Our mission is to care for people living with Dementia in our home-like facilities, specifically designed to ensure that the desired outcome is ‘living well with Dementia’. We maintain or enhance quality of life and optimal general well-being with passionate management, multi professional team services, compassion and respect.
Certificate nr.2 – In the Instance that the Facility accommodate a Person living with any form of Dementia, a Certificate from the Department of Community Mental Health indicating:
The Certificate Number
The Name of the Facility, address of Facility
How many people may be accommodated.
B)Ask for the Registered Nurse ?
If any Frail Residents or Persons living with Dementia are accommodated in the Facility, the Facility must be Registered as a Category C (Frail Care) Facility. In such instance the Facility must employ a Registered Nurse/s to be in charge of the Clinical Management of the Facility. In most Facilities of small medium size accommodating from 15 to 25 Persons, it will mean that a minimum of two Registered Nurses will have to be employed for shift working.
C) Walk around and observe the Facility’s Layout, Sizes of Rooms, Dining Areas, Living Areas, Kitchen, Laundry, etc.
Below is a very short summary of “Part 2. NATIONAL NORMS AND STANDARDS REGARDING THE ACCEPTABLE LEVELS OF SERVICES TO OLDER PERSONS AND SERVICE STANDARDS FOR RESIDENTIAL FACILITIES”.
Single Room size of minimum 9 square meters.
Double Room size of minimum 16 square meters.
Ward Type Rooms – Maximum Persons of 4. Each Bed/Person with a 7,5 square meters space. Un-obscured 1,5 meters between beds.
Hand Basin in each room with Hot and Cold Running Water.
Nurse call system in the Rooms
Toilets and Bathrooms
Minimum Requirements is 1 Toilet and 1 Bathroom for every 8 Persons. 1 Toilet must have at least a Floor area of 2,9m, 1,6m wide and door bigger than 800mm.
Separate staff and public toilets with hand basins for Male and Female.
Emergency Nurse Call system in the Bathrooms, non-slip, grab rails.
Passages, steps, staircases and ramps
Outside passages must be protected for elements.
Corridors of at least 1,8m wide with grab rails on one side.
Non slip, steps not higher than 130mm or narrower than 355mm
Minimum of 7,5 square meters and many other requirements.
Minimum size of 16 square meters for 32 Residents alternatively measure 0,5 square meter per Resident. Example a home with a License for 18 Persons must have a kitchen with at least a 9 square meter floor area.
YES, there must be a Dining Room with at least 1,5 square meter per person of space. So again a Facility with 18 persons, must have a Dining Room of at least 27 square meters.
Living Room/ Recreation Room
A Separate Living room of also 1,5 square meters per person or then 27 square meters for 18 persons.
This room must be designed such that it can be used for Occupational Therapy.
Rest of Buildings/Facility
Nursing Office/ Nurse Station
Staff Rest, etc.
The “National Norms and Standards Regarding the Acceptable Levels of Services to Older People and Service Standards for Residential Facilities” handle with many more aspects, below is not a complete list, such as:
Admission Procedure and Policies
Residential Care Regulations
Provision of Food, Meals etc
Management services such as Residents Committees
Financial and Asset Management
Human Resources for instance the Formula of Minimum Number of Nursing, Care and Support Staff
Rights of Older People
Individual Care Plan for every Person
Health and Safety
Is your loved one living in an overcrowded, unlawful Care Home? If so, you have the right to speak up.
The abuse of elderly people happens in their own homes, while living with family and in facilities responsible for their well being. We must speak up when we suspect that an elderly person is being financially exploited, neglected or harmed by their caregiver.
Our constitution protects the rights of all, especially the vulnerable, and this includes the elderly. In South Africa, 8% of the population is older than 60 years.
All of us deserve to be respected, to feel dignified and safe where we live. Find out how to spot the warning signs, know the risk factors and how you can prevent and report instances of abuse.
What is elder abuse?
Elder abuse is the neglect or mistreatment of an older person, who can’t or doesn’t have the means to fend for themselves. This kind of mistreatment can take place in a private home or home for older persons.
There are various forms of abuse and mistreatment, ranging from:
emotional abuse, and
Intentionally or unintentionally neglecting to care for an elderly person is also abuse.
The practise of taking and with-holding a pensioners South African Social Security Agency (SASSA) card without their consent is illegal. Loan sharks are known to take the cards and give pensioners loans with very high interest rates that are impossible to repay. There are companies that prey on the elderly by illegally deducting money from their pension. You can report any suspected fraudulent activities regarding pensions or grants on SASSA’s toll-free number 0800 60 10 11.
What are the signs of elder abuse?
Signs of abuse vary from physical, such as bruises, scratches, cuts, malnutrition, lack of medical care, and behavioural such as withdrawal, fear and anxiety.
An important indication of abuse is based on what an older person says. Claims of abuse or mistreatment should be investigated.
A common form of elder abuse encountered by caregivers of older persons is self-neglect. When the person experiences physical or mental impairment or a diminished capacity, they may no longer be able to care for themselves. Signs to look out for are:
a lack of personal hygiene or cleanliness,
living in dirty conditions, and
unable to pay bills or manage medications.
Self-neglect may be a sign of depression, Alzheimer’s, dementia, grief or any other health issue. They may refuse to seek help due to denial, worried about losing their independence and feeling ashamed for needing outside help.
6 ways that you can make a difference in the lives of older people.
1. Visit or call your elderly loved ones and invite them to family gatherings and other special occasions.
2. Older people have valuable skills and knowledge. Find out what talents and skills your older family members, friends and community members have that they can share with you, your family and the community. Examples of skills are knitting, baking, cooking, gardening, sewing, etc.
3. If you know of an elderly person who has a family member or a professional person serving as a caregiver, support this person by helping out sometimes and making sure they get a break.
4. Contact your non-governmental organisations that support the elderly and offer your support in the form of donations, fundraising or volunteering.
5. Volunteer your time and service to old aged homes or to a housebound elderly person.
6. Talk about elder abuse to your friends and family to create awareness so that we can bust the myths and stigmas about this kind of exploitation of the vulnerable.
What can I do to stop elder abuse?
The Department of Social Development works closely with NGOs to prevent elder abuse. If you suspect elder abuse, you can contact your nearest Social Development office.
There are non-governmental organisations that deals with the abuse of the elderly and whose mandate includes awareness campaigns and initiatives. You can contact:
I want you never to come to the point of placing your Loved One in the care of a Dementia Care Home!
I never want you to come and visit our Home.
I never want you to walk through our gardens, do not look at the peacocks, the chickens, the little ducks around your feet.
I do not want you to walk down the passage with me, peaking into people’s rooms. Do not look at their personal belongings, the familiar painting, the comfortable chair with the worn seat, the smiling photos of another life.
I do not want you here…..
But you will get here…
And the question is.
When is the right time to leave your Loved One in the care of a Home?
Almost five years later, and all I know is…
sooner is better than later.
There comes this time when you feel like your own life is falling apart. Your life is not what you expect it to be a couple of years ago! The retirement dreams are faded.
You are looking after someone who was supposed to be there for you. Someone who is taking away your quality of everyday life, complicating even the simplest task as going to the shopping Mall.
Someone who is following in every foot step you take, not even allowing you to go to the bathroom, standing infront of a closed door, moaning, not being able to understand the closed door between you two. not being able to know, how to open a closed door. How did all this get to this day?
The day when you open the bathroom door, and bumping into this familiar stranger….you know!!
It is time!
Or the day when you pack your bags to visit your children and grandchildren….
When you hug those little people against your soft grandma body, and you see the fear in their eyes for this old man next to you. The man with the helpless eyes looking at his own daughter, not remembering.
And when he sits down next to you on the couch, not leaving your side for a minute among these “strange people”. No expression, no feelings for what once was a part of him.
And the night comes, and you take him to a strange room, strange smells, strange noises….and he gets upset for being there. a place he does not know, and he does not belong.
He wants to go home! Wherever that may be!
And frightened and upset you bundle him into your car…to take him home.
Half way home he is even more scared, and he tries to get out of the car. He doesn’t understand. He doesnt know you. He pulls on the door handle, and he scares you! It is chaos in the car! Sobbing you take the long road home.
Is this you?
But when is it the right time to place your Loved One in a Home?
Because today, he is almost lucid. I can almost see the man I love, the man I’ve been married to for 40 odd years! The father of our children. The provider for our family. The man who made me laugh…
Is this you?
So when is the right time?
SOONER THAN LATER…..is the right time.
But why sooner? I can still suffer through the bad days, awaiting the good odd day.
Sooner, because, you can still survive. You and your family.
And you can still have good memories of him and with him, and you can treaure that.
You give us the time to still get to know glimpes of the person inside the person living with Dementia. We can get to know him, with all his complications, but also with what is left of the person before Dementia. We can create new emotions in him of feeling loved and cared for, of being safe, of belonging somewhere.
And he can still get to know the environment of where he is, where his favorte chair is, the spot in the sun, the dog coming to steal something from an offering hand. He can still settle and feel that he belong somewhere. The uncomplicated, safe routine of a Home, can give him the security he needs. the smells from the kitchen and good food, can make him feel loved. The famliar faces of staff, the smiles of another resident….he can still find a safety in all of that.
Sooner is better for him with Dementia, because he is living his own new life now! A life where you are only the visitor…
And the joy comes…
when you see him smiling
or dancing or keeping the rythm with his foot
or taking a long walk on the farm
or whistling while he walks down the passage to his room.
New research from Johns Hopkins University has identified a variety of biomarkers that can be used to predict the onset of Alzheimer’s disease years before symptoms appear. The study presents nine measures, produced from several decades of data, that can signal the onset of the disease up to 30 years before cognitive decline becomes apparent.
Many researchers believe the preclinical phase of Alzheimer’s can commence over a decade before the disease becomes clinically visible. As a vast number of prospective Alzheimer’s drugs have failed in clinical trials, it is hypothesized that the disease may be best treated in this preclinical stage, before any neurodegeneration progresses to the point of major cognitive decline.
Unfortunately, we do not have any clear diagnostic framework to identify the disease at its earliest stage. Blood tests, PET scans, eye tests, genetics, and even sniff tests, are all being investigated as ways to identify the earliest stages of cognitive decline, but no single biomarker has been wholly confirmed as clinically reliable so far.
This new Johns Hopkins Study reviewed medical data from 290 subjects considered to be at a higher than average risk of developing Alzheimer’s or early-onset dementia due to the presence of a relative diagnosed with the disease. The subjects were tracked for almost 20 years, completing annual cognitive tests alongside bi-annual MRI brain scans and cerebrospinal fluid testing.
At the end of the project, 81 subjects had been diagnosed with either Alzheimer’s disease or mild cognitive impairment (MCI), allowing the researchers to be able to effectively track the preclinical progress of those conditions across the pre-symptomatic years.
Looking at the cognitive tests, the researchers identified subtle changes that could be detected between 10 and 15 years before symptoms appeared. The MRI data revealed minor, but detectable, decreases in the size of a brain region called the medial temporal lobe. These changes could be tracked between three and nine years before any symptoms appeared.
Most interesting were the cerebrospinal fluid test results which signaled the earliest potential biomarkers for the disease. Increases in the presence of the tau protein in cerebrospinal fluid could be associated with Alzheimer’s around 30 years before any cognitive impairment became apparent. Other proteins, including amyloid beta and phosphorylated tau, appeared between 10 and 15 years before symptom onset.
“Several biochemical and anatomic measures can be seen changing up to a decade or more before the onset of clinical symptoms,” says Michael Miller, a biomedical engineer working on the project. “The goal is to find the right combination of markers that indicate increased risk for cognitive impairment, and to use that tool to guide eventual interventions to help stave it off.”
Sample size is of course a significant limitation in turning this data into an effective diagnostic tool, and while the researchers do suggest the scale of the study is large enough to determine statistical significance, further work is underway to add more data to the model. The study notes an agreement is in place with five different research sites around the world to collect comparable data so the overall model can be improved.
The big challenge here is that this kind of research takes a lot of time. In order to identify patterns that signal the onset of Alzheimer’s or MCI, subjects need to be tracked for years, or even decades. Despite this slow progress, the researchers are positive this work will ultimately lead to effective ways to detect Alzheimer’s in its earliest stages.
“Our study suggests it may be possible to use brain imaging and spinal fluid analysis to assess risk of Alzheimer’s disease at least 10 years or more before the most common symptoms, such as mild cognitive impairment, occur,” says Laurent Younes, an author on the newly published study.
“Mom, just remember you going to have a lot of residents one day. You only have 4 now. You will not be able to love them like you love these!” My son said.
It is 4 years later….and I do!
I’ve counted, and 40 people came into my life at Jura. And with them, their families, I found a place for each one of them in my heart.
But it is hard. It is hard to understand the life living with the sickness. It is hard to make sense of it all! You would think by now I would be fine with all of this! But I am not! I do not want to understand this disease robbing people of a life with their families. I do not want to understand this disease robbing someone of their own being. I do not…
It is hard to see them slipping through your fingers, every day a little bit more. Physically their bodies are changing the way their brains are changing. They become thin. They eat as much as you and I together, but they become thin. You get anxious as you feed them. Almost trying to force feed them just to keep them from slipping away. Maybe if they eat even more, they will still be a little bit more who they were.
But it is hard to see them slipping away, becoming more distant. Getting that faraway look in their eyes, as if the pupils in their eyes become so small, so black, just a little black hole they are slipping into. But just when you think you have lost ….a smile break through, and almost reach the tiny black pin holes, and all you know is, they are still there!
It is hard to take them into my Home. To take them and to hold them and to try and make a difference. Sometimes the difference is so small, only for me to see. Sometimes there is no difference. It is what it is. Sometimes there is a bit of a difference and it is for all to see, and you are so happy. You did it! You achieved something. And for a moment you actually allow yourself to think you are good. Only… for you to loose that again. To see it slipping away! To see it being a no improvement again! The shimmer of hope, that shimmer of something in the black small pin holes are gone again. But you cling to the memory. Your memory, of achievement even if it was just for a moment. Because you need it. You need to know you are doing this to make a difference. Even if it is slight.
It is hard to look family and loved ones in the eye. It is hard to try and gain their trust to care. It is hard to allow yourself to feel their pain of abandonment. It is hard to feel their pain of letting go. It is hard to try and help them through their guilt.
One day someone asked me a question, while frantically busy leaving her Mother in my care. The Mother was fighting and screaming and swearing and refusing to go into the building. She was 87 and was walking up and down, up and down the farm road. Fuming. ” I am not staying here! I want to go home! TAKE ME HOME! ” It was still my first couple of months with only my academicals studies behind me, and a bit of practical caring for a few. So the daughter with wide eyes asked: ” So what is the Procedure now?”
There is NO PROCEDURE.
Because it is hard.
It is hard to let that person on their first day into my Home. I did visit them before. I did visit the family before. And I did have numerous communication to try and learn a little bit of this person.
But it is hard to take that persons’ hand. A stranger. And to her …I am that stranger. And to her, this doesn’t even make sense. She does not even know exactly where she is, she does not understand why. She hardly knows the person leaving her here. All she knows, I think, is a familiar feeling with the person ( her daughter) who was with her in the car a short while ago.
My heart is pumping in my chest, because I know the first couple of hours is so important. I have to make sure this person will experience love and safety as soon as possible. But it is hard with someone without trust. Someone I can’t reason with. Someone with minimal communication skills, let alone vocabulary. Someone with very little inhibitions. Someone who will not mind kicking or slapping me or swearing at me.
It is hard to break through the mantle of distrust, to find a soft spot for your hand to slip into. To become the Safety Net. The one to Trust. The one to feel comfortable with. The one who will be recognised by her smile….and the one she will allow into her disrupted life.
There is no procedure.
It is hard.
To care every day is hard. To have to see the destruction of the person, is so hard.
It is hard to see and to hear….
The repetition of sounds. The only way of communication?
The repetition of a movement. A way to let go of frustration? A way to keep a busy brain busy? Or just the only message the brain is still capable of sending?
Laughing out loud for anything and everything. A way to let out emotions? Or is it the beautiful sense of humour that has always been there, that is just overflowing into laughter?
The packing and unpacking. Is it not wanting to move, but to keep this emptiness inside, too busy from realising the emptiness?
The wandering. Is it to ease the physical pain? And if there is no pain, is it to ease the pain inside of you?
It is hard for me to see…
And then it is hard to take on this responsibility. Sometimes you want me to make them better. Sometimes you want me to keep them from never slipping and falling, or to keep them from getting sick. Sometimes you want me to change them back to who they were. Sometimes you want me to give them the home they were asking for all the time. Sometime you want me to tell you what is the use? And sometimes you want me to tell you…how long still?
In OSA, the soft tissue walls of the throat relax and impede airflow, reducing the amount of oxygen in the blood.
The authors argue that this oxygen reduction may be linked with the thinning of the brain’s “bilateral temporal regions,” as well as an associated type of memory decline.
“Our results suggest,” explains senior study author Sharon L. Naismith, a professor in the School of Psychology at the University of Sydney in Australia, “that we should be screening for OSA in older people.”
Dementia and OSA
Dementia is a syndrome, or group of symptoms, in which there is a progressive decline in ability to think, remember, have conversations, do everyday things, and live independently.
An estimated 50 million people worldwide have dementia, and the annual rate of new cases is just short of 10 million. About 60–70 percent of dementia cases are caused by Alzheimer’s, which is a relentless brain-wasting disease wherein toxic proteins build up in the brain.
The new study adds to evidence of a link between OSA and dementia. In 2017, for instance, we reported on a study that linked OSA to raised levels of amyloid beta, which is involved in the buildup of toxic protein in the brain in Alzheimer’s disease.
Like dementia, the chances of developing OSA rise with age. In the U.S., it is believed that OSA affects around 18 million adults.
OSA has also been tied to high blood pressure, stroke, heart disease, and even cancer. There is also evidence — from studies that have followed people over time — that OSA is linked to “increased risk of cognitive decline and dementia in the elderly,” note the researchers.
OSA and changes to brain structures
Against this background, Prof. Naismith and colleagues decided to investigate whether OSA might be associated with changes in certain brain structures in older adults “considered ‘at risk’ for dementia.”
The study involved 83 people, aged 51–88, who had been to see their doctors about memory and mood problems. None had been diagnosed with OSA.
They all underwent tests of memory ability and to screen for depression symptoms. They also had MRI brain scans and an assessment of OSA that involved being connected to a “polysomnograph” machine overnight.
From the MRI scans, the researchers were able to measure different parts of the brain, while from the polysomnograph results, they could spot changes in brain activity, blood oxygen, breathing, and heart rate.
An analysis of the results demonstrated that low blood oxygen levels during sleep were tied to reduced thickness of the brain’s right and left temporal lobes. These brain structures are vital for memory and are known to change in dementia.
The analysis also showed that these changes were “associated with reduced verbal encoding,” a type of memory skill that retains new information. The team believes that this is the first study to find such a direct link.
In contrast to evidence of brain shrinkage, the results also showed that OSA was associated with a higher likelihood of increased thickness in three other brain regions — the right postcentral gyrus, the pericalcarine, and the pars opercularis — and “increased volume of the hippocampus and amygdala.”
The researchers suggest that these changes might be due to inflammation and swelling caused by low blood oxygen.
‘Modifiable risk factors’
Prof. Naismith explains that 30–50 percent of dementia risk “is due to modifiable factors, such as depression, high blood pressure, obesity, and smoking.”
OSA can be treated with continuous positive airway pressure (CPAP). This continuously blows air through a mask that is worn over the nose, mouth, or both during sleep to ensure that a person’s airways stay open.
The team is already investigating whether or not CPAP can put off cognitive decline and improve brain connections in people with mild cognitive impairment (MCI). MCI sometimes precedes, but does not necessarily lead to, dementia.
“There is no cure for dementia so early intervention is key. On the other hand, we do have an effective treatment for OSA.”