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.”

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 has Alzheimer’s and is abusive to many of us, including my mother, who lives with him. How can we help her?

By Anthony Ferraro on

May 2, 2012

- Alzheimer's Care, Elder Law Articles

Even if an abuser has Alzheimer’s disease and can’t control his temper because of it, it is still difficult to put up with. But you can’t take it personally. If his behavior is merely an extension of the way he used to treat people, you at least know what is happening. But if it’s a full personality change, it understandably could come as a shock. It will likely signal a period of mourning, where you will have to come to a point of acceptance that there has been a dramatic change. Give your mother breaks since she is otherwise with him all of the time. It might mean hiring someone to come in and be with him, or using an adult day care center, or having family members rotate in. But you must realize that your mother needs breaks. The odds are he will act differently with non-family members. However, if he still verbally abuses home care workers or staff at the adult day care center, you have a bigger problem. Then, it might be time to get the doctor involved. See if the doctor has any suggestions — he might suspect depression or anxiety is in play and prescribe something for it accordingly. Often, Alzheimer’s patients act out due to an underlying cause such as depression, anxiety or pain. You also can deal with this volatile situation with humor. You can’t control how your father acts out, but you can control your responses. The staff at one adult day care center simply refers to harsh words or verbal abuse as its “terms of endearment.” You also might want to openly acknowledge your father’s feelings to him. This could lessen his frustration level. A person with Alzheimer’s loses so much independence, he may rail against those nearest to him, especially if he’s receiving different sets of advice or orders from different people. Would-be advice givers need to be careful that they offer suggestions and directions in a non-threatening way. If your father resists, don’t press him and go back to the topic later. After an informal cool-down period, you may have better luck. To have success, you should also not talk down to him. He’s an adult and has his own personal history of independence and success. That should not be discounted. Your father will sense if he is being treated differently. Another solution for you caregivers is to join a support group. Very often, there will be others in a group with the same or similar problems. They can either give you successful strategies or simply the comfort and understanding that you need to know you’re not alone in this battle. You and your mother also should journal feelings and frustrations about your dad’s behavior. By dealing with your feelings, you’re better able to help your father. To find a support group near you click here.

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.

How do we not upset Mom’s routines if we hire an in-home helper?

By Anthony Ferraro on

April 19, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Narrow your candidates down to two or three and then invite them into your mother’s house to observe them interacting with her. This should be very enlightening and help you trim the choices further. Look for someone who is kind and attentive. Other things can be taught, such as where things are and where they belong, how routines are run and tips on how your mother likes baths, food, dressing, etc. But if a good spirit and healthy interaction aren’t there between two people, that’s hard to overcome. It’s very hard to force after the fact. Involve your mother as much as possible in the selection process. Even if she has late-stage Alzheimer’s, she can tell you in her own way what she thinks about the candidates. It might be through a gesture such as a wrinkled up nose or a thumbs-up or -down. Or she might resist giving an opinion at all. This is not insurmountable. If she does not consciously want to help you through the selection process, observe her body language around the candidates. How does she respond to each? Once you have hired a helper, bring her or him in one day before the official start of work. Give this person plenty of time together with your mother so they can bond and get to know each other better. By all means, let your mother know what is happening, and that this person is going to be with her for long periods. Be firm but sympathetic. Tell the hired caregiver about your mother’s likes and dislikes with regard to food, activities and other situations. The better the caregiver and your mother know one another, the better the care will be. Some people like to start a new caregiver with just a few hours of work the first day. This helps let your mother know her world has not been suddenly 100% turned upside down. You should keep a good, professional relationship with the caregiver. Encourage this person to call you with information — good or bad — about your mother. Constantly check with your mother on how things are going. Let her express her feelings. If she is unable or unwilling to tell you anything, you still can learn a lot simply by observing her body language. This is vital for determining whether you should keep a current caregiver or move on to another one. For more information, an excellent resource is “The Indispensable Alzheimer’s Resource Kit.” It can be downloaded at no cost by clicking here.

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

By Anthony Ferraro on

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.

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?

By Anthony Ferraro on

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.