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Friday, March 6, 2015

Seniors and Oral Health

At a young age, we're taught that brushing and flossing our teeth everyday is very important. We also learn that visiting the dentist regularly keeps our smiles bright and healthy. However, as we age, these simple oral care habits can become very difficult.

teeth; toothbrush; happy and; healthy; dentist; floss; toothbrush
In seniors over the age of 65, the development of arthritis is common and a significant hindrance for brushing and flossing regularly. For a person with arthritis, these simple daily habits can be very painful, if not impossible at times. Even still, seniors with memory related diseases often completely forget about their dental care all together which can lead to a number of health conditions.

As we grow older, keeping ourselves healthy becomes increasingly important, and as our oral health is closely tied to our whole body health; keeping up on our daily oral hygiene practices needs to be a priority. Aging with poor dental care can have a much larger impact on your overall health than you might expect. Bad dental health can you put you at an increased risk for
diabetes and heart disease.

According to nearly a quarter of all seniors over the age of 65 have severe gum disease which is often caused by chronic dry mouth. Chronic dry mouth, which can be caused by medications and normal aging, directly contributes to gum diseases and significant tooth decay.

While many people know that regular dental exams are important, few understand that as we age how staying on top of our oral health is paramount to maintaining our overall health. So don't forget to brush and floss your teeth everyday, and make sure to visit your dentist regularly.

Monday, February 23, 2015

Extravagant Romance In Senior Living

I'm a superficial romantic. I love flowers, nice dinners and all sorts of other things that you see or read about in those great love stories. But I never forget that behind all those enchanting tales real life is just around the corner. Yes, who doesn't like to get swept off their feet, wined, dined and romanced?  But in the end, do all those things stand as abiding examples of real romance? To that I offer a very resolute no.

Real People in Real Love

There are a few reasons I think real romance is comprised of much sturdier material than rose petals and caviar, but since this is a blog  about senior living, you are right if you guessed that it might have something to do with my vocation.
Over the last 15 years I have had the honor of witnessing some remarkable people who have shown that, even after decades of marriage, extravagant love can still thrive, despite the obstacles of physical, mental and even emotional challenges. They don't include tear-jerking professions of unrequited love or dinners with diamond necklaces as dessert, but they are every bit, if not more, moving than the best romantic cinema you've seen. And because they’ve have had such an impact upon my life, I’d like to introduce you to a few of these love stories.

Heartthrob in Denim Overalls

Pearl was one of the residents in the skilled nursing where I worked over a decade ago. She was in the final stages of the dementia, nonverbal and, for the most part, non-responsive to most outside stimuli. She sat at the "feeder" table because we had to make sure she was fed every day, every meal.I knew virtually nothing about her due to her current state, but we all got to know her husband, because he came to feed her lunch- Every. Single. Day.
She never spoke to him, sometimes pursed her lips so he couldn't get the spoonful of pureed food into her mouth and even took a swipe at him a few times.
Yet day after day he came. He stroked her hair and called her by name. Each day, like clockwork, he'd arrive in his old denim overalls and repeat the ritual of feeding his beloved wife. We all got to know him and, once, he even brought in one of their wedding photos. It was remarkable to see the same woman we cared for each day as she had been in her prime; vibrant, bright and so alive.
I realized then that the woman in that photo was the one he was coming to see; the contracted, silent woman we all cared for wasn't the wife he saw, for he knew her essence and her soul, and that's why he kept coming back even after the outer shell had long deteriorated. 

Timing is Everything

Mr. and Mrs. James had resisted moving into the community where I worked for quite a long time despite the fact that they really needed the additional help. Finally they made the decision and, with the help of their adult children, in a whirlwind, they were in the community. Within a few short months he passed away. You see, he knew he was dying and one of the final things he wanted to do was make sure they moved to a community where his wife would be well cared for after he left her. 

Holding Hands and Hearts

 Bill and Lucille, after getting married within days of the Pearl Harbor bombing and decades of marriage, lived out their final days in a skilled nursing facility. Despite near blindness in one and dementia in the other, one of the most beloved sights to all of the staff was the two of them sitting side-by-side in their wheelchairs, holding one-another's hands and saying they loved each other. The image of Lucille's hand being gently held in Bill's will forever be imprinted in my memory. 

Seven Decades of Love

Finally, there was the gentleman, who after 70 years of marriage (no I didn't make an error, it really was 70 years) had lost his wife. I hadn't known her when she was well, but all accounts given reported that even after nearly three quarters of a century they were still like newlyweds. He was talking to me one day and out of the blue he said “Do you tell your husband you love him every day?" I was stopped dead in my tracks and wasn't quite sure how to respond, mostly because I know I don't do that every day without fail.
Most days, yes, but every day? I wasn't so sure I did. He replied “Well, you should because you never know when you won't have him." I left that conversation and went into my office and cried. I wept for the loss that he was feeling from his wife's death, but mostly at the profound truth he communicated to me. It wasn't about flowers or chocolates or having a date night once a week. It was simple; tell my husband I love him every day. And mean it. 

Weathering the Storm

So, don't get me wrong, I won't turn away flowers and other sweet trappings, but the real romance I'm moved by isn't found in a sappy movie.  Instead it finds breath in the lives of people who have persevered, held on to a faith bigger than one another's shortcomings and, above all, held fast to their commitment through every wave and storm.
That, my friends, is real romance.
Leslie Quintanar — Executive Director at The Meridian at Lake San Marcos 

Thursday, January 29, 2015

Heat Stress

As outside temperatures rise, the elderly are more prone to heat stress. Heat stress occurs when the body can't adequately cool itself or maintain a healthy internal body temperature. Normally, we cool ourselves through sweating, but sometimes this just isn't enough and the body's temperature keeps rising. Heat-related illness can range from mild conditions such as rash and cramps to more serious and potentially life threatening conditions like heat stroke. Heat stroke occurs when the body becomes unable to control its temperature, and the body temperature rises to 106F or higher. Heat stroke can happen in as little as 10 minutes and can cause death or permanent disability if emergency treatment is not immediately provided.

Be alert for the following warning signs of overheating or heat stroke:

  • Very high body temperature
  • Dry swollen tongue
  • Nausea
  • Rapid Pulse
  • Red, hot and dry skin
  • Throbbing headache
  • Confusion or strange behavior
How to protect yourself and your loved one:

  • Drink cool, nonalcoholic beverages
  • Rest
  • Take a cool shower or bath
  • Wear lightweight clothing
  • Do not engage in strenuous activities
  • Limit tea and coffee
  • If possible, seek an air-conditioned environment
The elderly require extra vigilance. Not only does the aging body have a harder time regulation its internal temperature, but the elderly often have a decreased thirst awareness. Taking certain medications can reduce the skins ability to sweat and may increases health issues like blood circulation problems which can put an elderly person at higher risk for overheating. If you have an elderly friend or relative who is currently living alone, check on them twice a day. Look for signs of dehydration and heat stress. If you see any of these warning signs of overheating or heat stroke, get help immediately.

Keith Ayers — Executive Director at Pacifica Senior Living Modesto

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Wednesday, January 28, 2015

Constipation: Cause and Treatment

Constipation is one of the most common disorders in Western societies, and its prevalence increases with age.  Many of the factors that predispose older adults to constipation are not a direct effect of normal aging, but are closely related to it. Fortunately, there are therapies which can improve this distressing condition.


A majority of people over 65 take one or more medications that effect nerve conduction and smooth muscle function.  Medications such as opioids, NSAIDS, calcium supplements, and various others increase the risk of constipation in older patients.  Other common risks include low-fiber diets, limited fluid intake, impaired mobility, and cognitive disorders.  Studies also show that there are distinct physiological changes which can affect colonic motility in older people. 


Treatment should focus on education.  Informing patients about diet, exercise and bowel techniques, including evacuation timing, breathing, and the way they position themselves on the toilet, can be incredibly effective.

Depending upon the type of constipation, a routine that includes taking a fiber supplement mixed with 2 ounces of water every evening, can be a proven therapy. Additionally, adding a morning routine which begins with mild physical activity- just stretching in bed- a hot, preferably caffeinated beverage and possibly a fiber cereal followed by another cup of a hot beverage- all within 45 minutes of waking can increase the possibilities of effective evacuation.

Having a routine and an organized plan will provide patients with an improved quality of life. It offers more than the band-aide of taking a laxative, as laxatives really do not provide a long term solution, nor do they promote health.

Tuesday, January 27, 2015

Have You Had Your Residents Poached?

Few things aggravate me more than a “well-meaning” outside care provider or the like, coming into a community and telling a family or resident that they should be relocated to a different level of care or a different community. This could be skilled nursing, a designated hospice wing, or the classic board and care. I am by no means opposed to their help and services when necessary, but I’m primarily referring to the ill-timed incidences when business appears to be more important than the residents well-being.

Dying Alone

Let me illustrate my point with an experience I had several years ago.  A resident who had been in our community for an extended length of time was approaching the end of his life. He was in the hospital and despite the fact that they knew we could do hospice care in our building, the hospice agency told the family that he should go to their specialized wing as we wouldn’t be able to handle the care of their resident.
It was not even close to the truth.
His daughter, who didn’t know the complexities of the senior healthcare system, went along with the agency’s advice and he went to this “specialized” unit.  When I found out what happened I called his daughter and told her that we could have taken him back and would have loved to have cared for him in his final days. At that point he was far too frail to move again so he stayed there for the remainder of his days. When he left this world, it was alone, without staff that had cared for him for years, fellow residents with whom he had built meaningful relationships, and the familiar surroundings of his room and our community. And it was precipitated by a suggestion from a staff member of an agency who thought they were doing the “right” thing.

Poaching as a Common Practice

I’ve since had experiences in which others have come into the picture and suggested other living arrangements for our residents; as a matter of fact I don’t think I’ve ever worked in a building where it hasn’t happened at least once. But despite that, each time it happens it is no less infuriating. It is so maddening because in most cases, we as the  provider are working hard to ensure our residents are happy; we know not only them, but their families, preferences, and have diligently met their needs from the day they’ve entered our buildings. So when another provider, let’s say a home health or hospice employee, comes in and completely disregards the history, rapport, and well-being of the resident, it makes me feel as though I’ve been betrayed. Yes betrayal is a strong word, but I think it’s an accurate way of describing the experience.
Why do I feel so strongly about this frequent occurrence that happens in nearly all communities?
I can tell you adamantly that is it’s not because of a loss in occupancy or revenue. It is because I firmly believe that as an operator, a large part of my vocation is to ensure that each resident who calls our community home is indeed kept in their home; surrounded by familiar sounds, visual stimuli, people, and routines to which they have become accustomed. To remove someone from that level of comfort when they are dying because we don’t keep a bowel and bladder book is a little silly, isn’t it?

There is Enough to go Around

My point is this; we are all in this business of caring for our seniors together. There is no shortage of people over 65 to care for and thus we need to learn to better communicate and work together instead of against one another.  Finally,  we need to put the needs of our residents ahead of our sales targets and financial goals.
Just to give this a little more perspective here are a couple facts:
  • From 2010 to 2050 the numbers of Americans over 65 will more than double; from 41 to 86 million.
  • By 2050, the number of people age 65 and older with Alzheimer's disease may nearly triple, from 5 million to as many as 16 million.
Based on those two statistics alone it is quite easy to see that we are living in an era where there are an abundance of people who can be classified as seniors. And it is only increasing. Therefore, why not work together with the varied repository of resources to create a strong, unified network of providers who strive to do their best to ensure our elders are given the dignity and respect they deserve?

Calling a Truce

White FlagWe all know that in today’s business climate it’s often easy to see providers pitted against one another in the name of quality care, but I don’t think we should allow that to become our standard of practice.Instead, let’s call a truce. Let’s remember to look at things on more of a macro rather than micro level.
The next time a provider of any type comes to your community or office, or a family from a competitor comes to see you regarding a possible move, I challenge you to ask the following questions before proceeding:
  • Is this suggestion because of a genuine concern for the quality of care of the resident?
  • Do you know the family history and their rapport with the community?
  • If dissatisfaction with another community is involved, can you share with the other competitor to allow them the opportunity to rectify?
  • Is it in this resident’s best interest to be able to return to their current community from an emergent occurrence to prevent as  little upheaval as possible?
  • Is the resident at a significant safety risk or is it simply a preferential suggestion to relocate?
If we can all answer these questions each time our paths intersect with regard to our common residents, I am confident that we will all serve our elder population with greater efficacy and increased camaraderie. After all, we are in this together; let’s act like we mean it when we say that we put our residents first.
 Leslie — Executive Director of The Meridian at Lake San Marcos, a Pacifica Senior Living community. 

Monday, January 26, 2015


Not long ago, I had lunch with a former Executive Director who now owns her own senior referral agency. During the course of our conversation, I asked her if she ever missed that role which she held so many years ago. Her response was one of the best assessments of the job I’ve ever heard, “When it was good, there was nothing better.” 

The Gift of Today

Today wash one of those days for me. After two weeks of holidays, family, sickness and a December full of events and activities galore, I've found it difficult to follow my usual routine, both personally and professionally. Finally this week, things have returned back to normal. One of those routines that I enjoy most is walking through the dining rooms and visiting our memory care neighborhood. This afternoon, I got to spend some time in that special neighborhood, and it was nothing short of magical.
Our activity person was in the kitchen with a couple of memory care residents making Ambrosia salad. A mixture of fruit, mini marshmallows, shredded coconut and cool whip that instantly transports you back to summertime family gatherings and happy memories. As we continued working in the kitchen, more residents came in to see what was happening. One was helping at the sink, washing dishes, another comes in to eat some grapes, and a few more came in just to see what was going on. I grabbed a bag of mini-marshmallows, adding them and a few other ingredients to the mixture. Once everything was mixed together, we all tried a spoonful, uttering praises about the yummy creation before turning the conversation to shoes, babies and other topics.
After leaving the kitchen, I walked across that hall to the activity room, and spoke with a resident that I hadn’t seen in a while. Usually quiet and sometimes even withdrawn, she has recently become animated, talkative, and more engaged than she has ever been before. When I sat next to her she leaned toward me saying, “I haven’t seen you in a while” which warmed my heart in a way that is difficult to describe. While there I met one of our newest residents, greeted three other ladies and watched as our newly acquired community pet walked around and gently interacted with the residents.

What’s So Special?

I know that you are probably thinking, what is so magical about salad making and a dog roaming around a memory care neighborhood? Here’s what’s so special. All of those ladies, plagued with dementia had temporary slipped their bounds and were once again engaged, vibrant women. There weren't wracked with anxiety, worried about what they cannot remember, and weren't experiencing sun-downing behaviors. For this brief window of time, they were simply women enjoying themselves, engaged in the simple practices of everyday life that we often take for granted. They were ALIVE.
As I walked back to the main building, I felt as though I had been given a very valuable gift. I had been able to not only witness, but be part of a small time period in which these ladies were once again like their former selves. We laughed and talked, and I was able to envision what it must have been like before they were stricken with this terrible disease. I felt blessed to have to have been a party to something that was so special and beautiful. And then, I thought about my new friend, the former Executive Director, and how her words couldn’t ring truer for me than today: “When its good, there is nothing better.”
Leslie Quintanar — Executive Director of The Meridian at Lake San Marcos

Monday, December 15, 2014

Don't Lose Heart

I once had a conversation with the President of a senior living organization for whom I worked in which he related that he believed that the Executive Director role is by far one of the toughest in the industry. You’re ultimately responsible for driving occupancy, meeting financial targets, cultivation an engaged workplace, over seeing compliance issues, functioning as the community HR representative, and overall quality assurance. Finally, we are expected to have a resident focus and create a setting that will allow each individual to have a quality of life that is vital and relevant. Piece of cake, right?
Sisyphus in Training
Anyone who has been or is currently an Executive Director wholeheartedly resonates with the laundry list of expectations. We’ve put in the longs days, lain awake at night remembering things not completed that day and thinking ahead to the next day’s challenges. And to be honest, sometimes it’s just exhausting. There are days we could very accurately compare our jobs to Greek tales of Sisyphus—always pushing the rock up that hill only to watch it roll back down and being faced with doing it all over again. Ever. Single. Day. So what do we do when we fell as though we cannot push that boulder up the mountain one more time? When we hit the proverbial wall?
And the answer is…
I got the answer last week when I was talking to a dear friend and fellow senior living warrior. We hadn’t spoken in a while, and as we were catching up she told me about a coworker who recently took her to his office, put some headphones on her to listen to some smooth, mellow music, and told her ” Do not lose heart—what you do has meaning, and even though tit is hard it’s worth it in the end.”
An AHA! Moment
I knew as soon as she spoke those precious words that their impact would be far-reaching and a source of strength I could pull out in some of my most difficult moments. It would be a source of reassurance to me that there is purpose, value, and hope in my role in senior living. In the last week as I’ve had to deal with staff changes, a belligerent resident, an unfortunate communtiy event, licensing complications, and numerous other challenges, that phrase has been my mantra.
Here is what I learned:
Do not lose heart—for every resident who is difficult there are other who are quick to tell you that you are special to them and that you’ve changed their lives.
Do not lose heart—for every staffing change that happens, you’ve got the unique opportunity to bring in someone fresh, new perspective and they’ll see things in ways you’ll need for that advancement of you community.
Do not lose heart—for every emergency situation you have to deal with you have the opportunity to prove to your residents that they can indeed trust you and you wil do all you can to ensure that they are safe and secure.
Do not lose heart—when you are exhausted and think that you cannot hear one more problem, you find that one resident who shars with you just how happy they are and how you and your staff have made it possible. I’m sure you are seeing a theme here; as leaders in this industry, we often come home emotionallyu spent, physically tired, and mentally drained.
Yet, ask most of us in this business and you’ll find that we cannot imagine doing anything else. Nothing compars to laying your head on you pilow each night and knowing you’ve helped alleviate a families fears, delivered on promised to create a community that exceed their expectiations, and wholeheartedly poured yourself into the lives of those entrust to you care and oversight. So, if you’ve had a tough week, take a few moments to balance the good with the bad, see the blessings in the challenges, and don’t forget to give yourself this piece of advice. Do not lose heart. Leslie