My mom thinks, after a few sessions, that her doctor-ordered speech therapy is a waste of time. Should we put up with the stress of forcing her to do this if she doesn’t want to? | Chicago Long-Term Care Planning Attorney Anthony B. Ferraro

August 9, 2012

- Alzheimer's Care, Blog, Elder Law Articles

You better go talk to the physician involved before you assert yourself here. Also, discuss this with the speech therapist to find out what type of therapy work your mother is undertaking. The therapist should have her individualized care plan available to discuss. It should include a goal and various steps for meeting it. Speech therapy does a lot more than most people realize. It is not just about talking more clearly. Some of the most important work may have to do with swallowing issues, which can be quite dangerous if not addressed appropriately. As Alzheimer’s disease progresses, for example, swallowing becomes more difficult, sometimes to the point of being life-threatening. Choking is a big concern. Speech therapists can assess such situations and apply therapies as needed. Rather than just having a person form sounds and letters, speech therapists also conduct swallowing tests on people with dementia — sometimes with the use of X-rays. These can help form care plans. It is easy to see why an Alzheimer’s patient might not understand all of this. You probably will want your mother’s doctor to explain the seriousness of the situation to her, and why the speech therapy is needed. Then, if your mother complains in the future, you can rely on the authority of the doctor. You also will both be more knowledgeable and familiar with the reasons for speech therapy. For more information from the Alzheimer’s Resource Kit, click here.

How will we know when it’s appropriate to move my dad from adult day care to a nursing home, or an assisted living facility? . | Chicago Long-Term Care Planning Attorney Anthony B. Ferraro

By Anthony Ferraro on

July 26, 2012

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

The answer is simple: When you no longer can care for him at home. Adult day care is just a day service, so it occupies only part of the time. Care at home is still needed for nights and weekends. There are some adult care centers that offer evening and weekend services, but often it is not enough. Some people “package” services from a home care agency with the time spent at adult day care. In addition, a home care agency can assist with evening and weekend care to reduce the strain on you, and keep your father at home longer. But as you can see, that takes quite a bit of coordination, and still a fair amount of resources, to do properly. Everyone’s situation is different and everyone has a different threshold, so you have to figure out what is appropriate for you and your loved one. It is time to consider a nursing home or assisted living facility if you are feeling overwhelmed and the quality of life at home has fallen. You need to remember that it isn’t fair to either of you if your time with your father is so strained it diminishes your quality of life. If he were to go to an eldercare facility, your time together would likely be decreased, but then your time together could be that much more focused on doing things you like together, and in a lower stress environment. Some assisted living facilities have staff members who are trained and equipped to work with Alzheimer’s residents. But many do not. You must research any long-term care operator’s limitations before making a decision. Some will accept Alzheimer’s residents until they become incontinent or require some other type of skilled care. In that case, you must consider what an extra move might mean to your father’s well being and sense of orientation. This is a decision that you, as primary caregiver, must make. Everyone has different limitations and goals. When you know you have reached your limit, make the most appropriate, effective decision for everyone involved. Realize you have done your best and that that is good enough. Let go of any guilt, for it can only destroy you. For more information about Alzheimer`s, click here for our Resource Kit.

The nursing home changed my father’s medications and now wants to evict him and have him checked him for possible inpatient admission because of aggression. Should I have him assessed if the odds are he won’t be taken back by this facility?

By Anthony Ferraro on

June 29, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Extreme agitation is typically the source of aggression. If the agitation is under control, the aggression should lessen, if not stop altogether. If you believe the nursing home’s staff members did not handle this the best way possible, you can meet with the facility’s director of nursing and the care-plan team to discuss the situation. If that doesn’t bring satisfaction, you can take it further, to the state’s long-term care ombudsman program. Ombudsmen are trained volunteers who, upon request, advocate for nursing home residents and their families when there are problems with a facility. If you are confident that staff members did all they could, your father needs to be assessed. Outbursts of aggression are not only difficult on the people around the Alzheimer’s patient, but also on the individual himself or herself. There is little quality to life when one is agitated all the time. There are various good assessment programs throughout the country. You can learn about some at the Alzheimer’s Association website (www.alz.org). Look for a program near your area. One good thing about an inpatient assessment is the 24-hour-a-day observation. Its value is evident because there can be additions, deletions or changes to medications — and observation of any effects of these changes. You could learn that his medication is causing his agitation. Be sure to keep his doctor informed of what you’re doing and what is happening. When he is being assessed, you have an excellent opportunity to meet with discharge coordinators or social workers. They can help you find the right facility. They may not recommend any one facility but they can give you guidance. Another thing to remember is that environment can play a huge role in how comfortable a person is. If your father is not comfortable where he is, a move might be the best idea for him. Even though moving a person with Alzheimer’s can create confusion and possibly setbacks, the odds are he will recover. Your father needs an environment that feels loving and accepting to him. Staff members are usually the key in this regard. So if/when you wind up looking for another nursing home, be sure to meet staff and observe their interaction with residents. Additionally, if your father didn’t live on an Alzheimer’s unit before, look for one now. Their staff members are specially trained to deal with symptoms and issues that accompany Alzheimer’s.

How do I handle things when the rest of my family isn’t helping take care of loved one with Alzheimer’s?

By Anthony Ferraro on

May 30, 2012

- Alzheimer's Care, Blog, Elder Law Articles

In brief, if you’ve tried to involve other family members with the care of your loved one and they haven’t responded, you have to let it go. You cannot control how another person responds. Also, you don’t need the burden of worrying about others’ actions added to your significant concerns. Many times, family members can be intimidated by Alzheimer’s disease. Others go through denial. Regardless, the fact is they have chosen to be uninvolved and that is their problem. You’ve chosen to deal with it and help out. You have to move on and take care of yourself. When solo caregiving gets to you, seek help. Don’t be afraid to look for support groups, counseling or non-family sources of help even before you think or feel you need it. But when you do get to the totally overwhelmed point, be sure to confide in a trusted friend or look for an area support group, or both. That’s where you can express your feelings. In a group, there is almost always someone who can relate to your situation. Sometimes, you can “adopt” someone new to become a part of your family — perhaps a friend, church member, or acquaintance — and receive help that way. Everyone deals with stressful situations differently. Try to keep your family in the loop as much as possible. Give or send them pertinent information pertaining to Alzheimer’s so they have the means to be knowledgeable and then you have to … let it go. They are adults, capable of making decisions for themselves and living with them.

My husband, who has Alzheimer’s, doesn’t like me telling him what to do … How can I improve this?

By Anthony Ferraro on

May 25, 2012

- Alzheimer's Care, Blog, Elder Law Articles

No matter what, you should always try to make him feel like an equal, and like an adult. Include him any way you can in the goings-on of the day. For example, if you need to pay a stack of bills, you can ask him to pick out one that you should pay first. Give him a choice of two. He could also stay involved by stuffing envelopes or putting stamps on envelopes. Then, you can make a trip to the post office part of the routine. The key is you keep him involved, and he’s comfortable with his involvement. Be sure to talk with him. Nod and don’t argue when he talks. Let him answer questions and don’t worry about whether he’s really right or not. Use your sense of humor. If things don’t go precisely as planned, laugh together. By the same token choose your battles. If you must remain firm about something, try to figure out if it really matters if chore “X” gets done. If he doesn’t want to get dressed, is it hurting anyone? Again, treat him with respect and dignity, and like an adult. You can do this by acknowledging his feelings of frustration and loss. Above all, he needs to know you care. Think about how you would want to be treated if the roles were reversed. You wake up one morning and many simple things you could do yesterday you now can’t do. You might not know where you are in your own (long-time) home, or you might not remember how to get dressed, to go to the restroom or how to set the table. Remember to treat this as a person with a disease, not as a “diseased person.” It is an admittedly difficult situation for both of you. Your loved one needs help because he is no longer independent. This means you lose some independence, too. Give yourself frequent breaks. This is obviously a very hard situation. When things get really tough — and face it, there will be those times — take a step back, inhale deeply and then move forward with resolve and patience. Take each moment and each day one at a time. For more information, please click here to download our FREE “Indispensable Alzheimer’s Kit.”

What’s the best way to communicate well with someone with Alzheimer’s?

By Anthony Ferraro on

May 22, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Good communication can help many problematic situations and behaviors, and even sometimes negate them. The No. 1 tip you can learn on this topic is to treat a loved one with Alzheimer’s as an individual with a disease, not as a diseased individual. The person has an entire, personal, individualized history that will stay with him or her throughout life’s journey. Some characteristics will never leave; some will become more pronounced. A high-anxiety person could still be tightly wound, while a laid back person could become even more so. Everyone needs to have his or her feelings validated, and individuals with Alzheimer’s are no different. In fact, they might need it even more, given their likely memory loss or possible insecurity issues. Here’s an example: You mother, who has Alzheimer’s is angry with your wife a lot of the time. They were on good terms in the past, but now she blames your wife for everything. You have to keep in mind that it is the dementia talking, not your mother. You can validate her feelings by saying, “I don’t blame you for being angry” and then move on. What she feels is real to her (even if it’s not true) and you should at least afford her some validation. Of course, you might have to coach your wife at this point, too. Reinforce that the comments and action aren’t necessarily against her at a personal level. It’s the nature of this devastating illness and, in the long run, is only a temporary condition. People who have Alzheimer’s respond well to affirmation so be generous with the praise and comments such as “good job” or “way to go,” etc. Here are some other tips to conducting good communication with your loved one (or anyone) who has Alzheimer’s:

Identify yourself when you begin a conversation. If he says he knows already, laugh and joke it off
Maintain eye contact when speaking
Slow down when you talk
Use short sentences
Smile and be pleasant
Be aware of her body language. A sudden change in position (i.e. sit-to-stand) could indicate the need to go to the restroom, or another form of discomforts
Be aware of YOUR body language. Try not to appear tense, upset or intimidating. Remember: The majority of communication is conveyed non-verbally
Don’t argue
Ask only one question at a time. Give enough time for responses. Yes/no questions are the best
Don’t talk about your loved one as if she or he weren’t there — you can never be sure of just how aware she or he might be. Also, don’t be condescending or order the person around
Try to avoid a high-pitched tone of voice. It could be interpreted as anger
When your loved one is upset and communication between you just isn’t working, try a hug. Soon, anger should be forgotten and you can try again
Use gentle touches to get your love one’s attention if necessary. You can try by putting your hand on his shoulder, knee or hand
Eliminate any noise that could be distracting, such as TV or radio. Go to another room to talk if it would be helpful.

For more information, please click here to download our FREE “Indispensable Alzheimer’s Kit.”

Can I seriously consider being blessed to be a caregiver?

By Anthony Ferraro on

May 10, 2012

- Alzheimer's Care, Elder Law Articles

As devastating as Alzheimer’s is, you can look at it as a burden or a blessing. We cannot control so much of our life — like what people think of us or how they run their lives. Or whether we get a disease. But what we CAN control is our own reactions. While it might be very difficult, as a caregiver you must arrive at a place of acceptance. But you do not get there without grieving first. Grieving is undeniably a personal journey. Some people progress at a fast pace while others take longer periods at various stages. Some stages they might never experience. Grieving can consist of many emotions: Shock — You can’t think, speak or react after hearing the diagnosis Emotional outpouring — Yell, cry, even throw things at this stage Depression — Loneliness and a feeling of isolation set in Physical signs of distress — You might feel ill or extremely tired Anxiety — Worries about what’s going to happen in the future grip you Anger, hostility — You’re mad at the afflicted person, your family, doctors, even God. You then can feel guilty, especially for the anger you have directed at God Guilt — Your thoughts and feelings make you feel guilty, or you feel that you’re not doing enough as a caregiver Not keeping up with normal activities — You worry about how others will react or treat your loved one Healing of memories — You come to the slow realization that healing memories are often painful memories. This is the time to come to grips with what is happening and realize that life has to change if it’s going to continue. Feed off the good memories to keep you going. Acceptance — You start to accept you are in a new chapter of life. If you can accept that, you can get on with your life, and with much less stress. Realize that you will continue to grieve due to the ongoing changes with Alzheimer’s disease. Even when you might get to the “acceptance” stage, you won’t be at the end of the line — you might cycle through the stages again, or through just a few. This is normal. It will not mean you’re regressing or going backwards. Afford yourself a break. Let yourself feel. The blessings start to become apparent once you hit the “acceptance” stage. It’s said Alzheimer’s disease can be a person’s second chance in life. Inhibitions disappear. Patients become blatantly truthful, and often funny in the process. You did not ask for your loved one to have dementia, and you didn’t ask to care for her or him. This situation has been “given” to you. That means it is a gift to you. And you discover that your loved one also is a gift to you. 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.”

My father thinks people and events on TV are real and he often wants to interact with them? What should I do?

By Anthony Ferraro on

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.

Does pain — such as from a UTI — worsen the effects of Alzheimer’s?

By Anthony Ferraro on

March 6, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Pain can worsen confusion, agitation and/or depression in someone with Alzheimer’s. But pain itself does not cause a decline in Alzheimer’s symptoms. Pain can be a terrible puzzle when dealing with someone with Alzheimer’s. Because many times the person with Alzheimer’s can’t communicate adequately, he or she will resort to wandering, sleeping, grimacing or being agitated — or shutting down altogether. Take a cue and watch closely because if your loved one has a sudden change in behavior (such as confusion, for example), it’s possible he or she is experiencing pain or discomfort. This could be anything from an infection to simply having shoes that are too tight. When caregivers work with cancer patients, their goal is to keep the person as comfortable as possible by eliminating or soothing the pain. It should be the same with individuals with Alzheimer’s, no matter what the stage or age. They should be comfortable and pain-free. A urinary tract infection (UTI) definitely can cause pain. Its symptoms include burning, itching and inflammation. Treatment is neither complicated nor invasive and will increase quality of life. For other chronic pain-producing conditions, such as arthritis, a person with Alzheimer’s should continue treatment according to doctor’s orders. For things like sore throat, backache, headache and foot pain, seek a doctor’s advice as necessary — do not let the condition linger too long or get out of hand. Depression is not uncommon for individuals with pain. If a loved one who has Alzheimer’s is suddenly a lot less enthusiastic about previous interests, it could be a sign he or she is experiencing pain. Be aware, however, that people also can act this way when there is no pain present. For further information, please access our FREE “Indispensable Alzheimer’s Resource Kit” by clicking here.