Tag Archives: Memory Care


CNNMoney reports on a New England Journal of Medicine article that notes the cost of Alzheimers  and Dementia care is already more than the cost of heart disease and will continue to rise.


Read the article here Dementia Care costs top $100 billion
The headlines are clear.

A new study puts the cost of treating Alzheimer’s and other forms of dementia at $109 billion, making it more expensive to society than either cancer or heart disease.  Moreover, the current crisis will continue to grow rapidly as the baby boomers in America age.  What is less clear is the answer to that question of how to provide the care, in a humanistic and family oriented way, at a reasonable cost.  We want to suggest THE CURE TO THE INDIVIDUAL AND GLOBAL HEALTH CARE CRISIS.

TLCSR is the pilot study that answers the question! 

By focusing on continuity of care, people including care team, residents and family society benefits and the care provided is socially more complete.  That is how you get the best value for Senior Care dollars and fix the problem of the global and individual health care crises.  More good news is you dont have to wait for the goverment to help you find the Best, Most Cost Effective, Alzheimer’s and Dementia Care.  You can do it yourself right now!  Visit Tlcsr.com and tlcsr2.com to find out what to look for in all Senior Care Settings.

How can Continuity of Care and the TLCSR model of care be the cure for both the individual and global health care crises?


Our plan cures the issue not only of Dementia Care and Alzheimer’s care but helps fix the individual and global health care crisis.  We have seen a mis use of funds away from the direct care system to sub specialities many of whom say ” I only do this or that.”  That disjointed level of care leads to expensive and less comprehensive care.  A la Cart billing is good for the CEO, Stock holder and the companies bottom line but the servcie buffect, in-kind services, and mothers family style care is better for getting care when needed.  We are not blaming any one person since everyone has participated in getting where we are.  Doctor, Families, Individuals, insurance companies and the government.  What is needed is a better understanding of what care is.  How many of us have at one time or another under valued a caregiver, a mother, a domestic worker, who cares for us?  I have at times felt that as the “skilled” doctor I was smarter, better, than someone less educated.  By doing years of direct care for my own parents mother and  now father I see that caregiving is a skill!  Indeed, my wife and sister do it differently and in many ways better than I do.  Now after 10 years as a direct caregiver I am a much better caregiver.  My view is very unique in that few doctors are given the change to do direct care.

Care does include emotional and social care.

Feelings are the final expression of all Health care no mater what the label.  Indeed most studies specifically exclude feelings, emotional health, social and financial variables since they cant study them.  Even if we cant study them they are the most improtant factor in work, productivity, feeling good, family and social wellness.  Read our post on care vs caring or how are physical care and caring different as other reading. These are not the total answer but they start to provide guidance as to how we can value each other, family, mothers and caregivers more and in turn get more caring and value for our health care and life spending.

Tender Loving Care Senior Residence advertised Continuity of Care and complete care and not just urgent care or quick care.

Indeed, do you want a quick fix or heart felt care from someone who is INVESTED IN YOU FOR THE LONG RUN?

A hospitalist who cares for you for a week, then another doctor in rehab for a week, then …  In all cases you have to be your own doctor and coordinating the care.  While you know how you feel you probably do not really know which tests you would pay for if you were spending your own money.  The tests with the best value physically and emotionally to you.  You are not a doctor, you do not know how to quantify risk, benefit, or cost.

Did you know it is cheaper to buy many medications for cash, out of pocket than, to pay just the copay?  Yes, the co pay alone is more than paying cash!  Why you ask.  The systme makes more money. You have almost no way to know the details of what is needed, and the magnitide of the risks and benefits of your choices even if you are informed. That is why you need a doctor.  The probloem is the doctor directly or indirectly works for someone other than you. The relationsnip with you and the doctor is indirect and short lived.

Continuity of care can help all get more care, better care, for a better price or value.

That is especially true in Dementia Care where the care team is the best treatment for Dementia.

Find the most continuity of care and complete care, find the best individual members of your care team and you will get the best value for your Senior Care dollars.




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Dr Shawn McGivney

Dementia Care-Exercise, social interaction may trump meds for Dementia Care

I am glad that medicine is starting to study Dementia Care and emotional health and wellness as much as they are able

Many many not know that most studies SPECIFICALLY EXCLUDE FEELINGS, SOCIAL INTERACTIONS AND WHAT DOCTORS CALL TRANSFERENCE.  I understand why they do so.  They do so to allow them to focus on variables they can monitor, understand, and quantify.  The problem is that feelings and humanisms, social interactions are way to complicated and multi facited to study.  Love, Hope, Feelings productive, needed, wanted and belonging while essential to humanism and feeling good are very hard to define and quantify.  We all can agree that a picture is worth 1000 words and feelings are invaluable.  Symblols help us to see but social experience, education, enviroment, social values and many other things are needed for each person to produce that unique invividual feeling.

Read this article and then read my comments on the post.  Do you see how one might use this good research to modify how they look for Assisted Living and Senior Care?

Novel Exercise Program May Trump Meds for Dementia

Great article by Caroline Cassels  that confirms what common sense has told us for a long time.

People, all people, have feelings, emotional needs, and being more attentive to them can help all people including people with Dementia Feel better.

At one level that is scarey.

That the science doctors think is complete, their studies, actually fail to include the most powerfull variables to feeling good and getting better where better is feeling betterI often think of the power of family when I recall the old women who one minute is crying in pain from a broken arm, total body arthritis, and bone mets and then just seconds later, has no pain and is smiling when she is offered the change to hold her 3rd great grand child.  Many doctors, social managers, think of the dollar cost and these physical things which is the biggest short coming in my mind for health care today.

A much brighter use of this study is that to feel your best, get the best care, you need to interact with people

That includes staff and other residents.  That is a type of medicine or treatment.  Take a friend out for lunch and you pay.  That might be a better value than the co pay on a pill for depression.   People, friendships, the search for independence are never ending and ongoing up until we die.  Read this article and hear the physical claims but also read betweent the lines to see if you see some of the things I see.

They talk about combining eastern and western therapies. 

I saw straight social dynamics.  We had them sit in a circle.  Circle to me is very group oriented and social.  Indeed, we do an exercise program at Tender Loivng Care Senior Residence every day in a circle.  Less for the exercise and more for the emotional and social benefit.  What you call it really does not matter but the fact is people need people to feel good.  The physial place matters much less than the people.  A second example is our email program at tlcsr.  We do that more for the family to feel connected than the senior with mild dementia.  Some may say that is a semantic difference but we believe those social sensitivity differences make a big difference in how the entire social system feel and deals with aging now and then their own againg in the future.

Second, the author notes”the program focused on creating a “loving, nonjudgmental enviroment to promote postivie feelings and joy” and used music to enhance this effect.  I agree 100%.

What I was hearing is find the best caregivers and care team you can.  

Look for continuity of care to get the best care, and best value for any private senior care dollars.  Of course, we say repeatedly in this blog Continuity of Care  is the cure to the individual and global health care crisis and that includes Dementia Care, Alzheimer’s Care, and Memory care and ALL OTHER DISEASE LABELS YOU HAVE!

Quoting Patch adams again

“If you treat the disease you win or loose but if you treat the person you WIN NO MATTER WHAT THE OUTCOME.!”

Really look at the last part of that quote.  No matter what the outcome.  Seniors and all of us know we will die. Dying is not as scarey as being alone, abandonded, and shifted home, place, facility to facilty.  More accurately being shifted from one care team to the next!!  Being shifted away from the main care team, your family you have known for your entire life!  Look for a care team that can and will be able to stick with you, visit you, no matter where you go to get the best value and care possible as you age.  If you accept the sales pitch you did not look far enough.  Take the time to meet the entire care team from Doctor, Administrator, caregivers, med techs.  And ask if they interact with each other.  The more continuity of care in your broad based system the better you will feel and the more value you will get for THE SAME health care dollars.

dementia-careIn discussing these variations of interpretation though words and this blog I hope to raise awarness that all people, families, seniors and care teams need to value each other.  Realtionships, caring are a two way street.  Take the time to find the most continuity of care when ever anyone you love is forced by aging to need assistance and choose Dementia Care or any Senior Care Setting.  Not I did not say move. That focuses onthe physical place, instead use this post to focus on the care team and continuity of the people and care.

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Assisted Living and Senior Care Alternatives

By Shawn McGivney

Safe Harbor-Lesson in Assisted Living

Mom and Step mom were human.  The X- Wife, Susan Sarandon, was jealous of the younger, new wife, Julia Roberts, but in the end when her breast cancer was progressing, the mom, Susan Sarandon, wanted the best for everyone even her X husband, her kids and her rival the Step Mom, Julia Roberts.   That is the power of people, caring, and relationships.  That power is invaluable and hard to quantify in Dollars.  Look for that and you will get the best value for you Senior Care dollars.

Saw the movie Safe Harbor and wanted to share my Senior Moment

http://tlcsr.com/blog-Assisted Living-Happy-seniors

The Safe Harbor is another creative way to show that even when one is dead.  The Mother who guided the new wife to help her husband and kids still has value.  I see the similar values to families, society and seniors as they age.  Images of what was, is and can be continue to be powerful influences to families and society.  I know no simple dollar formula for love, hope, trust, feeling needed, wanted, productive and valued.  Likewise defining “safety” is hard for most seniors to swallow since the social worker, family, or individual defining “safety” for the senior often times is focused more on financial, legal, or physical safety than on emotional well-being, continuity of care and relationship building.

I see families faced with aging, loss as individuals who are aging and families who are losing large parts of who they are. In losing a senior, but in all cases they want to help each other.

Seniors know they are aging and they just want to be known, remembered, and to help if they can.

Feelings are the end point of all process.  Pain hurts less when you are holding your own new born or a grandchild.  The sum of all pains, pills, and Emotional and social therapies including continuity of care and relationship building is part of the treatment.  Complex and powerful therapies, and feelings like hope, trust, belief, faith, belonging, parenthood, creation, choice and empowered to choose, take time and social relationships to achieve.  Seniors and all of us know helping can mean getting others to provide the care so the Family can visit, email and carry on.  Pain and life have large emotional elements that doctors cannot study.  Indeed, few studies add in emotional health and wellbeing since you can’t “study” or quantify it and it varies so much person to person and day to day.  However, that does not mean we don’t value those things.  Indeed, those are the things we buy based on even if we do not know we are.
http://tlcsr.com/blog-Assisted-Living-Senor-safehousehttp://tlcsr.com/blog-Assisted Living-change

http://tlcsr.com/blog-Assisted Living-seniors
If you want to be “Safe”, have a “Safe Hospital Discharge”, “Safe transition to any Senior Care Setting” look for individuals, people, and care teams with

continuity of care.

Sub segmented systems based on business organizational flow sheets and financial payment models pale in comparison to Continuity of Care and Relationship building to make someone feel safe.  To feel safe you have to know and trust the individuals who provide the day to day care and who the problem solves or manager are.  They have to know your social system and visa a versa.  You have to respect what they do and value it also.   Then you can hope to feel safer in a process of transitioning to a senior care setting.

Aging and even dying are not bad they are expected.  What is bad is not having a care setting with caring and a relationship to allow physical care to be transcended to Family-style care we all want.

Two quotes from Patch Adams of the Movie, Patch, that show Caring is more than care.

  1.         Treat the most devastating problem of all indifference or apathy.
  2.        If you treat the disease you win or lose but if you treat the person you win no matter what the outcome.

http://tlcsr.com/blog-Assisted Living Grandkids
To me, even if you die, that is not as much of a loss if they had someone who was there, caring, respecting, all that that person has done and continues to do for the family.  That sets a social and family example of valuing people and not just disposing of them which helps each of us in the family, caregivers and all the people surrounding the senior.  I care for my dad and he helps me every day by giving me some space to work.  Yes, he comes in but he then let’s me finish work and that is helping.

http://tlcsr.com/blog-Assisted Living grandparents

Seniors who can find a safe haven or care setting with caring and continuity of care can help their social system and continue to enjoy family life.

Look for Continuity of care in any care setting Assisted Living, Home Care, Hospice Care, Residential Care, Dementia Care, and Alzheimer’s Care, Memory care, Respite Care, Elder Care, Nursing Home Care and any Senior Care setting.  Meet the entire care team and you can find caring with the physical care that all promise you.

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By Shawn McGivney

Family Values, Relationships, and Continuity of Care Affect Value In Senior Care

While assembly line style of care, productivity management, and six sigma standards of efficiency work for inanimate products they are not as good when dealing with a social service like Senior Care. We all need to become more aware of Social and Emotional costs and benefits in choosing a Senior Care setting before we make this expensive choice. Why not get more social and emotional benefit for the same dollar cost that is value.

Life, Social, and Emotional Values  VS Simple Dollar Value
When faced with the difficult and expensive task of finding a Senior Care Setting.

http://tlcsr.com/blog-Senior -Care-Family-Values

Choosing a Senior Care Setting for a loved one is a Life Changing event for the entire Multi Generational Family.

Facts about this Family Decision.

-Financially Expensive

-Socially Expensive.

-Emotionally Expensive.

-Physically Expensive.


While most people will see that the cost of $3-6K / mo or$36K – 72K / yr is Financially Expensive most will not initially see the Social and Emotional costs to the senior, the grand-kids of the senior and  the adult children who often helping make the choice of a senior care setting for the senior.

http://tlcsr.com/blog-Senior -Care-Assembly Line http://tlcsr.com/blog-Senior -Care-Controlling Staff

Do not be misled by a Title.  Assisted Living Facility often times is a room and meals with no assistance.  While they do offer assistance from the A La Cart Menu their basic services are more accurately Independent Living, a hotel room and a meal plan.  The services are often more like hotel services of laundry and room cleaning instead of Family Style, continuity of care, based personal care.

No matter what any one or a brochure says the services are, you do not know what they AND WHO IS DOING THEM, until you meet the entire care team including the Administrator and Owner.  Do not forget the Administrator and Owner do run the show even if you do not know them.

How the Family sees you, the Adult son or daughter of the senior, do matter in most social settings.  That leads to emotional feelings for all generations who will often want to do more.  All adult children who are faced with helping a senior make this decision will feel some amounts of  guilt that they can’t do more themselves  with any choices they make.  However, all can feel their best, if they follow one simple rule

Meet all of the Direct Care people INCLUDING THE ADMINISTRATOR AND OWNER.

Meeting the entire care team is the only way you can know what services you are getting.  The sales lady can’t describe who is providing the services you are getting.  The tour of the physical plant or building is such a small part of the SERVICES you need and are contracting for.  We believe that many over look the social and emotional costs in favor a quick walk through of the building on a tour.  Without meeting the people who will provide the care on a day to day basis you will not really know what you are getting.


Do not underestimate the value of meeting the administrator and owner.  The management directly affects what the caregiver and medication technicians do day in and day out.

The more hands-on the Administrator and Owner are,  the more likely they are  to value the feelings of the resident,  families and their own staff.   http://tlcsr.com/blog-Senior -Care-Staff-Thumbs-Up It is much harder for any human including managers and owners  to down size, under staff, do less if they make an agreement themselves in person.  When the sales lady promises service she will have no involvement or responsibility for it is likely her promises will mean much less than a promise from the Administrator and Owner who will work side by side with their staff day in and day out.  Indeed, most business people will tell you to maximize profits for the business the managers and owners should not know you or the staff.  Knowing the staff and families  makes it socially harder to under value them.  Of course, our goal is not to maximize profits for the institutions but to show Seniors and Families how to get the most caring they can for their private pay dollars.

 http://tlcsr.com/blog-Senior -Care-Handshakes-have-ValueHand Shakes Have Social Value- Look for Hand Shakes not Paper Contracts when Choosing Services.

In general, all people work better, are more involved, when they are socially and emotionally appreciated.  That is human nature.  Look for that when choosing a senior care setting and you will get the most care and caring for your private pay dollar.

Of course, their will always be some financial reality of who each owner and administrator chooses for their staff but our experience is that more hand-s on the management, the more personally involved the management is with their own staff and the seniors and families they care for that leads to the best value for the Senior and their private pay dollars.

When choosing Senior Care in all care settings Assisted Living, Home Care, Hospice Care, Dementia Care, Alzheimer’s Care, Memory Care, Hospice Care,Residential Care be sure to meet and shake hands with the entire care team including the top management.  If you don’t meet they you can’t access their degree of commitment and sincerity to care vs a more financial only, A la Cart, Model of Care.

Help us spread the word.  Click for Free Ways to help.

Click for The Best, Most Cost Effective, Assisted Living and Senior Care Alternatives.

By Shawn McGivney

8 Mistakes People make When Choosing and Assisted Living and Comments

8 Mistakes People Make When Choosing Assisted Living and our comments below.

By Shawn McGivney MD, RFA
This article from A Place For Mom  is a good general article.  We feel it could be more helpful if it provided a little more detail on how to do the 8 things.  Just saying “don’t over look future needs” or don’t judge a book by its cover, or choose a community to match your parents needs are just not detailed enough.

http://tlcsr.com/blog |life values   http://tlcsr.com/blog | care-home-ahead-sign    http://tlcsr.com/blog | assistance

This discussion of care applies to all care settings Assisted Living, Home Care, Hospice Care, Dementia Care, Alzheimer’s Care, Memory Care, Residential Care.  Care is a service and you need to understand you are buying the skills of knowledge but also compassion, dedication, caring, which might be even more important skills than hard medical or nursing skills.  Indeed, the social skills are often the therapy for aging, dysphoria, depression, cognitive loss, and promoting people to feel good as they see they need increased levels of care.

8 Mistakes People Make When Choosing Assisted Living


We want to share our comments to that with you.

Our comments

Great article. I think the details are given better at http://tlcsr.com/blog.

You need to meet the management, administrator, and care givers. This article seems to
come up short of saying that but that is the only way you can see into the middle
chapters of this article.

Second, Continuity of Care is not mentioned. Shift work, A
La Cart billing tend to promote lack of continuity of care and relationships.


Assembly line hallway Efficient Assembly for physical care
Third, we agree with don’t go it alone, don’t judge only by proximity, don’t find a place
with an isolated private room because you as a younger, non sick,  persons would choose
that, choose for your parents who need assistance and will need even more assistance
and remember it is the staff who provide the caring and care now and in the future.
Meet the entire care giving team including the management! We find superficial discussions like this are too general to be really be helpfull and can be misleading if you don’t get these details.  When faced with a social and financial decision of this magnitude take the time to meet everyone involved in the care starting at the top. The management does impact  the care the staff provide. Socially, you can be respected for finding the most cost
effective and best care and set the example for your entire social system. You can
save money when compared to the usual course of a bait and switch type A La Cart
system where they get you in for the room and meals AND NO, OR MINIMAL CARE OR ASSISTANCE, and
then rasise the price to 4, 5, 6K when, not if, you need care.  24K / yr at 2K a month
or 48-72 K a year at prices with minimal assistance are worth spending the time to
meet the entire care team. Do not think you can or will get the same level or amount
of caring you most likely expect unless you meet the entire care team.

The management may define care as included in the contract DIFFERENTLY than you do.  For example, how many have found out after they bought the insurance that the “support” they purchased had indeed be re sold many times and now was bundled into who knows what, giving you some phone care from another country?
Hands on management _ Do not accept management on paper, long distance calls to the corporate office as the main level of management.  This is a service and you need to meet, shake hands, and know the direct care managers.  If the Aide is the only person you meet and know like in home care then she is the de facto manager, owner, and aide but know that is who and what you are getting.  You are most likely still the manager and highest level skill person on your team.  You did not add any skilled people, advice, or a back up care team you added an aide and often times at a high dollar cost.  Home care is a great option but be sure to consider who the day to day manager is since that is part of your care team.
To get these smiles you need to know the entire care giving team.
People, Pets and Flowers Can provide Smiles and Caring to go with your Physical Care.


This is a service industry and you need to meet the entire
care giving team from top to bottom to really start to compare what you are getting
for your 24 – 72K a year.

Take the time to learn all you can you will be socially viewed in the best light and
your parents will get the best care and best value for their health care dollars.



By Shawn McGivney