I’m a member of the ‘sandwich generation’ and need help now that Alzheimer’s has entered the picture

May 17, 2012

- Alzheimer's Care, Blog, Elder Law Articles

“Sandwich generation” refers to individuals or families that find themselves raising not only their children but also parents or other elderly relatives, often while also holding a job. This obviously is a complicated scenario and can be very stressful for everyone involved. The oldest might become harsh or impatient with the younger members of the household, and vice versa. The younger ones might feel as if their grandparents are encroaching on “their” space. Trying to be a primary caregiver in this environment can be an especially complex minefield, and it is highly recommended to join a support group to obtain some coping strategies. In addition to this, you might want to look up a support group for children of people with Alzheimer’s. The type of “blended” family described above can work, despite any battles that might break out. One place to find some assistance is the American Health Assistance Foundation, which has a number of very helpful publications. The national Alzheimer’s Association also has many resources. Its contact center is available 24 hours per day at (800) 272-3900.

What’s recommended when looking for an in-home caregiver?

By Anthony Ferraro on

May 16, 2012

- Alzheimer's Care, Blog, Elder Law Articles, Medicaid and Paying for Nursing Home Care

There are several groups that can give you a list of private-duty agencies that provide in-home care in your area, including: the Alzheimer’s Association, your Area Agency on Aging, Department on Aging, and Social and Rehabilitation Services. You can find a wide range of abilities and offerings, from aides to sitters and homemakers. They can perform specific or general duties. If you need skilled care or a nurse for something specific, you should contact a home health agency, or speak with a local healthcare provider such as a skilled nursing facility or hospital, which might have referral groups or divisions that they themselves operate. Typically, a physician must be involved when setting up skilled services. This encompasses any nursing, physical therapy, occupational therapy or similar services. So check with the physician’s office for more referrals. Another great place to find information and referrals is through fellow members of a caregivers’ support group you might be a part of. You also can attempt to hire an individual on your own. There are many individuals who work independent of any agency. But quality varies and while you should screen any direct caregiver or therapist, you must really check out any individual you might hire on your own to provide in-home care. Groups such as the Alzheimer’s Association have lists of individuals for hire but they typically will pass along only feedback they have received about caregivers, and not make recommendations. There are many variables involved, so you need to take appropriate caution during this process. You must treat this as what it is: a business or employee-employer relationship. Use an application form, even something generic like those that can be found at office supply stores. Obtain a copy of valid identification cards, such as a driver’s license, Social Security card and anything else that might indicate stability and training, such as a certificate for nurse-aide training. Since we’ve established this is an employee-employer relationship, ask for a resume and references. Any reputable caregiver will have them and be glad to give them to you. Interview more than one candidate. It’s the only appropriate thing to do, unless you are under extremely odd circumstances. Schedule a time when each candidate can spend some time with your loved one in his or her living setting. Notice how the two interact. Is your loved one comfortable with this person? Be sure to include your loved one in the process. It’s widely observed that individuals with dementia seem to have a “sixth sense,” so to speak, about judging people. So be sure to let your loved one have a say before you make a hiring decision. You might need to hire a certified nurse aide (C.N.A.). They take care of basic but important tasks such as bathing, dressing, feeding and administering medications on time, in the proper quantities, etc. They must undergo a significant number of hours of formal training and typically have experience dealing with individuals with Alzheimer’s. Another thing you’ll want from your caregiver is proof of CPR training. Get a copy of their certification. Once you have hired someone, the process isn’t over. Keep good records, including identification slips, background check results, copies of certifications, etc. Make sure your new employee is appropriately oriented to your house — and to any special needs or preferences your loved one has. Give detailed instructions about routines since people with Alzheimer’s seem to do better with familiar patterns of activity. Suggest activities and interests your loved one enjoys so the caregiver can get started on incorporating those, or expanding upon them as possible. Nurse aides also can help with chores around the home, such as cleaning or cooking. But if that is all you will have them do, then hiring a homemaker specifically for these tasks would probably be a better, more economical idea. Realize that, in some states, paying an individual to take care of your loved one (with proper care contracts in place) might cause Medicaid eligibility issues. You should consult an elder law attorney to be clear on this.

How likely is it that my loved one with more lucid days and less lucid days with Alzheimer’s?

By Anthony Ferraro on

May 11, 2012

- Alzheimer's Care, Blog, Elder Law Articles

It is very likely he or she will be just like anyone else: The person will have good days and bad days, clearer days and foggier days. Sometimes it will seem like nothing is wrong; others, there will be no doubt Alzheimer’s is at work. On a good day, the person might remember things like he or she once did. Patients might appear upbeat and say they are feeling good. You should savor these times. Such lucidity is a blessing you should embrace. You might begin to question whether the Alzheimer’s diagnosis is accurate. This would be false hope. Realize these times should be savored, for they will pass. Caregivers tend to go through a grieving process and that can lead to fantasizing. It might seem like everything is just a bad dream, or that things will go back to the way they were one day. Denial might set in. We look forward to our loved ones “snapping out of it” any day. If and when lucid days come around, they can validate such fantasies. But then reality will hit us squarely between the eyes. While you must let yourself grieve, you also must remember to enjoy each moment of the good times. It might be a few good days, or even just a few moments. Enjoy them regardless! “Quality” is more important than “quantity.” This is what you have to remind yourself. If your quality time is limited, at least you have those moments to draw from. Look at them as a blessing — and look back to them to help you get through bad times. For more information, please click here to download our FREE “Indispensable Alzheimer’s Kit.”

Does music help aggressive behavior in dementia patients?

By Anthony Ferraro on

May 9, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Generally speaking, most individuals with Alzheimer’s or other forms of dementia respond well to music. Music is known as “the international language” and can be very helpful in many therapy endeavors. Of course, responses depend greatly on the individual, the Alzheimer’s stage — and sometimes even to the degree the person liked (or didn’t like) music previously. Then, there’s also the issue of what kind of music is to be played. There is a stereotype that seniors will like only “old music,” or music that was popular when they were much younger. But that is an unnecessarily narrow view. Any music from the time of their birth to the present day is “from their era.” Too often when working with people with Alzheimer’s, or seniors in general, we think too narrowly of possibilities. If you play music for a loved one with dementia and it doesn’t appear to be helping, try a different kind of music. Almost any genre of music — including classical — can feel hectic or stressed. This can over stimulate someone with weak defenses. Then, it ironically could become a case of causing more anxiety or agitation, rather than soothing it. Individuals with dementia can’t always say how they’re feeling, so the next step might be to act out. Therefore, closely monitor what is played, and what works. Music or recordings that can be described as “white noise” are often soothing to individuals with Alzheimer’s. While “white noise” machines can be purchased, just running a fan or being somewhere near a bubbling fountain also could help your loved one relax. You also can find CDs or other recordings with calming sounds of the wind, the ocean or birds, though you will want to observe whether any bird sounds become over-stimulating. If they do and start to create agitation, just turn off the recording. Just like other people, sometimes individuals with Alzheimer’s want and need silence. So when all else appears to fail, try some peace and quiet! For more information, please click here to download our FREE “Indispensable Alzheimer’s Kit.”

Sometimes my mother totally refuses to cooperate with me (for dressing, cleaning up, etc.). But if we call in a familiar nurse-aide, Mom’s a peach and there are no problems. What gives?

By Anthony Ferraro on

May 3, 2012

- Alzheimer's Care, Blog, Elder Law Articles

The difference in relationships matters. Non-relatives sometimes have easier access or more cooperation precisely because they are NOT family members. Many times, loved ones are harder on their relatives than anyone else. Your mother probably feels she can act however she wants around relatives. Sometimes, loved ones don’t have good relationships to start with and this is just continuation of that dynamic. But usually a person will be on his or her best behavior for someone outside the family. That’s good news for aides, doctors and sometimes even strangers with whom they interact. Sometimes all the family contact, and familiarity it brings, is too much. You both might just need a break from one another, having spent too much time together already. This is not something you should take personally. Your mother still loves you. Just remember that she has a form of dementia. Many people don’t realize that almost all inhibition is eliminated with dementia. It’s a bit of a mystery, frankly, how some people can maintain such good manners with someone who is not as familiar with them as you. It’s important for caregivers (such as yourself) to learn to let things go. You should weigh things such as: If all she wants to eat is chocolate pudding, is it hurting anyone/anything? If she wants it for breakfast, it might not be the most nutritious thing for her, but it’s not going to harm her (unless medically contra-indicated, of course). Learn to step back and evaluate the overall implications of odd requests or off-plan behavior. Choose your battles wisely. Often, if a loved one with Alzheimer’s doesn’t want to eat or dress or do some other common task, she or he will cooperate when you ask again later. For more information, please click here to download our FREE “Indispensable Alzheimer’s Kit.”

If a person has Alzheimer’s disease, how important are routines for them?

By Anthony Ferraro on

May 1, 2012

- Alzheimer's Care, Blog, Elder Law Articles

This is a very good question because routines are very, very important. A steady routine will be familiar and comforting as a person with Alzheimer’s progresses into the disease and loses more memory. If you live with your loved one, make everything a part of a schedule or routine if possible. You should do this for both of your sakes. Rituals, such as at bedtime, are critical. If your loved one always ate something particular before bed, or checked a door(s) or performed some other task, you should continue with it. If your loved one becomes restless before bed time or is having a hard time getting to sleep, allow him or her to get up and do anything in their ritual. This will help the person feel at home. To reiterate rituals and routines are very, very important. A daytime routine might include specific medication or eating times, checking the mail, bathing, going to get a haircut, grocery shopping with you and just about anything else you want to include. Putting drinking water into the routine is great because it can add to a sense of process but also keep a person with Alzheimer’s hydrated, which can sometimes be an elusive task. You both should also be sure to include relaxation time in your regular schedules. Some other good things to include in a daily schedule could be: feeding a pet(s), folding laundry, reading the newspaper, going for a walk or drive, taking out the garbage, getting a snack, drinking coffee, etc. It might be difficult, but while trying to keep a steady routine, you have to avoid becoming too rigid. If the activity you had planned isn’t working out well for your loved one, be flexible and don’t argue. Move on to the next thing and go with the flow. If you have an activity that simply must be done (such as dressing), take a break from it and try again late. For more information, click here to receive our FREE “Indispensable Alzheimer’s Resource Kit, ” which has additional information regarding caregiving issues. In addition, attend an Alzheimer’s Support Group. To find one in your area click here.

Would it be helpful to have my mother hold a doll since she is in Stage 5 of Alzheimer’s and always looking for ‘her children’?

By Anthony Ferraro on

April 27, 2012

- Alzheimer's Care, Blog, Elder Law Articles

There are pros and cons to this, but it is probably worth a try. It has worked for many people who have Alzheimer’s since a basic human need is to nurture. There have been many people with Alzheimer’s who have thought the doll was real. It can be beneficial, as they carry the doll everywhere and make sure it is cared for. However, it also can have negative effects since the person with the doll might take worrying about it to extremes. Take, for example, one woman at an adult daycare center who had been a volunteer in healthcare facilities much of her adult life. She loved to take care of people and things, and she liked to keep busy. The staff gave her a doll. It looked like a great idea at first and appeared to be a solution to her “busyness.” But after just a few hours, she began worrying about feeding the “baby.” She worried so much, she became agitated. Some clever staff members told her they were baby sitting and were able to get it out of her sight that way. With the “baby” out of view, the woman began to calm down. Staff put the doll away for several months and then gave it back. The woman was able to carry it around and not stress out about it at that point. Your mother needs a lot of validation and assurance — on an ongoing basis. Assure her that her children are safe and doing fine. Most likely she is thinking about them as being young and is therefore worried about their wellbeing. Try to redirect her toward other kinds of activities to keep her mind busy, and off her children. One alternative that has worked well is stuffed animals. A person with Alzheimer’s has the need to touch, love and give affection, just the same as anyone else. Stuffed animals can fill that need.

Are animals and Alzheimer’s a good mix?

By Anthony Ferraro on

April 26, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Pets in general, including dogs and cats, can be very therapeutic. Many nursing facilities, in fact, incorporate “pet therapy” into their daily routines as much as they can. However, as with many treatment or alternative therapy options, everything is contingent upon the individuals involved. Some will respond well to animals, some do not. Sometimes, responses are entirely a surprise. Take, for example, the resident of an Alzheimer’s unit who grew up on a farm. She liked animals, but because they were never allowed in the house, an aide had to take her for a walk whenever visiting pets were brought into her facility — her HOME. It upset her to see dogs in her “house.” Many people fear animals, including dogs. Some dogs, however, can be trained to be excellent companions or “playmates.” They are taught to remain calm around elderly individuals and will not to become rambunctious or jumpy. Often, the trained pets are taught to lie nearby so they can be petted throughout the day. It also creates a more leisurely “home-like” feel. If a person with dementia has enjoyed pets most of his or her life, odds are pets going to be well-received and enjoyed even after Alzheimer’s or another debilitating condition arrives. Sometimes caregivers or family members buy a dog specifically to give an individual something to focus on and to provide more companionship. A pet will create an entirely extra world of activities. A person with dementia can feed and/or water a pet, or brush it or take it for a walk. This also can raise self-esteem because the person will acquire a sense of responsibility for a living, breathing and tail-wagging friend. Every individual needs to feel needed and a pet can fill that purpose. If there is a dog already in the house, watch to see if its behavior changes, too. If a dog senses something is different, it will respond and, in this situation, become very protective. The dog is likely to stay close to the person with dementia and act as guard and protector. If the dog belonged to another family member or was not particularly close with the Alzheimer’s patient previously, it doesn’t matter. The animal will remain close with both of you, but it most likely will take a lead in accompanying the person with Alzheimer’s. Many types of pets can be therapeutic. Cats have soft coats and like to curl up in laps. This is an example of the way pets can be wonderful additions to Alzheimer’s patients because they offer “unconditional love.” Fish can be fun to watch and are quite soothing. Birds can serenade, and also be fun to watch — inside or out. Filling outside bird feeders might be a good activity for you and your loved one to complete together. Then, you can sit back and watch the grateful birds fly in for their snacks.

Can art be therapeutic, even if a person was never an artist or very ‘artsy’?

By Anthony Ferraro on

April 25, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Art is an excellent way someone can express himself in a non-verbal manner. It is one of the common therapies used for people with dementia. In essence, it is another way of journaling thoughts and feelings, just in pictures not words. Caregivers should remember to savor the moment when a person with dementia is creating art; it is not the end result that should be celebrated (necessarily) but rather the process. If an individual with Alzheimer’s is having fun while creating some piece of art, realize you have achieved success and art will have served its purposed. It is “the process of getting there” that is the key. Realize ahead of time that your loved one might finish a painting with satisfaction but a short time later fail to recognize it. There is a highly commendable program run by the Alzheimer’s Association called “Memories in the Making.” It involves volunteer artists going to facilities to work with watercolors with small groups of people with Alzheimer’s. The facility purchases supplies for the project through the Alzheimer’s Association. To see someone who hasn’t spoken for months pick up a brush and begin to paint is beyond expression. It is incredibly uplifting. You can simulate this program in a home setting, too. Seek out artists in your community who would be interested in volunteering some time. The artist can either recommend materials to you or bring them himself or herself. It’s not uncommon for someone with Alzheimer’s to resist taking part in an activity like this. Praise their efforts, no matter how big or small, and encourage them throughout. Remember: It is the process, not necessarily the end product, that is the goal. That said, often you will still be amazed at the results.

As the primary caregiver for somebody with Alzheimer’s, should I journal my thoughts?

By Anthony Ferraro on

April 24, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Absolutely. Keeping a journal is a good idea for everyone — especially someone with a stressful and emotional burden such as caregiving. Journaling means putting your thoughts on paper and keeping them between you and the paper. Keep the journal in a secure place if you’re worried about someone else reading it. Just don’t forget where it is so you don’t write in it! Actually take time to schedule journaling into your routine. You don’t have to find time every day, but you should make a point of doing it regularly. Journaling is to the brain and emotions what physical exercise is to the body. You don’t have to write a lot, just enough to get things out and off your chest. Write about your thoughts and feelings. Write of your anger, resentment, fear, guilt and any other strong emotions. You can even make this a practice of “writing to the disease.” Go ahead and tell it how it is upending your and your loved one’s lives. Let it know you hate it. Tell it that it is messing up your retirement years after so many years of hard work and planning. This is a good way of dealing with your feelings. It is healthy to do so. Your journal also can reflect your observations about your loved one. Include notes on patterns that might emerge regarding behavior, eating, sleeping, toileting, etc. This will help when you talk with the doctor. It also can help you reflect on the way you handled certain situations. Journaling is a good way to help you sort out your thoughts — on many levels. If you’re feeling overwhelmed, it can help pull things back into perspective. It is important, however, not to allow journaling to be your only outlet or release. Human interaction is still very important. You must continue talking with friends and other members of your family. A support group might also be a good idea. Everybody needs human contact and socialization to re-energize. In fact, The FREE Indispensable Alzheimer’s Kit includes a Caregiver’s Journal specifically for this purpose. Click here to download it now.