Those caring for a person afflicted with cognitive deficits (Alzheimers, dementia, strokes, brain injuries) usually get to a point where they wonder what do I do when I cannot be the caregiver any longer?  They start looking into options of getting more help with the care at home or placement into a care facility.  Once a decision to get your resident placed has been made, how do you decide where to place them?  They need to be assessed by a competent individual who can guide the placement. This placement decision is critical in helping figure out how this person is going to live out the final leg of their life journey. When assessments are made, the individual can be at different stages in the deficit or disease process.  It is up to the assessing person to figure out, based on their experience and available information, when and where this person should be placed.  Consideration must be given to: -Type of cognitive deficit and functional level-Medical condition and the type of care required-Physical capacity and functional level including mobility-Nurturing, reassurance, and encouragement needed Most seniors with a cognitive deficit being considered for placement will do best in an Assisted Living setting versus a Skilled Nursing Facility (SNF).  Placement into a SNF should be limited to those individuals that have a challenging medical condition and need a great deal of nursing care. The rest of the candidates being considered are going to need to be placed based on their medical condition, amount of assistance and care that is required, financial resources available and how well they may adapt to the setting.   Most facilities fit into one of these 3 categories.  Keep in mind that once you select a category another breakdown could be done on the facilities within that category to choose the best fit for the senior.  3 Types of Placements: 1)      SNF/Rehab - high degree of medical assistance, poor on nurturing and managing behaviors or non-medical challenges which accompany cognitive deficits due to unavailable staff and care model objectives, (they are not setup for the added non-medical care needed). 2)      Large ALF It can be a good fit if the resident can function at a high level, is able to do many things by themselves, with some reminders, and can appreciate the amenities that many of these facilities offer. When the residents needs increase and they cannot be met any longer, then one of the other settings could prove better.3)      Small ALF (residential) resident would benefit from more oversight, more nurturing, some extra help managing their day-to-day functions, smaller group of residents helps eliminate anxiety, financially more affordable than #1 or #2, customized approach to caring based on the setting and the other residents, Staff is more stable and consistent and helps resident adapt. They often have a higher care-to-resident ratio.  It may not have fancy amenities. Residents tend to stay in these settings through end of life. Editors Note: This article was submitted by Russ Udelhofen,  Administrator of Jaxpointe Assisted Living Memory Care Homes. He may be reached at 303-420-5590 or by email at Info@jaxpointe.com

When working properly, our brains have a social filter. This is a thinking skill that most people have developed over time and can control without even realizing it. We all have unkind thoughts from time to time, but we do not always say out loud what we are thinking. Our social filter helps us use words and actions that show kindness and consideration to others.An example of this is when we get a handmade sweater from our Grandma. The unkind thought might pop into our mind Wow, this is sure ugly!, but we don't want to hurt her feelings, so we instead say: Thanks for the sweater, Grandma, that must have been a lot of work! - our Social Filter at work.Social Filter on - brain is considering other people's feelings; Social Filter off - brain is only thinking about one's self.The front part of the brain is responsible for these Social Filters and when Dementia hits this part of the brain, it can destroy the learned responses that filters provided and unkind words or actions can come out. This can be an insult here, a racist remark, an obscene gesture, foul language, sexually inappropriate behavior or comments, really any of a number of things that might be construed as mean or insulting. Also as quick as this behavior appears, it can be replaced by properly functioning social filters causing an observer to wonder what is going on.As professional caregivers of people with dementia, we have developed techniques to help with this inconsistent behavior of the brain. We try to learn as much about the person who has the dementia and exhibits these behaviors so we can help them remember what they forgot, their filter. We remind the offender that we don't act or speak that way to this person because they are our friend or that you just hurt them - helping them relearn their filter.Now with dementia they don't always remember what just happened, but when this reminding happens with the right technique, some elements of learning do take place. Other times we learn that the filters are lost when the individual with dementia is in pain and they don't know how to ask for help or say they are in pain. They do remember how to call attention to themselves by losing their filters and it is up to their caregivers to discover there might be a medical problem underlying this behavior or change such as an infection or dehydration or any number of things.Editor's Note: This article was submitted by Russ Udelhofen, Administrator of Jaxpointe Assisted Living Memory Care Homes. He may be reached at 303-420-5590 or email at info@jaxpointe.com.