties that bind the members of a family council have to do with the fact that members all have relatives who live in the same long-term-care facility.

Independence

Independence is an extension of autonomy. The administration does not have claims over the family council. The councils are not dependent upon the facility. Moreover, the council is not considered to be a government program. It is an independent association of families of people living at a particular facility.

Interest

A family council must be made up of a group of people who have an interest in the facility. In this context, “interest” does not simply mean a curiosity. It means there has to be an interest in more of an economic sense. Member families have to have some “stake” in the facility and, going further, in the standards according to which the facility operates.

Openness/Inclusivity

There must be no barrier to entry into the family council other than having a close friend or relative involved in the facility. The council be must inclusive or open in terms of its membership.

Privacy

The group is owed a private space that should be provided by the administration of the facility on the facility grounds. The facility cannot appoint a staff member to “sit in” on the meetings.

Administrators or staff may be invited by the group to attend meetings. But, apart from such an invitation, presumably furnished by a council officer or spokesperson, the group should be allowed to meet privately.

Once again, the facility may endorse or sponsor other, staff-led groups. And these groups may also listen to complaints or solicit feedback from families and residents. But, the existence of such facility-controlled groups does not undermine the ability of residents and families to form their own councils to advance their own interests.

Notes:

[1] Presumably, if there is a conflict, a resident could also revoke a family member’s permissions or otherwise “block” one of his or her family members from participating in a council.

The post Intro to Family Councils in Long-Term-Care Facilities appeared first on Alzheimer's Proof.

This type of reporting is not mandatory across the entire United States.  Currently, there are only six (6) states that mandate a physician to report on a patient’s ability to operate a motor vehicle. These six states include:

• California
• Delaware
• Nevada
• New Jersey
• Oregon
• Pennsylvania

Not all mandatory states direct their reporting law toward those who are afflicted with Alzheimer’s Disease or, indeed, any sort of dementia whatsoever. Below are some specifics around each mandatory state and what is defined in their law.

If you want to see and hear me present the material, feel free to watch the YouTube video that I prepared, here:

California

The state of California is the first that I will discuss. It’s a prime example of a state in which (a.) there is mandatory reporting, and (b.) that reporting is at least partially concerned with Alzheimer’s Disease expressly.

The California Legislative Information website (leginfo.legislatures.ca.gov) references chapter 3 – Disorders Characterized by Lapses of Consciousness [103900-103990].

103900 states: “Every physician and surgeon shall report immediately to the local health officer in writing, the name, date of birth, and address of every patient at least 14 years of age or older whom the physician and surgeon has diagnosed as having a case of a disorder characterized by lapses of consciousness.”

This law specifically includes Alzheimer’s Disease as a disorder that involves the requisite “lapses of consciousness.”

For additional information, see the entry on California – “What does California State Law say about Driving with Alzheimer’s?” – in my “50-State Guide to the Laws on Driving With MCI and Alzheimer’s.”

Delaware

In Delaware, the focus is on conditions that are characterized by “losses of consciousness.” In this respect, Delaware’s statutory language is similar to the “lapses of consciousness” verbiage present under California law.

Title 24 of the Delaware Code Online – Professions and Occupations Chapter 17, Medical Practice Act states: “Every physician attending or treating persons who are subject to losses of consciousness due to disease of the central nervous system shall report within 1 week to the Division of Motor Vehicles the names, ages and addresses of all such persons unless such person’s infirmity is under sufficient control to permit the person to operate a motor vehicle with safety to person and property.”

Again, for further reading, scroll down to “Delaware’s entry, HERE.

Nevada

Nevada is a good example of a state in which, while there is mandatory-physician reporting, it is not directed towards cognitive impairments such as dementia (of which, as we know, Alzheimer’s Disease is the most common variety). (On two ways of understanding the difference between Alzheimer’s Disease and dementia, see my YouTube video, HERE.)

According to the Bradley, Drendel & Jeanney law firm: “…Nevada laws can regulate the driving rights of individuals with epilepsy. In fact, doctors in our state are required to report epileptic seizures to the state’s Department of Motor Vehicles…”

You might be picking up on a recurring theme, here, but… for additional information, click down to “What does Nevada State Law say about Driving with Alzheimer’s?” in my 50-State Guide, HERE.

New Jersey

The New Jersey Academy of Ophthalmology, states, “NJ Law (N.J.S.A. 39:3-10.4) requires all physicians to report patients to the Motor Vehicle Commission within 24 hours after determining that a patient experiences any of the following:  Recurrent convulsive seizures, recurrent period of unconsciousness or impairment, or loss of motor coordination due to conditions such as, but not limited to epilepsy in any of its forms which persist or recur despite medical treatment.”

Even so, New Jersey appears to be one of those states in which physicians could potentially be held liable, legally, if they don’t report potentially dangerous drivers.

While New Jersey law has established an elective reporting system for drivers with vision deficiencies and mandatory process for reporting specific neurological dysfunctions, there is no statute that protects a physician from liability if they have failed to report a patient that may cause injuries to a third party due to a condition known by the physician.

Given this, you might think that a New Jersey doctor will err on the side of reporting. And, I may be inclined to agree.

For more info, where do you think I’ll send you? My state guide, of course! Find it, HERE.

Oregon

The Oregon Driver & Motor Vehicle Services states: “Most medical professionals are required to report drivers who can no longer drive due to impairment.”

It is required of medical professionals to report on a patient’s impairment, even if that patient has agreed to give up driving.

The Oregon Secretary of State website similarly states: “…mandatory reporting by physicians and health care providers of those persons with severe and uncontrollable cognitive or functional impairments affecting a person’s ability to safely operate a motor vehicle.”

Cognitive impairments as specified in Oregon include: attention, judgement and problem solving, reaction time, planning and sequencing, impulsivity, visuospatial, memory and/or loss of consciousness or control.

Intuitively, this list is expansive enough to range over various cognitive impairments like dementia and Alzheimer’s Disease, even if they are not singled out for special or explicit attention.

See: “What does Oregon State Law say about Driving with Alzheimer’s?” which is a subsection of my longer, and more comprehensive (but certainly not exhaustive) reference, elsewhere on this website.

Pennsylvania

According to Schemery Zicolello Law Firm, the Pennsylvania Medical-Reporting Law requires health care personnel to report to the Pennsylvania Department of Transportation the full name, date of birth and address of every person over 15 years of age that is diagnosed as having a disorder or disability that could impair his/her ability to drive.  In the list of reportable medical conditions, the attorneys specifically call out dementia.

That’s good enough for me.

If you want a bit more detail, scroll down to “Pennsylvania,” on my article, HERE.

Utah

Utah was mentioned in an article by National Center for Biotechnology Information (NCBI) as a reporting state. However, in the Fact Sheet for Patients and Families provided for Utah drivers, the indication for mandatory reporting by physicians is not present.

The document does state that the patient is expected to report and disclose their impairments to the department of motor vehicles.

So… I don’t find that Utah is actually a mandatory-reporting state.

For more, see: https://alzheimersproof.com/u-s-laws-on-driving-with-mci-and-alzheimers-disease/.

Concluding Remarks

Bear in mind that just because a state does not have mandatory-reporting laws, it should not be assumed that physicians won’t report anyway.

In the first place, a doctor might believe that it is his or her ethical duty to report a potentially dangerous driver – regardless of whether state law strictly requires that he or she do so.

Additionally, the physician’s other professional entanglements – for instance, his or her affiliation with a medical group or his or her professional-liability insurance – might have stricter requirements governing action steps in relevant cases.

Additional Information Or Resources

Over the course of several months, I compiled an article as a reference to U.S. Laws on Driving with MCI and Alzheimer’s Disease which provides a guide on all 50 states and their associated laws.

Another of my references is the post Canadian Laws on Driving with MCI and Alzheimer’s Disease which outlines comparable laws specified within the Canadian provinces.

You might also want to consult the National Highway and Traffic Safety Administration at their website: https://www.nhtsa.gov.

Moreover, in the Physician’s Guide to Assessing and Counseling Older Drivers, Chapter 7, Legal and Ethical Responsibilities of the Physician, some important key terms are defined.  Here are a few highlights.

Mandatory Medical Reporting Law States:  In some states, physicians are required to report patients who have specific medical conditions (e.g., epilepsy, dementia) to their state Department of Motor Vehicles (DMV).  These states generally provide specific guidelines and forms that can be obtained through the DMV.

Physician Reporting Law States: Other states require physicians to report ‘unsafe’ drivers to their state DMV, with varying guidelines for defining ‘unsafe.’  The physician may need to provide (a) the patient’s diagnosis and (b) any evidence of a functional impairment that can affect driving (e.g. Results of neurological testing) to prove that the patient is an unsafe driver.

Physician Liability States:  Case law illustrates situations in which the physician was held liable for civil damages caused by his/her patient’s car crash when there was a clear failure to report an at-risk driver to the DMV prior to the incident.

On the NHTSA’s website, a survey of medical review practices can be found that indicate while all 51 jurisdictions accept reports of potentially unsafe drivers from physicians, only 6 jurisdictions require physicians to report drivers to the motor vehicle agency.

Another helpful article on NHTSA’s website is ‘Current Screening and Assessment Practices’.  This article summarizes the legal requirements in each of the six mandatory reporting states.

Another helpful resource is the National Center for Biotechnology Information, the website for which can be found, here: https://www.ncbi.nlm.nih.gov.

National Library of Medicine, National Institutes of Health contains an article within the Journal of General Internal Medicine (abbreviated “J Gen Intern Med”).  Of interest is an article titled “Reporting by Physicians of Impaired Drivers and Potentially Impaired Drivers,” which mentions that virtually all states have established policies for the identification of drivers with physical or mental impairments, however, the reporting is voluntary with the exception of specific states.[1]

Additional references on AlzheimersProof.com include:

“Is it Legal to Drive with Alzheimer’s Disease?”

This is a resource regarding the legalities of driving with Alzheimer’s or another cognitive disorder.  This is not legal advice, simply research and research leads presented in a comprehensive article to assist in locating additional sources for further information. You can find additional information and important aspects specific to your state within my 50-State legal guide, HERE.

“Are Drivers with Alzheimer’s more Dangerous than Others?”

The above article, also on my website, goes into a discussion about a number of factors that may impact a person’s ability to drive, given their cognitive or mental state. This not only addresses that Alzheimer’s Disease occurs in stages (for more on which, see HERE), but also addresses some concerns around other cognitive impairments.

“Is it Safe to Drive with Alzheimer’s?”

I also have an article – and a companion video (see my YouTube channel, HERE) – talking specifically about considerations of driving safety, apart from an explicit discussion on any legal requirements.

“Disabling Devices – Car”

Now, if it gets to the point where you have to actually restrict your loved one’s access to the vehicle (and I sympathize with you if this happens), then you might find something of use in the above resource.

“How do you Alzheimer’s Proof a Car?”

The final piece that I’ll note, here, is a general article that I did on the question of how to “Alzheimer’s Proof” a car. Recall that Alzheimer’s Proofing is akin, in this context, to baby proofing or childproofing. For more on this, see HERE.

Disclaimer

Please note – this article should not be treated as providing legal or medical advice, but purely as a reference that provides general information in regards to the laws that require a physician contact a licensing bureau in regards to a patient’s ability to operate a vehicle. This post is given as-is; I do not warrant that the information is accurate or complete. But I provide the information in good faith and I believe, to the best of my knowledge, that it is reliable.

Notes:

[1] As noted in the main text, the article’s list of states includes Utah, while in other references, Utah is not mentioned as a mandatory state.

The post Mandatory-Physician-Reporting States & Drivers’ Licensing appeared first on Alzheimer's Proof.