The difference in relationships matters. Non-relatives sometimes have easier access or more cooperation precisely because they are NOT family members. Many times, loved ones are harder on their relatives than anyone else. Your mother probably feels she can act however she wants around relatives. Sometimes, loved ones don’t have good relationships to start with and this is just continuation of that dynamic. But usually a person will be on his or her best behavior for someone outside the family. That’s good news for aides, doctors and sometimes even strangers with whom they interact. Sometimes all the family contact, and familiarity it brings, is too much. You both might just need a break from one another, having spent too much time together already. This is not something you should take personally. Your mother still loves you. Just remember that she has a form of dementia. Many people don’t realize that almost all inhibition is eliminated with dementia. It’s a bit of a mystery, frankly, how some people can maintain such good manners with someone who is not as familiar with them as you. It’s important for caregivers (such as yourself) to learn to let things go. You should weigh things such as: If all she wants to eat is chocolate pudding, is it hurting anyone/anything? If she wants it for breakfast, it might not be the most nutritious thing for her, but it’s not going to harm her (unless medically contra-indicated, of course). Learn to step back and evaluate the overall implications of odd requests or off-plan behavior. Choose your battles wisely. Often, if a loved one with Alzheimer’s doesn’t want to eat or dress or do some other common task, she or he will cooperate when you ask again later. For more information, please click here to download our FREE “Indispensable Alzheimer’s Kit.”
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.
This is a very good question because routines are very, very important. A steady routine will be familiar and comforting as a person with Alzheimer’s progresses into the disease and loses more memory. If you live with your loved one, make everything a part of a schedule or routine if possible. You should do this for both of your sakes. Rituals, such as at bedtime, are critical. If your loved one always ate something particular before bed, or checked a door(s) or performed some other task, you should continue with it. If your loved one becomes restless before bed time or is having a hard time getting to sleep, allow him or her to get up and do anything in their ritual. This will help the person feel at home. To reiterate rituals and routines are very, very important. A daytime routine might include specific medication or eating times, checking the mail, bathing, going to get a haircut, grocery shopping with you and just about anything else you want to include. Putting drinking water into the routine is great because it can add to a sense of process but also keep a person with Alzheimer’s hydrated, which can sometimes be an elusive task. You both should also be sure to include relaxation time in your regular schedules. Some other good things to include in a daily schedule could be: feeding a pet(s), folding laundry, reading the newspaper, going for a walk or drive, taking out the garbage, getting a snack, drinking coffee, etc. It might be difficult, but while trying to keep a steady routine, you have to avoid becoming too rigid. If the activity you had planned isn’t working out well for your loved one, be flexible and don’t argue. Move on to the next thing and go with the flow. If you have an activity that simply must be done (such as dressing), take a break from it and try again late. For more information, click here to receive our FREE “Indispensable Alzheimer’s Resource Kit, ” which has additional information regarding caregiving issues. In addition, attend an Alzheimer’s Support Group. To find one in your area click here.
- Talk with a calm presence
- Don’t argue — you’ll never win
- Validate feelings
- Smile and be pleasant
- Approach from the front so you don’t startle your love one
- Identify yourself, if needed
- Maintain eye contact
- Ask one question at a time
- Go slowly. Remember that hurrying heightens frustration
- Use short sentences
- Give plenty of time to respond
- Repeat information as needed. Repetition is good and usually helpful
- Use touch, such as on the shoulder, knee, back or hand
- Give hugs — many times a day
- Laugh together
- A high-pitched voice might convey that you are upset so speak with a lower tone when possible
- Speak clearly and directly (and, to repeat, slowly)
- Don’t correct your loved one
- Ask things nicely: Don’t make demands
- If you feel your words becoming heated, stop. Take a deep breath. Try again later
- Don’t take adverse behavior personally.
- Respect the person as an adult; don’t talk down to him or her
- If he or she cannot find or make the words, gently finish a sentence as needed.
- When at all possible, allow choices — such as “Should we pay the gas bill or electric bill first?” or “Would you like tea or coffee?” etc.
- Frequently praise your loved one and spread affirmation — for even the smallest things. Make phrases like these a frequent part of your vocabulary: “Thank you,” “Good job!” and “You’re the best!”
For more information, be sure to downloard the Indispensable Alzheimer’s Resource Kit which is available at no cost to you simply by clicking here.
The quick answer: yes. A doctor must be consulted for a full evaluation as soon as you notice the first symptoms of dementia —more than just mild forgetfulness or confusion. This type of professional check-up will help determine why the symptoms are present. Are they due to depression? Poor nutrition? Drug use or alcohol abuse? Organ dysfunction? If your loved one has never been evaluated for dementia before, your best bet is to consult a neurologist or geriatrician. For those who have been diagnosed with Alzheimer’s, a geriatric psychiatrist should be contacted for signs of anxiety, depression, agitation or any other behavioral issues. You must be comfortable with any physician you use, especially since you’ll likely get into very personal lines of questioning. Remember: Everyone is different, so a doctor who might be appropriate for a friend might not work for you. That is OK and you should keep looking if you’re not satisfied. Doctor referral services can provide a list of appropriate physicians. It is often comforting to know you are using a doctor whom others have used and liked. Caregivers also might receive information and referrals at support group meetings so look into those, too. The reason it’s so important to get an early diagnosis of dementia is it can make treatment easier and more effective for all involved. Most importantly, it can lead to appropriate medication that might help slow the progression of the disease. An initial, thorough check-up should include a physical examination, medical history, neurological tests, laboratory tests, brain imaging and function tests. An individual diagnosed with dementia will see a geriatrician, neurologist or psychiatrist for any issues directly related to the dementia. But a patient should inform his or her primary care physician of the diagnosis, and continue with the doctor for general check-ups. Experts agree the best proactive strategy to achieve successful caregiving at home is to have a healthy caregiver. Alzheimer’s truly is a family illness. A doctor needs to be aware of the caregiver’s stress level and be willing to offer support, suggestions and encouragement. The best doctors in this field will be concerned about the health and well-being of the caregiver.
New Rules As you may have read in recent columns, Illinois has adopted new rules for Medicaid coverage for long-term care for our citizens and the state of Illinois (“DRA”). These new rules took effect January 1, 2012. The new rules are going to require that our clients engage in what we call “Five-Year Planning.” This “Five-Year Planning” has become necessary because of the fact that there will be a new five-year lookback for all Medicaid applicants when there are asset transfers that take place after January 1, 2012. The Silver Lining What may come as a surprise to many of our clients is that the unintended consequences of these rules may be that long-term care planning for our clients may actually be enhanced in some ways. The silver lining in all of this is that while the lookback period and the need to plan further in advance is one of the negative aspects of the new law, the need to use trusts of a very specialized type in order to comply with the five-year look back may actually provide some very positive consequences. How to take advantage of the New Rule Following is an example of how the new rules could work in your favor. Instead of leaving assets for their children outright, parents can now consider leaving assets in trust for their children. Leaving assets in trust for children carries with it the following benefits:
- the ability to protect the assets inherited by a child from the creditors and predators of the child, such as divorcing spouses, business creditors, tort creditors, etc.;
- the ability to allow the management of the assets to continue under the supervision of the parents’ financial advisor who may have assisted the parents over the years in accumulating a critical mass of assets that can provide for many years of security for the children;
- the ability to meet the five-year lookback requirement of the new Medicaid laws;
- and, finally, the ability to prevent the children from squandering or losing the assets that the parents carefully accumulated during their lifetime.