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DODGE PARK REST HOME COMMUNITY NEWSLETTER NOVEMBER 2015 Dodge Park Rest Home has been serving the Worcester area since 1967 with the specific purpose to be recognized by the consumer and industry as the most professional, ethical and highest quality care facility for the elderly. We are committed to listening and responding to the needs of the residents, their family members and our employees. We are committed to going the extra mile when assistance is required by the public, the residents and their family members. We will remain committed to an entrepreneurial spirit, which does not tolerate waste or bureaucracy, but rewards achievement. -Micha Shalev & Ben Herlinger, Administrators /Owners C O N N E C T I O N THE DODGE PARK REST HOME A Cheerful Heart is Good Medicine In the Issue At Dodge Park Rt Home & Day Club memori are created for a life time! The Prospect of Dementia And Sleep Problems New Rules For Patient Discharge Dementia Costs Rocket higher Brain Implants New controlled by mice This Month Special Days in November Pumpkins Not just for Jack-o-lanterns Halloween Celebration Pictures from Dodge Park Celebrating Our November Birthdays! Calendar of Events Dodge Park Activities & Events Neighborhood Connection is now digital! Email [email protected] to get it delivered to your inbox each month. Print editions will mail out every other month only.

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Page 1: CONNECTIONdodgepark.com/wp-content/uploads/2009/09/NOV.DP_.pdf · 9.11.2009  · Pictures from Dodge Park Celebrating Our November Birthdays! Calendar of Events Dodge Park Activities

DODGE PARK REST HOME COMMUNITY NEWSLETTER

NOVEMBER 2015

Dodge Park Rest Home has been serving the Worcester area since 1967 with the specific purpose to be recognized by the consumer and industry as the most professional, ethical and highest quality care facility for the elderly. We are committed to listening and responding to the needs of the residents, their family members and our employees. We are committed to going the extra mile when assistance is required by the public, the residents and their family members. We will remain committed to an entrepreneurial spirit, which does not tolerate waste or bureaucracy, but rewards achievement.

-Micha Shalev & Ben Herlinger, Administrators /Owners

C O N N E C T I O N

THE DODGE PARK REST HOME

A Cheerful

Heart is Good

Medicine

In the Issue

At Dodge Park Rest Home & Day Club memories are created for a life time!

The Prospect of Dementia And Sleep Problems

New RulesFor Patient Discharge

Dementia CostsRocket higher

Brain ImplantsNew controlled by mice

This Month Special Days in November

PumpkinsNot just for Jack-o-lanterns

Halloween CelebrationPictures from Dodge Park

Celebrating Our November Birthdays!

Calendar of Events Dodge Park Activities & Events

Neighborhood Connection is now digital!Email [email protected] to get it delivered to your inbox each month. Print editions will mail out every other month only.

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Dodge Park Rest Home Web: www.DodgePark.com On Facebook: www.facebook.com/DodgeParkRestHome 32 Dodge Park Rest Home 101 Randolph Road, Worcester, MA 01606 Tel: (508) 853-8180 Fax: (508) 853-4545

Bringing LIFE to Those We Serve

DODGE PARK REST HOME

Micha Shalev MHA Executive Director/Owner

[email protected]

Ben Herlinger Adminstrator/Owner

[email protected]

Carrie Lindberg RN, BSN Director Of Nursing

[email protected]

101 Randolph RoadWorcester, MA 01606

Phone: 508.853.8180Fax: 508.853.4545

The Dodge Park Family of Care Services

Dodge Park Rest Home The Adult Day Club at Dodge Park Dodge Park At Home Dusk to Dawn at Dodge Park

Bringing LIFE to Those We Serve

The Prospect of DementiaBy Micha Shalev

Only few want to grow old, as most of us are afraid of becoming senile. But now that our

bodies last longer in better health, our brain being no exception, the prospect of living a fulfilled

old age is better than ever before.

It is not difficult to think of somebody really old who is still as sharp as a razor blade, still

driving, playing gold and visiting the gym. That sole fact is scientific logic against the notion

that old age turns you confused. Old age and dementia are two separate entities that, although

often coming together, are as different as old age and grey hair. Why then do so many people

believe that the two are closely attached?

The worldwide attention afforded to Alzheimer’s disease, as dementia is erroneously called, did

not appear out of the blue. For a long time dementia disappeared entirely into the background

as a recognized illness, and people who became confused in old age were declared to be

“senile”. Senility was thought to be a result of the “normal” ageing process and in the middle of

the last century little attention was paid to their problems.

The denial of the existence of dementia is a sign of the discrimination that old people faced. In

1975, led by US-based Dr Robert Butler, the first director of the National Institute on Ageing,

a new dawn of research emerged to break down this fatalistic view. Butler was a pioneer

and wanted to make a statement for both young and old. “Alzheimer’s disease” was finally

recognized by doctors and medical research scientists.

The positive part of the “war on Alzheimer’s” is that it put the issue of dementia back on the

map. Opinion formers and policymakers in many developed countries have predicted horror

scenarios, with the numbers of dementia patients increasing drastically in the coming years.

This is partly true because the post-war baby boom generation will have reached a very old

age by that time. After all, dementia is a disease that principally affects old people.

But those prognoses are based on the assumption that the statistical risk of getting dementia

will remain the same. This is a false assumption. Dutch researchers have shown that the risk of

getting dementia in old age was significantly lower after the year 2000 than before.

Brain scans carried out after 2000 showed far less damage due to cerebral vascular disease,

which would be a plausible explanation for the reduced risk. The epidemic of cardiovascular

disease has long been on the decline, beginning with a fall in the numbers of heart attacks

in middle age, and followed by a drop in the number of strokes suffered by old people. Now,

bringing up the rear, we see dementia figures falling for the oldest in society.

Is early testing necessary? There is general consensus that screening for dementia makes

absolutely no sense at all, and can even be considered unethical. Tests for early stages of

dementia can be a huge hazard, as people who receive such a diagnosis believe they are

doomed to die with dementia, but that is far from always being the case. After delivering the

diagnosis of dementia, modern medicine has

nothing to offer them by way of slowing down any

cognitive degeneration.

Micha Shalev MHA CDP CDCM CADDCT is the owner

of Dodge Park Rest Home and The Adult Day Club at

Dodge Park located at 101 Randolph Road in Worcester

as well as the new state of the art Oasis At Dodge Park

which schedule to open fall 2015. He is a graduate of

the National Council of Certified Dementia Practitioners

program, and well known speaker covering Alzheimer’s

and Dementia training topics. The programs at Dodge

Park Rest Home specialized in providing care for

individuals with dementia and Alzheimer’s disease. The

facility is holding a FREE monthly support group meeting

on the 2nd Tuesday of each month for spouses and

children of individuals with dementia and/or Alzheimer’s

disease. He can be reached at 508-853-8180 or by e-mail

at [email protected] or view more information

online at www.dodgepark.com

New rule would toughen patient discharge proceduresDischarge procedures for patients moving

from hospitals to skilled nursing facilities

would face tougher scrutiny under a

proposed rule released by the Centers for

Medicare & Medicaid Services on Thursday.

The proposal would require hospitals to

develop a discharge plan for patients within

24 hours of admission, and complete that

plan before the patient is transferred home or

to another facility. Hospitals also would have

a medication reconciliation process in place,

establish a post-discharge follow-up plan and

transfer patient medical information to their

receiving facility under the proposal.

The changes would meet requirements for

discharge planning described in the IMPACT

Act. The “simple but key” revisions would

modernize the discharge process and take

patients’ preferences into account as they

transfer home or to a nursing facility, CMS

Acting Administrator Andy Slavitt said in a

press release.

The American Health Care Association said

it intends to submit comments on the rule

to ensure that it benefits both providers

and patients, said Greg Crist, senior vice

president of public affairs..

“We support provisions of the proposed rule

on discharge planning requirements that

would enhance the transfer process to skilled

nursing care centers, increase the sharing of

patient information between skilled nursing

centers and hospitals, and improve patient

safety,” Crist said. “As patients play a greater

role in making decisions about their post-

acute care, we want to ensure that they have

sufficient and appropriate information to

make informed choices.”

Dementia costs rocket past heart disease, cancer

Healthcare costs for people with dementia are more than 80%

higher than those for people with heart disease or cancer, a

new study has found.

Patients with heart disease had an average total cost of

$175,136 over the last five years of their lives; those with

cancer incurred $173,383 over the same span. The costs for

patients with dementia was $287,038, a finding the study’s

authors called “stunning.” Investigators from New York’s Icahn

School of Medicine at Mount Sinai compared healthcare costs

for patients on Medicare from information gathered from the Health and Retirement Survey.

The researchers estimate out-of-pocket costs for dementia patients was, on average, $61,522, due

to the increased level of care and supervision needed by those with dementia. Those caregiving

costs were not covered by Medicare, the authors noted.

“This places a large financial burden on families, and these burdens are particularly pronounced

among the demographic groups that are least prepared for financial risk,” wrote lead author Amy S.

Kelley, M.D.

Check memory sooner: groupMore than 30% of those over age 70 have memory problems, and a panel of aging experts said this

population should have memory and reasoning ability evaluated annually by a healthcare provider.

Around 16% of those older than 70 have mild cognitive

impairment, noted the group, writing in the September

Journal of American Medical Directors Association. Fourteen

percent have dementia.

Progression of cognitive impairment can sometimes be

changed through lifestyle adjustment, they noted, such as

adopting a Mediterranean-type diet. Video games also can

help reasoning, memory and reaction time in older adults.

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Dodge Park Rest Home Web: www.DodgePark.com On Facebook: www.facebook.com/DodgeParkRestHome 54 Dodge Park Rest Home 101 Randolph Road, Worcester, MA 01606 Tel: (508) 853-8180 Fax: (508) 853-4545

This Month

N O V E M B E R 2 0 1 5

National Animal Shelter Appreciation Week,

Nov. 2-8.

Approximately

3,500 animal

shelters across

the United

States serve the

estimated 6-8

million homeless animals in need of refuge each

year. Show them some love and support.

National Hunger & Homelessness Awareness

Week, Nov. 14-22. Held each year the week before

Thanksgiving to give Americans a time to show

compassion for people experiencing hunger and

homelessness.

Geography Awareness Week, Nov. 15-21.

Spatial thinking through maps is one of the most

important skills that students can develop as they

learn geography, Earth and environmental sciences,

and so much more. Celebrate and explore the

power of maps!

American Education Week, Nov. 16-20.

Take this opportunity to celebrate public education

and honor individuals who are making a difference

in ensuring that every child receives a quality

education.

National Authors Day, Nov. 1.

Celebrate your favorite

writer—published or

unpublished—and

support authors with a

visit to your bookstore

or public library.

World Freedom Day, Nov. 9.

Celebrated on the anniversary

of the fall of the Berlin Wall in

1989.

World Diabetes Day, Nov. 14.

Led by the International

Diabetes Federation to engage

people worldwide in diabetes

advocacy and awareness.

International Games Day, Nov 21.

Libraries around the world participate in local and

international gaming activities, and game publishers

donate tabletop games and access to video games

to libraries for the event.

Thanksgiving, Nov. 26.

Enjoy some turkey and pumpkin pie while being

thankful for family and friends.

This Month

N O V E M B E R 2 0 1 5

Mice controlled with new brain implantsBrain control seems to be a reality—in mice, at least

Brain control seems to be a reality—in mice, at

least. Scientists at the Washington University

School of Medicine and the University of Illinois

have developed a tiny implant, thinner than

a human hair, that allows them to control the

movements of mice.

Previous attempts involving photostimulation

through fiberoptic cables or drug injection through

metal tubes required surgery and damaged brain tissues. The new technique uses

a small device mounted to the head of a mouse and powered by a battery. The

device delivers drugs from small reservoirs to the mouse’s brain. In one test, a

mouse was made to walk in circles after its brain was injected with a chemical that

mimics morphine.

In another set of experiments, scientists modified mice brains to make them

sensitive to light and stimulated brain cells with tiny LEDs. The mice were kept on

one side of a cage by flashing light pulses on specific brain cells.

Scientists and physicians hope that the experiments will lead to more minimally

invasive procedures to treat humans suffering from stress, depression, addiction,

and pain.

How much is that in galleons?Converting money when traveling to another country is difficult enough.

What happens when you travel to a different planet? Many famous fictional worlds

have their own currencies, designed by writers and filmmakers. Take a look at what

your cash would buy (as calculated by Mobile Money UK) in places you’ve only read

about or seen on the screen:

• Star Wars. Currency: Galactic Credit Standard. Conversion: 10 GDS = $10.10

• Flintstones. Currency: Clams. Conversion: 10 clams = $32.

• Harry Potter. Currency: Galleons. Conversion: 10 galleons = $73.50

• Game of Thrones. Currency: Gold dragons. Conversion: 10 Dragons = $13,157.89

• Discworld. Currency: Ankh-Morpork Dollar. Conversion: 10 AMD = $1,666.67

• Dune. Currency: Solari. Conversion: 10 Solari = $16.39

DODGE PARK REST HOME

The Day ClubMand

Bringing LIFE toThose We Serve

Bringing LIFE toThose We Serve

Invite you to...

A Christmasand Hanukkah Party

Please join your loved one as we celebrate with Santa andgive out a traditional Christmas gift to our residents.

Entertainment will be provided byWayne Page andPaul Lameroueaux

~The event will take place on December 17th, 2015

from 5:00pm to 7:00pm, at Dodge Park Rest Home.101 Randolph Road, Worcester, MA 01606

Come One, Come all! We are popping the cork, and having a ball!So come and join us and don’t be tardy, or you’ll miss a fabulous party!!!

Please RSVP toRenee Williams

at (508) 853-8180 byDecember 14, 2015.

Please invite all friendsand family members

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Dodge Park Rest Home Web: www.DodgePark.com On Facebook: www.facebook.com/DodgeParkRestHome 76 Dodge Park Rest Home 101 Randolph Road, Worcester, MA 01606 Tel: (508) 853-8180 Fax: (508) 853-4545

Military Family Appreciation Month.

Throughout

November, military

families serving

around the world

are honored

through a variety of

observances and

recognized for their commitment and the many

contributions they make every day in support of the

military and our nation.

National Epilepsy Awareness Month.

The Epilepsy Foundation estimates that 65 million

people around the world, and 2 million in the U.S.,

have epilepsy—a neurological condition in which

disturbances in the electrical activity of the brain

cause seizures.

National Epilepsy

Awareness Month

seeks to break down

barriers stopping

people with epilepsy

from reaching their

fullest potential.

National Peanut Butter Lover’s Month.

Celebrate your love of peanut butter this month

by sharing these facts with your friends: One

12-ounce jar of peanut butter contains about 540

peanuts; one acre of

peanuts can produce

enough peanut butter for

30,000 sandwiches; and

peanuts contribute more

than $4billion to the U.S.

economy every year.

Native American

Heritage Month.

Beginning as a single

day of recognition for the contributions the first

Americans have made to the establishment and

growth of the U.S., Native American Heritage Month

was designated in 1990 by President George H. W.

Bush.

This Month

N O V E M B E R 2 0 1 5HEALTH WATCH Watch for these risks of high blood

pressure If you haven’t checked your blood pressure lately, you may not be aware of some of

the risks associated with hypertension. Here’s what high blood pressure can do to

you:

Heart attack. Your coronary arteries can be damaged and blocked, as high blood

pressure causes atherosclerosis.

Stroke. Hypertension can cause the arteries in your brain to weaken, potentially

leading to a stroke if they clog or burst.

Heart failure. Narrowed arteries caused by hypertension can increase your heart’s

workload, which may lead to an enlarged heart unable to supply enough blood to the

rest of your body.

Kidney failure. High blood pressure can also caused narrowing of arteries in the

kidney, inhibiting their ability to filter blood and regulate hormones and fluids in your

body. Ultimately, kidneys can shut down if the arteries grow blocked.

Vision loss.

In the eyes, hypertension can cause bleeding, as well as swelling of the optic nerve—

both of which can damage your eyesight.

Don’t sabotage your diet during the long afternoonWatch out for these post-lunchtime habits

that can add on extra pounds (from the Health

Magazine website)

You can eat a healthful breakfast and a nutritious

lunch, yet still undercut your efforts to stay fit if you

slack off in the afternoon. Watch out for these post-

lunchtime habits that can add on extra pounds (from

the Health Magazine website):

Heavy snacks.

A mid-afternoon snack can turn into a second lunch

if you’re not careful. Don’t overdo it. Limit your

snacking to 150 calories or fewer.

Avoiding the gym.

Schedule time for exercise; don’t skip it just because

you’re busy or tired. Burning calories is important to

staying in shape.

The coffee shop.

If you need a dose of caffeine, don’t overload on

extra sugar and cream, and resist the scones and

muffins. Have a cup of coffee or tea at work, or ask a

friend to pick up something salubrious for you so you

don’t face the temptation.

Workplace celebrations.

Birthdays, showers, good-bye parties and the like

usually feature treats that can pack on the pounds.

Share your good wishes, but don’t go overboard on

the goodies.

Stay healthy when you travelTry these tips to stay healthy wherever you crash

Can your hotel room make you sick? Whether you’re on vacation or traveling for

work, you don’t want your accommodations to create health issues. Try these tips

to stay healthy wherever you crash:

• Get a smoke-free room. Avoid exposure to leftover smoke and nicotine by

requesting a smoke-free floor when you make your reservations, or at least a

nonsmoking room.

• Resist the minibar. Decline a minibar key when you check in. You’ll be free of

temptation to indulge in unhealthy (and expensive) drinks and snacks.

• Ditch the bed cover. Bed covers can be hiding places for bugs and other pests.

Store it in a dresser or a corner of your room before going to bed.

• Bring your own disinfectant. Wipe down the phone, TV remote, and other

devices with an antibacterial spray or wipe before using them to get rid of any

harmful bacteria and germs from previous guests.

• Use fresh cups. Don’t drink from reusable glasses and cups. Stick with your

own water bottle, or plastic disposable cups wrapped in plastic.

• Pack your own snacks. You won’t want to raid the minibar or visit the vending

machines if you bring your own snacks with you. Dried fruit, trail mix, and other

nutritious options will help you avoid overindulgence in your room and when you

eat out.

• Exercise. Take some time out to stretch, run in place, or do some simple

aerobics or yoga.

• Check the exits. Make sure you and your family (or fellow business travelers)

know how to get out of the hotel quickly in the event of a fire or other emergency.

Welcome tothe Oasis at Dodge Park

A Revolutionary Residential Care Facilityfor the Elderly and those diagnosed with Dementia and Alzheimer’s disease in Central Massachusetts

ReseRvAtions being ACCepted - opening FAll 2015

1 0 2 R a n d o l p h R o a d, W o R c e s t e R • at t h e s i t e o f t h e o l d o d d f e l lo W s h o m e

RESERVATIONS BEING ACCEPTED - OPENING FALL

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Dodge Park Rest Home Web: www.DodgePark.com On Facebook: www.facebook.com/DodgeParkRestHome 98 Dodge Park Rest Home 101 Randolph Road, Worcester, MA 01606 Tel: (508) 853-8180 Fax: (508) 853-4545

Health CornerWITH CARA ZECHELLO

DODGE PARK REST HOME REGISTERED DIETITIAN

Employee Birthdays Nicole C. 11/04Grace W. 11/06Tiffany W. 11/17Norma C. 11/24Merline V. 11/27Nereida R. 11/29

Celebrating November Birthdays

Are you caring for a loved one diagnosed with Alzheimer’s or other dementia and need a break during the day?

The Adult Day Care at Dodge Park offer the right solution for your respite care. To learn more about our Adult Day Care Program please join us for an afternoon of fun at our monthly Day Club open house with your loved one on the 3rd Thursday of each month between the hours of 1:30pm and 4:00pm .

The next open house will be on November 19, 2015.

This is a wonderful opportunity to get out with your loved one and have an enjoyable afternoon. The afternoon will consist of group discussions, music, arts, refreshments, and most importantly, laughter.

The monthly open house is FREE and open to the public. It is open to anyone at any stage of the Alzheimer’s/Dementia disease

process accompanied by friend, family, and loved ones.

Pumpkins - Not just for Jack-o-LanternsNow that summer is over and autumn has arrived we see pumpkins showing up in everything from soup to

pasta to even coffee. As a fresh, whole food, pumpkin in its purest form is packed with several nutritional benefits.

One cup of pumpkin contains only 50 calories and provides about 3 grams of fiber, which are both important for healthy weight management. This same cup of pumpkin provides 564 milligrams of potassium, about 12% of our daily requirement. Potassium is important for the body’s electrolyte balance, especially after exercising and it keeps muscles functioning properly including the heart muscle. Pumpkin is also a good source of vitamin C, with one cup containing 11 milligrams (20% of our daily requirement). Vitamin C is helpful in boosting one’s immunity.

Perhaps the star of pumpkin’s nutritional profile is vitamin A. Just one cup of pumpkin contains 200% of our recommended daily requirement of the nutrient. Vitamin A is important for a healthy immune system and for healthy vision, especially at night. Beta-carotene, which converts to vitamin A, is an antioxidant found in pumpkin. It is the carotenoid that gives pumpkins their vivid orange color. Beta-carotene has been the subject of much research. According to the National Cancer Institute, beta-carotene may play a role in cancer prevention. As an antioxidant, it may also help prevent heart disease. Studies done at Harvard Medical School have reported that beta-carotene may slow down cognitive decline. This is important research when it comes to Alzheimer’s disease and other types of dementia. In addition, beta-carotene is also helpful in reducing skin wrinkling.

When it comes to pumpkin, don’t forget the pumpkin seeds. Toast them up and enjoy them for a healthy snack. The seeds are rich in phytosterols, natural plant chemicals, and have shown to reduce “bad” cholesterol (LDL) and fight off certain types of cancer.

When fresh pumpkins are no longer available, canned pumpkin is a great alternative. Add pumpkin puree to your favorite pancake or waffle recipe too add a nutrition boost to your breakfast. Add roasted pumpkin cubes to pasta for a seasonal twist on an ordinary weekday dinner.

Roasted Pumpkin Pumpkin, peeled, seeded and cut into 2-inch cubes (about 4 cups) 2 shallots, finely diced ¼ cup olive oil Salt and pepper to taste

Preheat oven to 450 degrees. Toss pumpkin cubes with shallots, olive oil, salt and pepper till coated. Spread on a baking sheet in an even layer. Bake for 35 minutes or until tender, tossing once during baking.

Enjoy roasted pumpkin as a delicious side dish or add to your favorite stir fry or casserole.

I will be available to meet with family member to address any concern or questions regarding dietary needs or special diet for their loved one. I can be reach at Dodge Park Rest Home number (508-853-8180). Written by Cara Zechello, M.Ed., RD, LDN

ResidentsKen O. 11/5Agnes H. 11/8Clarie D. 11/15Mary M. 11/16Audrey J. 11/17Victoria L. 11/23Harvey M. 11/23Irene B. 11/29

Leonor P.

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Dodge Park Rest Home Web: www.DodgePark.com On Facebook: www.facebook.com/DodgeParkRestHome 1110 Dodge Park Rest Home 101 Randolph Road, Worcester, MA 01606 Tel: (508) 853-8180 Fax: (508) 853-4545

Contact us for Pre-Opening

special pricing!

Now Accepting Applications for Admission

Opening Spring 2016

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Dodge Park Rest Home Web: www.DodgePark.com On Facebook: www.facebook.com/DodgeParkRestHome 1312 Dodge Park Rest Home 101 Randolph Road, Worcester, MA 01606 Tel: (508) 853-8180 Fax: (508) 853-4545

DODGE PARK REST HOME

The Day ClubMand

Bringing LIFE toThose We Serve

Bringing LIFE toThose We Serve

Invite you to...

Thanksgiving Dinner atDodge Park Rest Home

Join Us To Celebrate Thanksgiving TogetherWe are so blessed and we count you among our blessings.

You are cordially invited (with all of your family and friends)to join us for our Thanksgiving Dinner Party celebration

with Paul Lamoureaux and Wayne Page.

O

RSVP Is A Must!!! RSVP to Renee Williams by November 15th

at (508) 853-8180 ext 117or [email protected]

Halloween Fun at Dodge Park!

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101 Randolph Road, Worcester, MA 01606 Tel: (508) 853-8180 Fax: (598) 853-4545

Please join us for our FREE monthly support group with Elaine Kapperman, LIC-SW. For family of individuals with dementia Nov 10, Dec 8, Jan 12 (2nd Tuesday of every month for children and spouses of individuals diagnosed with Dementia and/or Alzheimer’s disease) The meeting is from 6pm - 8pm.

For more information or to RSVP contact Debbie Williams (508) 853-8180. FREE Monthly Support Group “Open to The Public” Please join us!

Alzheimer’s & Caregiver Support Group Meeting

Neighborhood Connection is now digital!Email [email protected] to get it delivered to your inbox each month. Print editions will mail out every other month only.

Monthly Support Group “Open to The Public”2nd Tuesday of every month for children of parents

with memory impairments.