For the last 10 years, Dr. Rivera’s practice has been dedicated to the care of patients in nursing/rehab facilities and assisted living facilities, particularly those with dementia units. Much of the work in these units is to intervene when someone has acute changes in mental status or delirium – usually increased confusion, disorientation, waxing and waning levels of consciousness, agitation, visual hallucinations, etc.
Over 50% of consults received are for some type of agitation – from wandering, to exit seeking behaviors, from being combative or physically aggressive, to sexually inappropriate behaviors. Many residents experience increased confusion and agitation in the later parts of the day, something we call “sundowning.” Issues with depression, anxiety, insomnia, and changes in appetite are common complaints. Dr. Rivera has a reputation for excellence in this kind of work, even with the most difficult of patients or situations.
Dr. Rivera believes that every form of healing has it’s place. He’s had great results with, and strongly endorses and encourages the use and implementation of holistic alternatives in the care of dementia related symptoms. Modalities like music, massage, laughter, calming rooms and bathrooms, aromatherapy, gardening, etc., can be powerful tools in minimizing the use of potentially dangerous medications.
As of July 1st, 2013 the new focus of Dr. Rivera’s practice is home-based dementia care – Taking the knowledge and expertise gained in working with those with the most severe forms of dementia, and helping those who are still at home, or at an ALF, to remain as independent and functional as possible, for as long as possible.