By Max Wallack
Fundacion Alzheimer Aruba posted the link to my article on Facebook.
Within minutes, there were 36 comments. Unfortunately, they were not in English. I decided to message Fundacion Alzheimer Aruba and request a translation, if possible.
The translation I received was shocking.
Here is some of the information that the President of their organization provided:
“Here in Aruba the National Health Insurance has decided now since 3 years ago that the elderly older than 70 years will not receive all adequate services they deserve (e.g. thorough diagnosis and cognitive assessment) "because of their age"!
You would have noticed that your wonderful article caused a great consternation in Aruba and our friends on the Facebook (FB), and I am pretty sure the days to come! The messages and comments are all indicative that the Aruba Government and the National Health Insurance, (where every Aruban citizen is insured), is committing a discriminatory act against the elderly and the person with possible neuro-cognitive dysfunctions and/or neuro-degenerative conditions.
There was a comment on FB that nothing can be done but wait on the law (as in the Netherlands) for euthanasia and even mentioned Adolf H. Others will come forward with their experience of their caretakers in the elderly homes where several elderly were fixated (mentally with drugs, and/or physically in a chair/bed and without any daycare program in this home). Regarding the medication: the elderly with Alzheimer's receive medications, which are not being properly (on a regular base) monitored, even in the case of contra-indications (secondary effects) these has on the elderly.”The president of the Aruba Alzheimer's Foundation continues, saying:
“Max, it's a shame for me to tell the world, that the government of Aruba is not treating their elderly and the person with Alzheimer's or MCI right, whilst the government will continuously boast to the world that Aruba is "One Big Happy Island" (happy for who?) and one of the most visited islands in the Caribbean.
The Inspection of Health is not functioning properly (if not at all). The caregivers and patients with AD are afraid to stand up for their rights, since they are afraid for the consequences, repercussions these comments might have for their families and or caregivers.“It took a while for that information to sink in!
“There are more or less 3 daycare centers in Aruba not all are in place or adequately prepared or have trained professionals to care for the person with Alzheimer's, and there for business/ financial sake. There are also workers ( mostly volunteers) in the daycare centers that are doing a good job too.”
People who worked and paid into their system in ARUBA, are not receiving an adequate health insurance after the age of 70! To answer Bob’s recent question about age, I guess the island of Aruba, one of the most prosperous islands in the Caribbean, has decided that 70 is old enough!
The families of these patients sit and wait for euthanasia to be approved as the best means of attaining relief for their loved ones! “Elderly homes” regularly “fixate” their patients with drugs, not always monitored, and “fixate” their patients to chairs or beds. There is no adequate daycare program.
Dr. Melva Croes has been volunteering as President of the Fundacion Alzheimers now for 10 years. She says she often feels frustrated as a caregiver and advocate of her community, but she greatly values her work and her advocacy on behalf of Alzheimer’s patients.
To the Alzheimer’s Reading Room, Dr. Croes says,
“thank you for your wonderful and interesting articles.. . They really contribute to our knowledge of what is happening in your country and the world. I read them as soon as they reach our mailbox. We always do read everything usable to help us in bringing the awareness here in Aruba. Sadly to say that the contribution in this field on the part of the government will not always being honored: Last week I overheard that our proposal to start a research in Aruba together with the CBS on the prevalence of AD in Aruba, has been scrapped of the list of priority by the Aruba Government.”The citizens of Aruba are dependent on sites like the Alzheimers Reading Room as the source of information about new developments, caregiving, and Alzheimer’s awareness!
With a donation of Alzheimer’s puzzles from Springbok Puzzles, I will be sending puzzles to Aruba over the next week or two. I know that is way too little in the way of help, but I keep trying to imagine a smile on the face of one of these patients who, perhaps, hasn’t smiled in months.
Soon, Alzheimer’s Aruba will be publishing a program of the activities of their tenth anniversary of the "Aruba Alzheimer's Teal Ribbon Week" and a upcoming workshop.
I hope we will all encourage them in their efforts.
The following comments are Dr. Croes’s translation of some of the facebook comments:
"Some comments fall into the category of people not believing that they are paying into the system and not being able to enjoy all available benefits after the age of 70. The neuro-psychological diagnosis for AD and even dental hygiene is a good example of essential treatments not given to the people of 70+ anymore.
Another valid point made in the discussion is the fact that even a decent form of care is not available for those that have not (have) had a high income. This meaning that several adequate basic care becomes and elitist affair. After all, who can maintain themselves with the little bit of money the normal pension gives? ( more or less US dollars 500) per month.
Another man in this polemic mentions that he would rather undergo euthanasia to be sure he will not have to suffer from the inadequacies in care for those 70 or over. He even goes to suggest that certain mass murder practices such as that from the A. Hitler days could be used to relieve many of their miserable existence in one shot. The conclusion being that many people just cannot undergo euthanasia because there is no law for it yet in Aruba. To the euthanasia argument Fundacion Alzheimer Aruba replied by stating the ethical boundaries of letting a person with AD undergo euthanasia. The Dutch law prescribes the person to be legally sane to be able to make the decision him/herself, something that is not the case with AD.
Yet another lady goes on about the loose immigration policy for certain foreigners that immediately go into welfare and therefore not contribute to the national healthcare system.
For mismanaging this situation she also calls for the resignation of all national healthcare management and affiliated politicians, since the elderly are only beneficial for their votes and the financial contribution they have paid in the past (and deducted from their pensions now they are no more contributing to the Aruba workforce).
Another gentleman claims that after the age of 45 many people are subjectively degraded in various sectors in Aruba. He cites examples such as trying to get a job after 45 and being told that one is over-experienced. He also mentions that there was a system before the national healthcare system (ppk card) that covered many medical services such as dental work and glasses. With the introduction of this system this has disappeared.
Another person laments the fact that she nor the family was able to take care of the grandmother at home. She claims to be lucky to have found a "more or less" adequate elderly home for her, however; this does not always seem to be the case. Many elders are being fixated (mentally with drugs/ physically in a chair or bed), do not get enough exercise, only get to watch TV all day or watching in the space and sleep in rooms in which the air-conditioning is set too cold causing the rheumatoid arthritis to act up.
She goes on saying that when she goes visiting her mother she will set the air higher, but the next day when she arrives on her daily visit, the air is set very cold again! Before coming into that elderly home lots of questions is being asked: on e.g. what food does the mom like and what are her hobbies.
Unfortunately she does not get the appropriate food, and her hobbies are discarded, and she is left to sit all day doing nothing. Unfortunately the inspectors don’t function on Aruba. The rules are in much so in place for adequate care but these only seem to be there as decoration to a failing system of care.
The question of medication was also brought up. It would seem that the explanations of medicine given to the elders are not translated or communicated to the family. When the elderly starts complaining about side-effects due to interaction with previously taken medicine these complaints are discarded by the doctors / nurses or "professional" caregivers in the home. It would seem that a policy on what to do on medication that creates side-effects is absent. The elderly are usually shoved to the side ( saying because of the high age) nothing can be done, whilst on the other side prescribing lots of (sometimes even outdated) medication.
The family are not being informed on the medicines or change in medicines given to the elderly. And when the family member ask for this information, this would NOT be honored or discarded as impolite. Even though a black box warning of the FDA on the medication Risperdal is not taken seriously, nor it's side effects.
Another set of comments boils down to the crude, cold and economic thinking that seems to dominate the management of the national health care system and the elderly homes. Many do not find it to be fair that after working so many years and raising your children to become contributing citizens to society get degraded by the politicians and management of the national healthcare system."