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I recommend documenting what you have seen since your mother started the medication in question. You can also start out by directly calling the physician who prescribed it and asking about your concerns. Your mother could be experiencing a transition period, which might be expected. If you think you are getting resistance from nursing home staff members, you should speak with the facility’s administrator. You may also ask to sit in on the next care-planning meeting for your mother. This is where various members of the nursing home caregiving staff collectively discuss a resident’s health status and plan of care. By rule, you are to be informed of these meetings and allowed to attend them. If you are not satisfied with what you hear, then you have to make a further decision. There is the option of calling your state’s long-term care ombudsman. Ombudsmen have been trained to advocate on behalf of nursing home residents. This person can work as a mediator to help you and your mother’s facility work out any differences. You should feel comfortable enough that she is in a safe environment, with people who care for her around her. If this isn’t the case, you might have to move her to another nursing home. This is a difficult decision to come to because moving is hard, especially on a person with Alzheimer’s. Weigh the pros and cons. But the bottom line has to remain whether you are comfortable with the facility where your mother is living. If you’re constantly worried, then your qualify of life could go down. If all else fails in a situation like this and you are your mom’s power of attorney for healthcare, you can request a change in her medication. Just be sure to have spoken with her physician ahead of time to ensure that this is the best thing for her.  For more information, sign up for the Alzheimer’s Resource Kit here.
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If it’s done well — with proper staffing and development — it can be very beneficial. The idea of the dementia care unit is to provide specialized care, which includes trained staff for dementia, smaller units to soothe residents’ feelings and a locked area that will be safe for those who wander or pace relentlessly. The last two are symptoms that most Alzheimer’s patients experience at one time or another. Dementia units do not try to stop it from happening but rather aim to contain it to a safe environment. If your mother lived in an open facility — not a specialized unit— she might become more confused. Many such facilities are larger, have wide open spaces and high ceilings, and a lot more people coming and going. Those conditions are virtually eliminated in a special care unit. Dementia units raise the level of care while lowering the levels of stimulation. Many have done away with overhead intercoms since they can cause serious confusion or agitation for residents. The standard for Alzheimer’s care in most facilities is that the special unit has its own activities director. Often, direct care staff also are trained specially to participate in resident activities, which are specifically geared to the residents’ needs. For more information on special Alzheimer’s care facilities in your area, contact your state’s Department on Aging. It can give you a list of units or tell you where you can find one. If you have the option, visit at least three of these units in your area before making a choice. As always when visiting a potential home for a loved one, take someone you know and respect who preferably isn’t in the family. That way you can get a more objective view of what’s going on. Meet the staff and observe how they treat the residents, and how the residents respond. It’s not unusual for a facility to have a few deficiencies, but how serious were they and have they been corrected in a timely manner? You need to know these things. When you make a decision about a facility for a loved one, listen to your gut feeling. It is often a very accurate way to gauge. You still need to take stock of basic needs and questions; talking with the person who accompanied you on your visit will help sort things out. Then you can make a rational decision that everyone can live with more comfortably. For more information regarding Alzheimer’s, click here.
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States use different names for residences like these, which may have four or five people each. In some states, they are referred to as boarding-care homes. Some states license them and some do not. You should call your state’s facility licensing agency and ask. You also can inquire about getting a list of them. Look for homes like this, which are specifically designed to help people with Alzheimer’s or other dementia. Typically, staff there will be specially trained to work with such individuals, and keep everyone safe. If there isn’t a facility like this near your home, you might want to reconsider pursuing such living arrangements. One of the considerations for this type of living arrangement is whether your loved one can live out the rest of his or her life there. What happens if he or she runs out of money? Does the place accept Medicaid? Can he or she stay if she becomes bedridden, needs incontinence care or needs a wheelchair? With regard to dementia care, sometimes the smaller homes are ideal because they feel more like home, not an institution. The facility manager can keep a closer eye on things, though the appropriate employees still need to be hired and trained. Smaller homes like these typically have staff members cross-trained; they might be personal care assistants, as well as cooks and cleaners. You’ll want to observe at any home like this you may be considering whether residents have a daily schedule and routine. Some tasks might need to be modified to take an individual’s level of functioning into consideration. But by and large, residents can assist with things such as preparing meals, setting the table, folding clothes and towels, sweeping the floor, watering plants, helping in the yard, taking out the trash, and numerous other tasks. Allowing residents to help with daily chores makes it feel more like a family environment for everyone. This will be a community of its own for your loved one. It should be a place where he or she will make friends and have other caring individuals around.  For more information about Alzheimer’s click here.
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Be aware that you can narrow your choices by location and by whether they offer specialties such as Alzheimer’s and dementia care — at both assisted living and skilled nursing facilities. You can get a list of facilities from the Alzheimer’s Resource Center, Alzheimer’s Association, Area Agency on Aging or various telephone directories. Check out facilities that interested you in your area before your family needs one so you can make a decision under less stress. Take notes on several facilities so you can comparison shop because that is exactly what you’re doing: scouting out some of the most important services you may ever need. Make a few visits, and make them at different times of the day. Take someone you trust with, preferably not a family member, as this type of person will be more objective and see things in a different light. Gauge the atmosphere of the facility. Is it warm and inviting? Does it pass the “smell test”? How do staff members interact with residents? Are they treated with respect? Are they attended to promptly? Is the facility clean, both inside and out? Are there secure outdoor areas intended for resident use? Is administrative staff available? Does it seem like a friendly facility? Ask for at least three names and phone numbers of families you can talk to who currently have a resident at the facility. Ask around in the community about the reputation of the facility. Any nursing home you visit must have readily available the results of its last state survey (inspection) so don’t be afraid to ask to see them. Or check out the Nursing Home Compare website that the government publishes precisely for this use. Once your loved one is admitted, your responsibility for checking out a facility is not over. You can stay as involved as you want, and you should keep as prominent of a presence as you wish. Research has shown that proximity is the top reason most families choose a certain facility. This means visits should be convenient, and possible for other family members and friends. Use visits — by any others — to serve as check-ups on living conditions for your loved one. Although there are more and more Alzheimer’s-specific facilities opening, it is not uncommon for them to have waiting lists. It can be months before a spot opens up, so if you’re at all inclined, go ahead and put your loved one’s name on a waiting list. If you are called about a vacancy and aren’t ready for the move yet, tell them. They are usually more than willing to put you back on the list, farther down, and they will call again. For more information regarding Alzheimer’s, you can click here to view the Alzheimer’s Resource Kit.
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The top desire of most people — Alzheimer’s patients or not — is to keep a loved one at home for as long as possible. Each caregiver and each person has a different threshold for what he or she can deal with (and survive with) at home. For example, if incontinence is involved and a person can’t go to the bathroom on his or her own, a caregiver might think it is almost automatic that nursing home placement is necessary. Other issues involving “activities of daily living,” such as eating, dressing and wandering, or behavior or wandering issues, might worry caregivers, too. Sometimes caregivers think they have reached their limit but then realize things aren’t as bad as they first think. This is often the case if they have taken steps beforehand to pre-arrange help. Being prepared and pro-active will lower stress and worry, and likely put off facility placement, for at least a while. Whether to keep a loved one at home or in a nursing home is a very personal choice. Most caregivers want to keep their loved one at home as long as possible; most individuals agree with this philosophy. But keeping a person at home isn’t always the best choice. Nursing homes are a needs-based service and there are very real reasons people need to be there. Moreover, nursing home placement may be necessary for the caregiver’s health. If you are the primary caregiver and someone you respect voices concerns about your health, you should listen with an open mind. Many caregivers are too close to a situation and do not view things rationally or objectively. It could damage their health. There are numerous senior service agencies around to help with the decision about nursing home placement. Get a list of options soon after you receive the Alzheimer’s diagnosis. This will help you be more comfortable, by planning and being more proactive, rather than being unprepared and uncertain during what could become a crisis situation. Dealing with a loved one with Alzheimer’s is a daunting task. There’s no need to tackle it alone, however. An excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.
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You should start looking as soon as you are comfortable — realizing that it will almost always be difficult. Proper advance planning will help prevent or lessen a crisis situation later. Maybe you’ll never need the services of a nursing home, but it pays to be proactive and check them out anyway. Making decisions in crisis mode is much different than being able to plan ahead more calmly and thoughtfully. Local elder law firms, the Alzheimer’s Association, hospitals and other healthcare providers, the Area Agency on Aging and stage regulatory departments can be good sources for lists of facilities. When you visit a facility, take someone with you so you get more than one perspective. It also helps to have someone removed from the situation who can be more objective and might notice things that you don’t. Ask facility operators if they offer short-term respite care. That might be what you need to start with — or it might be the only thing you ever need. This can allow you a break if you get sick or need to go out of town, for example. If you have an unexpected situation that takes you out of the picture, you will have plans, and lowered the stress levels for you and everyone around you. Dealing with a loved one with Alzheimer’s is a daunting task. There’s no need to tackle it alone, however. An excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.
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This can be a complex task, not unlike finding a nursing home for a loved one. There is a matrix of criteria you’ll want to check and meet. One of the first is checking into your options BEFORE day center services are ever needed. This will help both you and your mother. You can find available adult day center lists from the local Area Agency on Aging or ARC. Winnow down your options by asking whether staff members are trained to work with people with Alzheimer’s. Once you find some you are considering, your first move should be to make an unannounced visit to one of them and ask for a full-facility tour. When this happens, observe whether participants at the center seem happy and content. Are they truly involved in an activity or just sitting around with a TV on? Television isn’t necessarily a bad thing, but it shouldn’t just be a personality-free baby sitter. Activities could be created to use it for sing-alongs or discussions, for example. Look around and watch to see if the participants interact freely with one another. Try to learn if staff members encourage individuals to be as independent as possible. Next, learn what’s needed to be admitted. Each facility has its own policies. Typically, a physical from a doctor and a medical history must be given, as well as a TB test from the last 12 months, or a chest x-ray. Ask if the facility itself can do the TB test (and if there is a cost for it). Make sure you go through the admissions packet carefully with someone at the center. Ask about all policies and procedures and pay particularly close attention to anything concerning fees. Inquire as to billing policies — including whether they bill in advance or after the fact. How do they handle absences? If you think of additional questions, be sure to call back to get answers or clarifications. If you let some centers know you’d like assistance filling out papers, they’ll help you get it done. You’ll want to check out licensing issues. Some states require licenses for these operations. They should be posted and available upon request, including how many participants it can legally serve at one time. Find out if the center has been cited for deficiencies — and whether they’ve been corrected, of course. Inquire about the staff-to-client ratio. There should be at least one staff member for every eight participants with Alzheimer’s. Meet the facility director and staff and observe how they interact with everyone. Gauge whether they’re attentive to you and your needs. You should ask about the age of the facility, whether staff members are trained to work with Alzheimer’s and how wanderers are monitored. Here are some other questions to ask an adult day center you’re contemplating using: • Do you have a social worker on staff? Someone knowledgeable in assisting with resources, financial assistance, counseling, discharge planning, etc.? • What are the philosophy and goals of the center and its various leaders? • What are the direct staff members’ credentials? • What is the rate of employee turnover? • Is there a charge for late pick-up? • How long and frequently does a participant have to attend? • What are the emergency procedures? • How are meals prepared and what special diets can you accommodate? • What does a “typical” day’s routine consist of? • How involved can family members be at the center?
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Alzheimer’s progressively creates difficulty swallowing. This is due to the brain failing to signal the throat to enact swallowing muscles and reflexes. As you imply, this can become a problem and caregivers need to remain alert to the situation at hand. If your father is past the beginning stages of Alzheimer’s, you need to closely observe him when he takes his medication and is eating. Notice whether he chews for long periods of time but doesn’t swallow. Watch for whether he pockets medication or food in a cheek and leaves it there for quite a while. There are some steps you can take if this becomes an issue. First, make sure medication issues are taken care of. Speak with his doctor and see if the medication can be eliminated. If not, see if it is available in liquid form. This goes for vitamins and other supplements, too. However, some liquid medicines might have a bad taste and your father might refuse to take it. Again, carefully observe what he is putting in his mouth and actually swallowing. Another consideration for medications is whether the doctor can prescribe something that can be crushed. Some medicines lose their effectiveness if crushed, so be sure to ask about this. If crushing is OK, you can then mix it into yogurt, applesauce, pudding or something similar. Watch the progression of the swallowing situation and note if it worsens. Remain in contact with the doctor so you can always stay on top of what medications are actually being ingested, which are not making it into your father’s system and which could be discontinued, if 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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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.”
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This can be one of the more difficult aspects of dealing with Alzheimer’s. Beyond its usual challenges, incontinence typically sets in during the middle to late stages of the disease. It can be a permanent or temporary condition. Discuss the situation with your physician. Have him or her check for possible contributing conditions that could be causing the problem. This could include a bladder infection or urinary tract infection. Once health-related possibilities are ruled out, it can be assumed the condition has set in permanently. In that case, it’s time to consider incontinence products. By being prepared with proper adult briefs or other products, your mother can avert embarrassing episodes if she has an accident. Consult a physician or other clinician for how to deal with the incontinence — many people incorrectly stop trying to conduct regular bathroom visits just because their loved one is wearing a brief, for example. When a brief gets wet, it should be changed as quickly as possible, to avert skin irritation and breakdown. At this time, the skin should be thoroughly cleaned with a wet cloth and dried. Red or irritated skin can be a warning sign of further problems down the line. Observe this condition closely! Should sores begin to develop, seek immediate medical help! Nothing good comes of compromised skin integrity, and once it starts to go, it can be a quick decline. If your mother sits in one place for long periods of time, have her shift positions frequently to redistribute the pressure on affected areas. The weight should be repositioned somehow so it doesn’t remain in the same place for too long. Get your mother up and have her walk — even a short distance — around the house or yard. This will relieve pressure bearing areas and get blood recirculation, both of which are very helpful. Changing chairs and lying down (if previously seated) also can be helpful. If her physician writes an order for an evaluation from a home health agency, take it seriously. The agency can make home visits. A nurse will take stock of the overall situation and set a plan of action in place accordingly. These recommendations should help everyone involved — your loved one as the “patient” and you and others who are caregivers. More success will mean less stress, and that, too, is very desirable. For more information, please click here to download our FREE “Indispensable Alzheimer’s Kit.”
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