Case XIII: Chapter 3: Adapt & Adopt

Chapter 3: Adapt and Adopt

As soon as he was certain Mrs. Branch was far enough away, Dudley turned toward the Main Conference Room where the meeting of the La Vida Aureo Community Assist Team was about to begin.  Beth Ford, the Team’s Leader, had kept him up-to-date on the Team’s activities and progress via email, but Dudley was eager to personally sit in on a meeting.

“Welcome, everyone”, Beth began. “I want to begin this morning’s meeting by summarizing the situation related to Roger Lindermann.  As you probably heard, Mr. Lindermann and his wife were responsible for the poisoning death of Mrs. Lindermann’s mother, Harriet Aldridge here at La Vida Aureo.  Thanks to the good work of Lt. Garcia and other unnamed associate sleuths, the Lindermanns have been charged with murder and the District Attorney is confident they will both be convicted.  While that is unfortunate, I want to focus on something else that came to light during the investigation.  Mr. Lindermann had enrolled in a course, presumably for Financial Planners, with the intent of gaining the skills necessary to defraud people, specifically the elderly, of their savings. We have discussed this issue previously and are all aware of the potential dangers to seniors. This incident serves as a painful reminder that there are a growing number of fraudulent schemes and we must remain vigilant.”

“On the same subject, I continue to read about the growing incidence of various telephone and Internet scams.   I marvel at the creativity and imagination of these and the ways the trusting nature of elderly folks can be used against them.  One of our guiding principles is to encourage people to be independent and not live in fear, but we must continually remind them to be on guard every day.”

“OK, I’ll get off my soap box.  Would anyone else like to update the Team on their activities?”

Arnetta Valencia spoke up. “I’ve observed considerable variability in the quality of personnel in nursing homes and particularly agencies purporting to offer home health care.  I continue to hear what can only be described as horror stories with some home healthcare agencies.  There appears to be a severe lack of screening in the hiring process and a definite lack of training.  The average starting wage is terrible which results in large turnover.  I know we’ve talked about this issue before in the Team, but I just wanted to raise it again as something we all need to be aware of as we work with elderly folks.  Maybe we should even consider creating some sort of check list or questionnaire to guide people when they’re looking at agencies for a parent or loved one.”

“If I could offer a comment here,” said Dudley. “The issue of personnel competence was recognized at the outset here at La Vida Aureo and I know it is a subject Mrs. Duncan takes very seriously.  It would be beneficial for you to ask her to attend your next meeting and provide her perspective on the subject.  It might provide some context for your future evaluation of home healthcare agencies and nursing homes.”

Dudley continued. “I suspect it is a matter of budgets in many situations and, from my perspective, it is a case of flawed economics.  By offering low salaries, you cannot expect to attract, much less maintain, the highest quality personnel.  The fallacy is that you spend significantly more money in recruiting and training costs due to the high level of turnover.  But, the all too common case is that salaries and training are the very areas where some organizations try to minimize costs.  It is absurd!”

Mila Espalin asked if she could share some information with the Team.  “I’ve been attending a number of Health Fairs throughout Central and Northern New Mexico and would like to share my observations with the Team.  And, thanks to Mr. Dudley’s friend Ray Little Feather, I was invited to several Fairs on the Reservation with Arnetta.”

“I’ve noticed there is very little information generally available out there concerning Alzheimer’s, despite a growing need.  Consequently, a large amount of misinformation has evolved to fill this gap.  There is a terrible lack of awareness about available resources, particularly for caregivers.  People need to understand Alzheimer’s is a disease and NOT a punishment from God for some past transgression.  Too many Priests, Medicine Men and Curanderas alike are convincing people they are somehow cursed and should be avoided. Some older people are bound by tradition or guilt or pride.  They refuse to seek help beyond their immediate family or close friends, sometimes their church, leading to considerable frustration or anger.”

“I’m particularly concerned for the caregivers and family members who are dealing with the situation.  I believe it would be a tremendous help to caregivers if they had some idea of the type of behaviors to expect and some coping strategies, as well. I realize there is no cure available and each individual case is slightly different, but I believe we must do something to help.”

“While I’m on my Soap Box, I want to talk about one more thing.  Lately, I’ve noticed these commercials on TV sponsored by the national Alzheimer’s Association.  I assume this is something new for them and it appears to be a new message.  The Executive Director of the local Alzheimer’s chapter is a friend of mine and she says she has noticed a significant change at the National Organization.  They have shifted their emphasis to large-scale fund-raising to advocate for more research to find a cure for the disease.  I assume that’s what’s behind the fancy new TV ad campaign.  Maybe I just don’t have the so-called Big Picture, but it seems to me that money, or at least a larger portion of it, could be spent supporting families who are dealing with the situation today. Those dollars could have a significant impact and benefit.  I’m not a doctor or research scientist, so I don’t know how likely it is for a cure to be developed, but there is an immediate and significant need out there that is not being adequately addressed.”

Beth spoke up. “I share your concerns, Mila. One of our principal goals is information.  We can impact the situation, at least locally, by creating Advocates, people who can speak to their respective communities   It might be worthwhile to talk to the La Vida Aureo Staff about effective communication strategies. “

“My reading has convinced me there is a tidal wave, even a tsunami, coming in terms of the number of people who will be affected in one form or another, by Alzheimer’s.  I’m concerned we will not be adequately prepared to house, much less care for, the large number of affected people.  I don’t know what the role of our La Vida Aureo Community Assist Team should be, but it certainly merits much more discussion.”

“Many of these issues are brought on by people simply living longer.  The family lacks the information about how to cope with these issues.  For example, older people get crabby or cranky as they age which can be expected.  But, when younger people begin to exhibit similar behaviors, it comes as a shock and is often misinterpreted as something else.  It could be early onset Alzheimer’s which can be very problematic.  In this situation, the disease progresses more quickly and behaviors can also change.”

“OK, let’s table that for the present, but make sure we come back to it in the near future.  It is certainly a valid concern and we would be remiss if we ignored it.  We need to make it part of our overall program.”

Minot Atkinson spoke up. “As our resident Geek, I believe there are some technologies we could and should examine as another means to help people remain independent and in their home for as long as possible.  We’re beginning to see a variety of so-called convenience devices that could potentially be adapted for easier use by older people.  My sense is that devices currently on the market are aimed at a more affluent and technically-savvy population, but I believe some could also be modified for more specific uses.  I don’t believe that any of the current devices can call 911 directly, but I’ve read of situations where the Police or Fire Department has been called.”

“I even saw a commercial on TV recently where the Housewife asked Alexa to change the operating settings on her clothes dryer, something like “Alexa, extend the dryer for ten more minutes, I have to do something.”  I mean, if these devices can communicate with appliances, we ought to be able to develop ways to assist elderly folks.  I’ll look into being able to adapt some of the currently available devices for use with home-bound folks.  We could encourage some people to try these out before asking others to adopt them.”

Mikaylah Willis chimed in. “Not to start a political discussion here, Minot, but are you suggesting we should focus our efforts on a program to Adapt and Adopt?

“Yikes!  Don’t get me started, Mikey …!   Anyway, there are many relatively simple devices available and we should encourage their use.  For example, even a common Medical Alert bracelet could be a big help, or having your Medical Directive clearly visible so a Fireman or EMT wouldn’t have to wonder what your wishes were.  Speaking of that, a friend of mine recently installed something called a Knox Box.  It is a secure lock box containing a key to your house and only your local Fire Department can access this box.  It’s a really simple idea, but could be very important in an emergency; better than having some burly Fireman break down your door if you need help!”

“To wrap things up today, said Beth, I’d like each of you to begin thinking about some sort of “early-warning system” to identify when independence is no longer viable option.  Our goal is to help people remain independent for as long as possible, but, for many, there will come a time when that is no longer appropriate or practical.  It may be the most significant benefit/positive outcome of the work we’re doing, while we continue our other programs.”


Later that evening, Dudley walked the short distance to Janetta Johari’s condo where he was greeted warmly at the door.  Dudley realized, somewhat embarrassedly this was not a friendly hug, but an affectionate embrace.  “I’m so happy to see you, Matthew and eager to hear about all the exciting things you’ve been up to at La Vida Aureo.”

Janetta ushered Dudley into her Living Room and offered him a glass of wine. She sat next to him on the sofa and took his hand.  It took Dudley a few minutes to regain his composure before he was able to begin telling Janetta about the most interesting conversation with Larry Blackburn and Don Orley.

“That sounds like a lot of fun and the opportunity to dig into some interesting New Mexico history and legend.  In addition to all your other duties and adventures, I trust you’ve had time to keep the Community Assist Team on track.”

“They really don’t need much help from me,” he said modestly. “In fact, the Team had a meeting today and I was able to sit in on essentially all of it.  I’m sure you’ll be interested to know that a major topic of discussion was Alzheimer’s and the effect it has on families and other caregivers. The overall situation can be quite frustrating to caregivers, particularly in terms of the various behaviors people suffering from the disease can exhibit.  The good news is that we’re experiencing a greater level of awareness among younger family members who are not so bound by tradition and realize they are dealing with a disease and can seek out appropriate resources.”

“I promised the Team I would give you their regards and inquire how your job is going.  They are interested to hear about any progress in developing a drug to address the symptoms of Alzheimer’s.  Mikaylah has been a valuable addition to the Team, but no one considers her your replacement.”

Well, Matthew, let me tell you a bit about what I’ve learned since starting work at Jalapeño Pharmaceuticals.  Their basic research approach was to try to “burn” away the plaque accumulating within the brain, a quite unconventional approach. Anyway, our initial versions of a new class of drugs seem to have the desired effect … in laboratory mice.  That is, we notice some improvement is the ability to perform some tasks, which we attribute to improved cognitive ability. Unfortunately, we measure a similar level of improvement in a control group.  With that group, we paid particular attention to their diet and level of physical activity.  There is some literature which seems to suggest that Alzheimer’s is a specific form of diabetes or inflammation affecting the brain.  If that is correct, then we’re back to the emphasis on “diet and exercise” as the primary means to maintain cognitive function as we age.”

“One other major topic of discussion at work concerns the overall area of research into Alzheimer’s and the so-called “race” to develop a cure.  The doctors and scientists who started Jalapeño are very outspoken about the way this very significant problem is being attacked. They acknowledge that the first company to develop an effective drug or treatment regimen will reap significant financial reward.  If some of the estimates of the number of people who will be affected by the disease are correct, the potential market may be larger than anything we’ve seen to date.  That kind of incentive, not to mention the associated fame, can lead to unintended and undesirable consequences.  In the short run, it has led to ruthless and often brutal competition for resources and funding.”

“Jalapeño is a very small, relatively unknown company and not located in any major metropolitan research area.  But the Principals want to use their presence in the field to argue for a completely new and different approach. They will present their preliminary findings at a major upcoming conference and use this opportunity to push for greater cooperation. They will offer a detailed proposal to examine the results from every study conducted to date in one massive data set.  To accomplish this, they’ve secured a major block of time on one of the Super Computers at Los Alamos National Labs.  They propose to have all the data and results from every study, drug trial, etc. loaded anonymously and allow the computer to search for trends, correlations, etc.”

“I plan to have coffee with Mikaylah in the very near future to tell her about the Jalapeño presentation and proposal.  I believe we both still have contacts within the major pharmaceutical companies and can speak to them and encourage their support.”

“Oh, Matthew, I’m neglecting my manners.  Can I pour you some more wine?”




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