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How do I deal with my sometimes-explosive outbursts at my mother?

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April 18, 2012

- Blog, Elder Law Articles

Anger is a common emotion when caring for a loved one, especially if she or he has Alzheimer’s. When you see someone you knew as being independent and who was likely somebody you looked up to now having difficulty with simple things, it can be very difficult. Your loved one might not be able to understand much of what is being said to her. She also likely has forgotten many treasured (and helpful) memories. Why wouldn’t you be angry? You are losing a little part of this person, day by day. You are grieving, which naturally can lead to anger. If your yelling occurs only occasionally, you’re may have to own up to the fact that you’re simply going to lose your temper every now and then and yell. If and when it happens, practice letting go of any guilt you feel. Give yourself a break: You are human. Yelling isn’t good, but it happens. This also might be a sign that you need a break from delivering so much direct care for your mother. Taking her to an adult day care center will give her something to do — and give you a break for a while. Or you can hire someone to come into the home so you can go do something on your own. Take advantage of other family members, friends, neighbors and volunteers who might offer to give you a break. You can also find relief by joining a support group or finding a suitable counselor. Knowing that you are not alone in these types of situations usually decreases the pressure you feel. You can also collect some tools to help you cope. If you find the yelling becoming more frequent, you might end up having to find other arrangements for your mother’s care. Quality time with her is more important than quantity time. If your time together is only stressful and becomes consumed by more and more yelling, it is time to make a change. This could mean a group home, nursing home or assisted living situation. Then when the two of you visit together, you might truly enjoy it more. It could be a healthy move for both of you. You shouldn’t feel guilty about having her live in a facility, if you go that route. You can still be very involved in her life, and help manage her care (in coordination with the facility). This can lead to more enjoyable time together. This might entail taking her out to a nearby park, a nice restaurant or even your home. You can have fun together. For more information, an excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.
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My grief is nearly constant about seeing my loved one slowly slip away. How can a person cope with this?

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April 11, 2012

- Alzheimer's Care, Blog, Elder Law Articles

First, realize that grief is natural and should be allowed to happen. You are not alone in this, and yet you ARE unique. To that end, if you know someone else in a similar situation, try not to compare yourself to him or her. They might handle the process differently. Some grieve quietly, some quickly, some prolonged. The goal is for all to reach a stage of acceptance. How can you alleviate your pain? Try writing in a journal. Grieving actually is an array of emotions — anger, depression, shock, resentment, fear, loneliness, anxiety — that need to be expressed. If you can journal your thoughts, it can create an “escape” to a “safe” place, which is easier than going to a support group or a counselor, or even talking with a friend. Writing in a journal is an immediate and healthy way of coping. You should still consider attending a support group. It can be very helpful. Go with an open mind — don’t become overwhelmed when you hear others describe their situations. Everybody will have his or her own similar, yet unique, situation. Remember, too, that you’re not only there to get help — you’ll also be helping others. We forget that doing something for others makes us feel good about ourselves, which enhances our personal health in several ways. If there is someone you can confide in, such as a close friend(s), talk with her or him as often as the two of you can. Instead of feeling that we’re a burden to others, we should realize “that’s what friends are for” was coined for a good reason. Our friends want to help us, but usually we have to make a first step somehow. Or at least a welcoming one. Don’t worry about having too many people to confide in, or feeling obligated to confide in more people than you might want. Usually, just a few will become the ones you rely on. You also should consider talking with a member of the clergy whom you know and trust. Many are trained for just these kinds of talks. In many church communities, there are also others with whom you could speak. Depending on your needs, do not think twice if you believe you might benefit from a professional counselor who is trained in grief consultations. Some of them lead grief support groups — something you might want to consider (as opposed to just a general caregiving group). Family members, of course, can fill many of these roles. Some families are always close when it comes to personal matters. But keep in mind that even those families that don’t consider themselves “tight,” often have members who answer the bell and are nonetheless there for one other when the going gets tough. If you have family members who are either unable or unwilling to “be there” for you, however, you definitely should turn to one or more of the sources mentioned above.  For more information, an excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.
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My mom has Alzheimer’s and will soon live with me, but I need to hire a caregiver. How can I make sure I get a person with the right skills?

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April 10, 2012

- Alzheimer's Care, Blog, Elder Law Articles, Uncategorized

This will depend heavily on how much care your mother requires. A private agency or home health provider can help determine what skill levels are needed and find you a suitable worker. You might need somebody just for housekeeping-type chores, such as cooking and cleaning. If your mother has not moved past the beginning stages of Alzheimer’s and remains fairly independent, you might want to hire a sitter so she isn’t left alone. If this is the case, make sure you specify you want a sitter with experience with dementia patients. If your mother requires more help with things such as bathing, toileting or dressing, you will need a certified nurse aid, or the equivalent. A nurse would become involved only when your mother would require skilled services. These become needs typically after a hospital stay. A home care agency can provide the aid and advice you require. An agency will do the background checks, actual hiring, training and payment of the worker — and dismissal if/when it’s needed. Many people think it’s worth it to pay for this bit of extra support. If you hire an assistant on your own, you can count on spending a lot more time on the particulars, though the monetary cost will likely be lower. Again, depending upon your mother’s abilities, adult daycare is another option. Your mother could attend all day and get any or all of the services mentioned above taken care of. She would receive supervision, meals, activities, socialization and assistance as needed. For you, as a family caregiver/hostess, it will give a needed break. Your mother probably also will like the change of scenery and socialization, among other things. And she should get good care. This is a scenario many people face. Remember to go with your gut feeling when you are dealing with anyone caring for a loved one. If you are not entirely — as in 100% fully — comfortable with a person charged with taking care of a loved one, you should reconsider and make changes as necessary.  For more information, an excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.
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My mother refuses to take a tub bath — something she always loved. What can I do?

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April 9, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Hygiene is often a concern as Alzheimer’s progresses. Reluctance to get into a bathtub often has to do with safety concerns for the individual involved so realize what you’re up against. A fear of falling might make her fearful about climbing into the bath. She also might be worried about the water being too cold or too hot, so make sure the temperature is suitable and THEN try to get her into the bath. Difficulty dealing with spatial relationships also can be a challenge with Alzheimer’s patients. When walking, they might not realize a black line or patch on a carpet is not a hole they can fall into. While bathing, they might not be able to discern where the water line is. Adding a few drops of food coloring to the water or using bubble bath can help ease concerns or help your mother discern where the water begins. Another possible idea is to put a brightly colored bath mat on the bottom of the tub. Your mother needs contrast to help determine where the tub begins and ends and where the water begins. Frequently one of these tips or some other modification you discover will lead your mother to start enjoying baths again.  For more information, an excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.
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My mother has Alzheimer’s and won’t shower any more. How do I keep her clean?

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April 6, 2012

- Alzheimer's Care, Blog, Elder Law Articles

People with dementia typically are reluctant, if not downright fearful, of bathing. This is not uncommon. Take into consideration how she has always bathed and use that as a template for how to proceed. Trying to adhere to the same schedule, rituals and routine will be helpful. If she always has bathed in the morning, keep with that. If she bathed four times a week or daily, stick to that. This is such a challenging issue, quite often family members will hire a bathing aide. Home care agencies can help you find someone if you don’t have someone on your own. It can be a win-win, as quite often the person with dementia will react better to someone outside the family, especially when it comes to something so potentially uncomfortable or embarrassing like bathing. Here are some suggestions for addressing the challenge of bathing someone with dementia: • Let the shower warm up the bathroom for a while before getting under way. Taking off clothes in a cold room is uncomfortable. • Play soft, soothing music. • Ensure good lighting in the bathroom. Fear increases when a person can’t see well. • Use a shower chair so the person can feel steady and comfortable. These can be obtained at medical supply stores or certain pharmacies. • Use a handheld showerhead or wand. This makes the situation less threatening, and it’s less likely to cause anxiety from water beating down on the person. • Use a type of soap she has always preferred. It will help if she recognizes a favorable fragrance. • See if she can bathe herself at all — then let her do it, giving her as much privacy as possible. • If you have a bathtub and she’s mobile enough, try to let her soak in it. This can be soothing, and it also allows cleaning of areas that might be difficult to get to with a shower. • Sponge baths are a good option between “regular” baths. Hospitals and nursing home regularly conduct bed baths, so there is plenty of precedence for it. The market has responded with various products that can help, such as dry shampoo. For more information, an excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.    
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What do I do if my dad, who has Alzheimer’s, decides to “call it quits”?

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April 5, 2012

- Alzheimer's Care, Blog, Elder Law Articles, Uncategorized

This is a good question for Alzheimer’s patient caregivers since it’s not an uncommon scenario. At some point, you dad may decide he’s ready for death. This could be verbal, but if he can’t talk, you still might be able to sense it. By this point, no doubt, the disease will have been a tough battle. He could be very tired. As hard as it might be for you or other family members, you have to let go and allow your father his wish, and the peace he is seeking. Death is, after all, a part of life. For him, death is a good thing. For those left behind, it can be difficult. It is never easy, no matter how long the disease has been around or how much you’ve prepared for a final good-bye. By this time, you will already have lost a lot of your father along the way, yet it is tough to come to grips with because it is so final. Let yourself grieve. Talk with others around you — friends, family, professional counselors, clergy, etc. Continue to speak with your father. Reminisce together. Sharing your feelings and thoughts can be a healing process. Of course, contact your father’s physician if you sense he is ready to die. The doctor might order hospice care. It is a wonderful service that will not only help your father but also you and the rest of the family. Hospice workers’ goal is to make your father comfortable, peaceful and pain-free. They also want to support you in your time of grief and lighten your load. They will allow you to rest and recoup energy. Hospice is there to help the entire family in the grieving process.  An excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.
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I moved my father with Alzheimer’s from out of state to be near me. Any suggestions on how to help him adjust to a new area?

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April 4, 2012

- Alzheimer's Care, Blog, Elder Law Articles

First of all, give it time. Your father might need a week, or months, to adjust. He’ll also need to be able to let out any concerns and other feelings. His concerns need to be answered and his feelings validated. Grief likely will be among the feelings. After losing his job, his wife and now his long-time home, he is losing a part of himself each day, too. You’ll find out — if you haven’t already — that many times it’s a dead-end street when you try to reason with someone with Alzheimer’s. Your father could become more confused and unsettled if you try to explain in detail why you had to move him. When he asks about the situation, you can tell him, “I know how hard this move has been for you, but I love you so much, I wanted to be nearby and have you close to me.” Here are some other things you can do to help him adjust:
  • Make a photo album of things that bring up good memories so he can review it over and over. Include pictures of family members, friends, the house, and favorite vacations and accomplishments. He can look to his heart’s content, several times a day, if he wants. When he’s feeling stressed or said, this should have a calming effect on him.
  • Make sure there are personal items he can recognize in his room.
  • Ensure that he knows his friends and neighborhood. Make introductions as necessary.
  • Let him write a journal, in which he can record his feelings at least once a day. (This could require extra help from you, the caregiver.)
  • Find a local support group near your house that he can attend. Call the Alzheimer’s Association for recommendations.
  • Have him talk with various people (not just you). Whether it’s a professional counselor, a priest, a friend or someone else, it will help immensely.
Remember: Your father will need a lot of time and attention. Give them. Constantly reassure him and affirm his presence. Repeat that he is in a safe place, that you love him and that you will continue to make good, healthy decisions for him, based on his wants and needs. Tell him often how well he is doing. Thank him profusely for whatever he helps with. Include him in as much decision-making as possible and ask him for input at a level he can handle. If you do all of this, things still might be difficult, but you will be doing the best that you both can. And who knows, he might surprise everyone and adjust with little difficult.  An excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.  
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What can we do for my mother, who used to love to read but now doesn’t?

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March 30, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Try giving her short stories or magazines if the issue has become that books are now too long. You also can involve shorter bits of reading activities, such as asking her to read parts of recipes while you’re cooking. She’ll feel good about helping, too. Of course, there are audio books, which you can check out from your local library. You can choose from all kinds of books and other printed material. In some places, you can actually check out a tape player or other equipment to take home for as long as it might help your mother. Some of the tape players are extremely user friendly; many are intended for use by people who are blind or have other disabilities. Sometimes, headsets are available. This helps allow listening in many places — and without disturbing others. Just pay close attention to the volume. If it becomes too loud, this can cause overstimulation, which might then produce agitation, anxiety or wandering. You can check out all kinds of books — inspirational, funny, upbeat, etc. Many libraries also have reading programs. Perhaps a friend or family member can take her to one of these, making a “trip” of it, if she’s up to it. Seniors centers also offer many adult activities. Adult day care centers are another option in many areas. This can be for most of the day or for just a fixed amount of time. If your mother can still read but doesn’t comprehend, she could read to other individuals, thereby feeling helpful and building some self-esteem. Many times, seniors centers have story times, when she could either read, or be read to. You also can seek out volunteers — such as girls or boys, neighbors, church members, relatives or members of a service organization — who can read to her at her home. These are great service projects for students, who nowadays often need service hours in order to graduate. There are many people who might be willing to help: They just need to be asked. Also, reading together could be some of the best quality time you spend with a loved one. But if you’re not able to do this, don’t feel guilty. Find someone else to do it in your place. There is no doubt, however, that if you’re looking for something to do with your mother, reading to her could be a big help for both of you. Even if she does not totally understand what’s being read, she will be experiencing an activity that she has always loved, and that will feel good to her.    
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My father thinks people and events on TV are real and he often wants to interact with them? What should I do?

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March 29, 2012

- Alzheimer's Care, Blog, Elder Law Articles

There have been people with Alzheimer’s who have refused to do something until getting an answer from a TV character; others have thought music shows are actual concerts. This has worried family members, who have wondered whether they should cut off TV watching altogether for their loved one. But you have to think it over: Is this causing any harm? This is not an uncommon behavior for someone with Alzheimer’s. You have to weigh what the TV situations might be doing to your loved one. Does watching TV become distressing, or are the characters and stories seen as friendly? Often, it’s the latter, and you can never have too many friends! If TV scenarios and people become threatening to your father, then you must limit how much TV he watches. If there is a TV in his room, you can remove it. Odds are, it isn’t doing much good for him if stress is involved. If or when he sees other residents watching TV, his attention can be redirected toward other activities. If he’s not living at home, talk with the staff at his care facility and let them know of your concerns. Tell them you would like to have his TV time limited. They can help redirect him toward bingo or other activities instead. If there winds up being no TV in his room, ask staff members to take him to one of the facility’s common areas to watch a favorite show(s) there. If there is a VCR or DVD player, you can bring programming that you have purchased or rented so he can view it.    
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What kind of support is there for a person with Alzheimer’s?

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March 22, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Head to www.alzhope.com. That’s where people with Alzheimer’s can become part of a loving community, can post questions to others caring for their loved ones with Alzheimer’s and more. Another good place is the Alzheimer’s Association’s website (www.alz.org). It has a list of programs offered, including for supporting individuals diagnosed with Alzheimer’s. Link from this nationally focused website to the appropriate local association. That will get the person resources closer to home. Perhaps the most common support is an early-stage support group. These are sponsored by the Alzheimer’s Association and are spreading around the country. These are primarily for the support of individuals who have just learned of their Alzheimer’s diagnosis. An experienced facilitator guides the group in discussions about issues such as the meaning of the diagnosis, family dynamics and emotional issues, and financial and legal concerns. This is a place to express one’s deepest feelings in a safe place — with people who will identify and understand. These groups laugh, cry, eat and problem-solve together. The groups meet once a month on average, typically for about an hour and a half. Someone from the Alzheimer’s Association will be able to judge individuals to determine whether the meetings would be a benefit to them. Meanwhile, family members have simultaneous meetings in their own special area (often in the same building). Professional counselors, members of the clergy and home health agencies also are options for individuals’ support. You also can get in touch with the Alzheimer’s Disease Education & Referral Center (ADEAR) at (800) 438-4380 or www.nia.nih.gov/alzheimer’s, or the National Institute on Aging/Alzheimer’s Disease Information at www.nia.nih.gov or (800) 222-2225.
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