When Leon Seaman was 90 and his wife, Ruth, not yet 80, he confronted her one day at the door of their Palm Springs home.
"Don't come with me," he angrily told her that day five years ago. "I have my cane, I don't want to hurt you, but I have to go to the police. My wife stole my money."
After months of more insults, Ruth Seaman started thinking about a divorce. She thought about it for several years until she read a book that defined her husband's problem as Alzheimer's disease, an irreversible nerve disorder that blights memory and leaves its victims confused and helpless.
Now she chronicles her husband's days in a growing pile of spiral notebooks that weighs, she says, "about five pounds." She plans to share the journal with a group of UCLA medical students who will study dementia--the loss of mental powers--in a new special-care unit that has been opened in Reseda at the Jewish Homes for the Aging of Greater Los Angeles.
Amid woeful ignorance about dementia, the month-old unit will serve as a teaching and research facility and as a care unit for some of the 850 residents of the Jewish Homes, said its co-directors, gerontologists Joseph Ouslander and Dan Osterweil. Both physicians are full-time faculty members at UCLA medical school.
Started with a $1-million endowment from the Maurice Amado Foundation, the 120-bed unit is housed in two buildings that are part of the Jewish Homes' Victory Boulevard complex. The task of raising another $4 million to complete and operate the nonprofit facility will fall to Ernest A. Goldenfeld, newly installed president for 1988 of the Jewish Homes.
The need to add a dementia unit to the complex of retirement apartments and nursing beds was great, Ouslander said. The average Jewish Homes resident is 88, he said, an age at which one in four Americans has severe dementia, according to the Congressional Office of Technology Assessment.
Geriatric ailments are increasing as Americans live longer and the nation's population grows older, but experts say the Jewish Homes unit is one of only a handful in the Los Angeles area for patients with dementia. The disorder can be brought on by Alzheimer's disease, multiple small strokes in the brain or other ailments.
A similar unit opened 18 months ago at the Motion Picture and Television Country House and Hospital, a nonprofit retirement community for film industry workers in Woodland Hills. In November, Westwood's John Douglas French Foundation for Alzheimer's Disease opened the nation's first hospital entirely devoted to the disease in Los Alamitos.
Elsewhere in the nation, treatment centers for dementia are equally rare. Of some 20,000 nursing homes in the United States, Ouslander said, fewer than 100 have dementia units.
Most hospitals and nursing homes are loathe to provide the laborious and unpleasant care demented patients need: wiping drool, changing diapers, chasing aimless wanderers, coping with bottomless despair, enduring insults, struggling to calm incoherent terror.
"It's easier," Osterweil says, "to zonk somebody out with some severe medications."
At the Jewish Homes, finance director Debe Holzer said the cost of caring for a bedridden patient was about $40,000 last year. Federal entitlement programs covered about two-thirds of the cost, she said, while donations and endowments made up the difference.
Although care in the dementia unit will cost another $2,500 annually for each patient, Holzer said, federal programs will not pay for it. The staff hopes donations will.
"The cost is high," notes Judy Wunsch, Los Angeles chapter coordinator of volunteers for the Alzheimer's Disease and Related Disorders Assn., "and it isn't covered by insurance . . . and there's no end. The disease can't be cured."
But as many as one in every five dementia patients can improve with treatment, Ouslander said. Sometimes, cutting back on frequently used sedatives helps.
Moreover, he said, careful diagnosis can detect patients who are mislabeled as demented when the problem is that they cannot hear.
The new unit requires no miracle machines, Ouslander said. Instead, specially trained staff members will diagnose candidates for admission and pay great attention to each patient.
"We're at the lowest levels here in trying to improve nursing care," he said.
Although the unit is 75% occupied, trained staff is in short supply and many physical details need attention. Double latches on a gate were improperly installed, fluorescent lights glare in the halls, corners on nursing station counters have not been padded--all hazards for disoriented patients.
But tailoring for Alzheimer's patients already is evident. A waist-high fence surrounds the two buildings, walls are painted in mild colors with darker trim to denote doors and seams where floors meet walls, armchairs are easy to get in and out of.