John's Blog
Help Wanted Print E-mail
Written by Kelly McNeal  
Thursday, 18 January 2018



     Finding licensed nurses’ aides to work at the Fields is the most difficult it has ever been. When I saw the unemployment rate dropping two years ago and more geriatric facilities coming on line, I warned the administrators that we might be on the edge of an employment situation we have never seen.


     The reality is worse than I predicted. Every segment of the labor force, not just health care and geriatrics, is desperate for good workers.


     Caring for people with dementia is complicated work. The physical demands are significant and the psychological challenges of understanding people with dementia (and them understanding us) is a new specialty in health care.


     My most over-used phrase with the young staff at the Fields, “When I was your age,” is apropos again: when I was their age, people with dementia were in nursing homes, in gerichairs, restrained by tray tables in from of them and drinking from plastic sippy cups.


    Now they’re up roaming around day and night and leading rather uneventful lives with high quality, not withstanding having dementia. By high quality, I mean they eat restaurant cooking, enjoy cocktails if they and their families are so inclined and have interesting, varied activities “24/7.”


     If they don’t want to sleep, they can watch I Love Lucy and the Honeymooners in black and white on big screen TV and have PB&J or cheese and crackers and milk or an ice cream sandwich and doze off in nice recliners.


     The get all the same infirmities as their peers who don’t have dementia but at the Fields, they have wicked smart nurses around “24/7” to manage their health and minimize the most serious medical problems, to the greatest extent possible.


     We just work a lot harder to find staff that understand aging and appreciate the dignity of dementia.


    But, reverting to our motto: if the glass is half empty, call for a refill. We’ll train our own new staff, LNA’s from Dover High School and the Red Cross programs and nurses from the Great Bay College School of Nursing.


     Dementia is here to stay for the foreseeable future. Geriatrics is curse and blessing of Western medicine. Up to a point, it’s miraculous health care. After a point, it’s now palliative and Hospice care.


    We have this covered.


     Any questions?

Written by Kelly McNeal  
Thursday, 30 November 2017



     First off, there are two stages to all these types of dementia: your world and my world. Stay in your world as long as you can, then come to the Fields and spend the rest of your lives with us.


    Too simple?


     Well, I’m a simple fellow and dementia is very complicated, if you’re in the business of making things complicated.


     There are some great philosophical approaches to keeping things simple that cut across all cultures for thousands of years (Occam’s Razor). Nature likes simplicity (Fibonacci Sequence).


     My current guests with dementia have at least five subtypes and they present differently as well as simply being in different people. Who you are before dementia strikes has a lot to do with how your dementia will present and progress.


     Beyond Alzheimer’s, I’m seeing frontal lobe, vascular, Lewy Body and Primary Progressive Aphasia variants in my guests. What they can and can’t do intellectually, how they engage other people, what they’ve lost and what’s preserved are all consequences of the different diseases.


     Since none can be cured, coping becomes the operating principle and we spend a lot of time and money teaching and learning coping skills. There are popular new training programs but there’s no new news.


     We study the people, their mannerisms, their personalities…we learn about them, then how to cope with their diseases becomes apparent.


     We know they change, gradually or quickly and nobody gets better…simple enough?


     The hard part is coping 24/7, 365 for about fifty guests at each place. That’s complicated. Keeping staff morale up is complicated when they have kids and spouses and flu season and holidays and we want them to share their energy and lives with old people who only survive thanks to the dedication of staff.


     That’s complicated. And it’s rewarding, if you thrive on dignity and compassion.

Working with dementia demands special people with special personalities and building them into a team.


     Too complicated?


     Not for us!

Flu Shots Print E-mail
Written by Kelly McNeal  
Wednesday, 18 October 2017



     Bellamy and Watson offer free flu shots to all employees.


     This year, the shot is a four part, not the usual three parts, containing four strains of flu which have been around in recent years. The Centers for Disease Control have a spotty record when it comes to predicting which flu strain will be the winter whopper and where.


     At the Fields, our guests can handle the flu as they have for 85 or more winters but as they age, it’s the threat of flu turning to pneumonia that worries us the most.


     The flu is a good (or bad) way of finding out whose immune systems are worn out and whose are still robust. Our vulnerable guests will get seriously ill and our robust guests will get mild, annoying, uncomfortable but not disastrous cases.


     We live in such close proximity, eating in common dining rooms, exercising and doing activities and enjoying the living rooms for entertainment, that we are all exposed.


     Feel free to quote me: we all get the flu; we don’t all get sick.


     Now, say it again.


     We wash our hands, push fluids on our guests, relentlessly wash table tops and other surfaces, scrub a dub the bathrooms and no matter what we do, the flu will have its way with us.


     Children with runny noses are dangerous. They get an influenza for the first time and pass it around to their schoolmates and they all get sick, then get well and, along the way, acquire a little immunity to the particular strain.


     The catch is, if the kids get a new nasty flu that my guests haven’t been exposed to in fifty or more years, those little runny nosers are going to spread a new flu around the Fields that could be devastating.


     We’ll be posting polite reminders (warnings) not to visit if you have flu symptoms. Please take your own precautions for your health and for the rest of your family.


    My public health training and feelings about flu shots lead me to suggest that you get a flu shot for your own sake and in doing so, you contribute to the health of the community by decreasing the risk that you will pass on the flu unnecessarily to other people.

Sing the song, Dance the dance Print E-mail
Written by Kelly McNeal  
Tuesday, 19 September 2017

Sing the song, dance the dance

Back to the drawing board Print E-mail
Written by John Hopkins  
Thursday, 31 August 2017



     The recent international conference on Alzheimer’s disease provided a nice week in London for a few thousand attendees but as for break-through news and “ah ha” moments, they might as well have stayed home.


     It puzzled me years ago that the two widely used dementia medications had nothing in common and worked on essentially completely different hypotheses.


     What they did, simply, was make enough of a small difference to be statistically useful, but barely, and have no bad side effects.


     Even with the bar set so low for drug approval, the last ten years have gone by without a single useful medication coming to market.


     In addition to touting the benefits of “good nutrition, exercise and a generally healthy lifestyle” as though that was news to anyone other than Rip Van Winkle, the field took a long step backward this week. A well-designed, longitudinal study found no effect between people who got a lot of exercise and people who got very little in terms of a risk of dementia in old age.


     Exercise is good for everybody nineteen different ways. It just has no statistical bearing on whether or not people get dementia.


     So, back to the drawing board. My money is on an inflammatory process or more likely processes. Inflammatory changes clearly underlie arthritis and other bone, soft tissue and organ diseases.


     A shift in research targets or at least a parallel track to retry some old anti-inflammatory while new drug developers continue the chase for the holy grail would be worthwhile.

The grail, of course, is also a financial blockbuster whereas a new use for an old medication available as a generic isn’t going to make anybody rich.


     And that’s the point. Or is it?

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