Editors note: The following article is the second in a series of articles about James and Josephine Reiland, and their familys experience with James Reilands Alzheimers disease. Part one of this series, Family copes with Alzheimers disease, appeared in the Dec. 21-27, 2005, issue of The Rock River Times.
Getting an Alzheimers patient to eat three bites of pudding is reason enough for staff in River Bluff Nursing Homes special care unit to celebrate. Such was the case with Alzheimers patient James Reiland Nov. 10, 2005.
As many as three nurses tried unsuccessfully for the better part of an hour to get Reiland to eat some pudding containing his medicine. After much coaxing, Reilandwho has a full head of white hair brushed straight back, bushy gray and black eyebrows, dark eyes, thick silver-framed glasses, a deep voice and a cleanly shaved facefinally stopped napping and took a few bites of the pudding.
Reiland, 84, of Rockford, suffers from Alzheimers disease, the most common form of dementia, which, according to the Alzheimers Association, gradually destroys a persons memory and ability to learn, reason, make judgments, communicate and carry out daily activities. An estimated 4.5 million Americans suffer the effects of the disease, which is the ninth leading cause of death in Illinois, claiming 2,161 lives in 2001, the most recent year for which statistics are available.
The Alzheimers Association states half of all nursing home residents in the United States have Alzheimers or a related disease. The average cost for nursing home care is $42,000 per year, while the average lifetime cost of care for an individual with Alzheimers is $174,000.
The number of Americans with Alzheimers disease is expected to reach as many as 16 million by 2050, with the greatest risk being increasing age and life expectancy. According to the Alzheimers Association: A person with Alzheimers disease will live an average of eight years and as many as 20 years or more from the onset of symptoms as estimated by relatives. From the time of diagnosis, people with Alzheimers disease survive about half as long as those of similar age without dementia. Average survival time is affected by age at diagnosis and severity of other medical conditions.
James Reiland was diagnosed with Alzheimers disease in 2003. He entered River Bluff Nursing Home, Winnebago Countys 304-bed nursing facility on North Main Street between North Towne Mall and Sportscore 1, in December 2004.
James wife, Josephine, and daughter, Mary Hilton, along with other members of the Reiland family, had been caring for James 24 hours a day, seven days a week. But on the morning of Dec. 13, 2004, James Reiland awoke and threatened to become violent with his mother and daughter. He had wet himself, and was unwilling to get out of bed. Hilton called her brother-in-law, son and nephew, to try to get James out of bed. When they were unsuccessful, the Reilands called the paramedics and had James taken to the hospital. At that point, Josephine and Hilton decided it was time for James to enter a nursing home.
Those last three months were just horrible, Hilton said. You cant watch him 24 hours a day like that.
Josephine, 84, said December was a difficult time to make the decision to send her husband to a nursing home. James, after all, had proposed to Josephine on Christmas Day, 1943.
I was in denial, and I wanted him home for Christmas, Josephine said. It was the 13th of December, and I wanted to hold on to him at least until Christmas with the family. You know, we didnt have trouble with him when we brought him in [to River Bluff]. He liked Rockford Memorial Hospital. So I told him this is Rockford Memorial Hospital. We wouldnt tell him it was a nursing home. And he thought he was at the hospital. He just loves it there.
Hilton added: One of the biggest things weve found is you have a tendency to deny whats happening to the person you love. Its a big, big, big problem. Because as things were happening and social workers were coming here to the house and showing us what to do because we didnt want to send Dad to a nursing home. And every one of them said, Sooner or later, you will have to admit to what is really happening to him.
In addition to Alzheimers disease, James Reiland also suffers from diabetes and ulcers, and has glaucoma in both eyes. He is unable to see out of his left eye, and only has partial vision in his right eye.
James Reiland is one of 19 Alzheimers patients housed in the special care unit of River Bluff Nursing Home. Hilton said the family decided to send James to River Bluff because her aunt, Hilda Reiland, had a good experience there. Hilda Reiland is on E unit, which Alzheimers jpatients.
Shes happy there, Hilton said. The first time she went in, she didnt like it. Hilda went to another nursing home, then when she went there, she asked to come back to River Bluff, Hilton said. She loves it.
At its peak, River Bluffs special care unit housed as many as 32 Alzheimers patients, according to River Bluff Administrator Phyllis Schwebke. But the nursing home is slowly phasing out the special care unit, due to Public Act 90-0341, passed by the 90th Illinois General Assembly.
The Act creates the Alzheimers Special Care Disclosure Act, and amends portions of other acts, to require nursing homes and related facilities with special care units to report to the state how they fit within the guidelines of a special care unit, including staff training and technology. Specifically, the act states as follows:
A facility that offers to provide care for persons with Alzheimers disease through an Alzheimers special care unit or center shall disclose to a State agency responsible for licensing or permitting the facility or to a potential or actual client of the facility the following information in writing on request of the Agency or client:
(1) the form of care or treatment that distinguishes the facility as suitable for persons with Alzheimers disease;
(2) the philosophy of the facility concerning the care or treatment of persons with Alzheimers disease;
(3) the facilitys pre-admission, admission, and discharge procedures;
(4) the facilitys assessment, care planning, and implementation guidelines in the care and treatment of persons with Alzheimers disease;
(5) the facilitys minimum and maximum staffing ratios, specifying the general licensed health care provider to client ratio and the trainee health care provider to client ratio;
(6) the facilitys physical environment;
(7) activities available to clients at the facility;
(8) the role of family members in the care of clients at the facility; and
(9) the costs of care and treatment under the program or at the center.
A facility that violates a provision of the Act would be guilty of a business offense, and subject to a fine not to exceed $500 for a first offense and a fine not to exceed $1,000 for a second or subsequent offense.
Its our intention to no longer have a special care unit, Schwebke said. She added that the nursing home reviewed possibly making the changes required by the Act, including necessary staffing and training requirements, and found that it just doesnt make good sense economically for the limited population the home usually has on that unit.
Schwebke said: It would be quite a burden financially, costing the nursing home an estimated $250,000 the first year. It would mean that we would not be able to provide additional services to other patients in the general population, Schwebke added.
Schwebke said River Bluff has not taken any new admissions to its special care unit for several months. She said the nursing home will accept Alzheimers patients, but will not be able to offer care to those with a particular tendency for eloping, or running off.
Currently, the Alzheimers unit at River Bluff is equipped with a coded wooden gate that leads into the two halls of the Alzh
eimers unit. The coded gate keeps patients from wandering to other parts of the nursing home without supervision. The only other exits lead outdoors to a fenced-in, secured courtyard. The doors leading outside are equipped with sensors triggered by wristbands or ankle bracelets that many Alzheimers patients wear.
The only real changes that will be made when River Bluff eliminates the special care unit is that the wooden gate will be removed, and patients will be worked in with the general population, Schwebke said. Patients will still wear sensors, and all doors will be equipped with alarms to let staff know when patients exit the building.
Schwebke said, As people settle in and become comfortable, we have found the need for that security is not needed. She also said that with Alzheimers patients, sometimes people just become total care patients, and the need for extra security is completely unnecessary.
I think it only limits us from taking those folks who truly need special care for security reasons, Schwebke said. I think, certainly, the families on our unit have been aware this change is coming. We know the group we have now. I dont expect there to be any major reaction. Some of them may venture to the bigger world of the overall facility.
She said many nursing home residents live by choice in a small area of the home because that is where they are most comfortable.
Josephine and Hilton both praised the quality of care James Reiland has received in the Alzheimers unit of River Bluffs special care unit.
That is a wonderful unit, Josephine said. Its a shame if they let that place go.
From the Jan. 4-10, 2006, issue