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How do I pick the ‘right’ nursing home or assisted living facility for my loved one?

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June 18, 2012

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

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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How do you know when it’s time to start nursing home care?

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June 14, 2012

- Alzheimer's Care, Blog, Elder Law Articles

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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When should I start looking for a nursing home if my father has Alzheimer’s?

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June 13, 2012

- Alzheimer's Care, Blog, Elder Law Articles

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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How do I agree to get my loved one to agree to attend an adult day center?

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June 12, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Alzheimer’s patients are often reluctant to leave familiar surroundings — and when you think about it, who isn’t? So don’t be surprised if this happens. An adult day center offers respite for the caregiver, not to mention activities and stimulation for the patient — and in a safe environment. Using a participant-friendly name for the center could make your loved one feel more comfortable. You might call it “the club,” for example. Others have had success calling it “school,” “work” or “volunteering.” You’ll know what will work best with your loved one, and whether certain techniques you have used in the past will be useful again. Perhaps saying, “This is your time to spend with your friends” or, “Please do this for me” will work well. Some caregivers advocate simply getting into the car and driving directly to the center. Answer questions along the way with positive answers such as, “It’s your day to go to the club” or, “We’re going to a fun place.” Often, someone with Alzheimer’s won’t remember being there before, but then also have some recognition that it’s a “safe” place with friendly people. If you still encounter resistance upon arrival, the center’s staff will be experienced in helping get your loved one into the center. Make your good-bye short and then leave! If the staff is properly trained, they should know how to take it from there, making your loved one feel welcome and loved. Get to know the staff well so both you and they feel comfortable. They’ll probably want to ask you questions in order to give your loved one the best care they can. You may call during the day to check on how your loved one is doing. Often, in fact, the staff encourages this. One key to success is to develop a consistent schedule. There will be various reasons for your loved one to miss a day, but the benefits to keeping a consistent routine far outweigh the urge to just drop in whenever you think “it’s about time for another visit.” Both you and your loved one (and, to some degree, the center’s staff) will benefit from consistent attendance. Participants often adjust well once they get into a routine and are familiar with it. Besides, this is something that your loved one might very well look forward to. Sharing time with people with like interests and/or backgrounds is usually a good way to spend time. Another way to overcome any complaints or objections from your loved one is to have someone who is NOT the primary caregiver take him or her to the center. This could be a friend, neighbor, someone from church, a family member or even a transportation service. The caregiver then will not be a “bad guy” while the person who will deliver your loved one will become a “hero,” especially at pick-up time (if the adjustment to the center still hasn’t gone smoothly). When your loved one arrives home, always try to put a positive spin on what happened during the day. Talk about any activity or menu items from the center. Ask how he or she felt about the experience. Even if there’s not much memory of what happened, stimulate conversation and reinforce good feelings. Stay focused on the positives and reassure your loved one that he or she will always be able to come home. Reassurance is crucial for dealing with feelings of insecurity. Sometimes caregivers hear that their loved one had a “bad day” at the center — from the loved one, but not the staff. The person might say that he or she never wants to go back. This is where you have to take control, with an adult version of “tough love.” If you feel the center is a good thing for your loved one, you should continue the routine of getting the person there. It takes positive reinforcement and persistence to find adjustments and make a routine work. Remember that because your loved one might be attending only part-time, it might take longer to adjust than if he or she were there for longer periods of time. If the center feels good to you, it is probably a good place. If your loved one complains but your gut is telling you something different, talk with the director of the center or a social worker and discuss the situation. If you still don’t feel comfortable after that, find another center! You are usually not locked in to many terms and you are able to come and go at a center without penalty. Another thing to consider is that some individuals with Alzheimer’s might become over stimulated if they are around a lot of other people, regardless of the environment. You must watch this carefully, too. In some instances, staying home with company or an attendant might be better than placing your loved one in a situation where he or she might be constantly over stimulated, with too many people around.
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How do I find the best adult day center for my mother?

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June 8, 2012

- Alzheimer's Care, Blog, Elder Law Articles

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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How will I know if my father can’t swallow medications any more?

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June 6, 2012

- Alzheimer's Care, Blog, Elder Law Articles

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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I’m the primary caregiver for someone with Alzheimer’s … How can I get a break?

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June 4, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Alzheimer’s is a family disease, so that means it affects everyone. Primary caregivers in particular experience a lot of stress. For this, the first steps are acknowledging it and getting help.   Take advantage of the generosity of any family members or friends who are willing to help out. If you’re one of the many family-member caregivers who don’t have this type of assistance available, look to any of the increasing home- and community-based services that can help afford you a break.   Look for these services nearby:  
  • Adult say services — Clients actually go to these centers for socialization, stimulation and supervision while primary caregivers get a break. Not all centers have experience caring for Alzheimer’s patients so check around.
  • Overnight respite — Many nursing homes and assisted living facilities offer short-term stays with the express purpose of giving caregivers a break. Most do it on a space-available basis, though, so you need to plan and have a calling list ready.
  • Hired caregivers — You can hire a live-in caregiver. Networking can be helpful here. Ask around church or other local groups, such as the Alzheimer’s Association or the Area Agency on Aging, for experienced caregivers who typically work on an independent basis. If no agency is going to be responsible for these caregivers, you must treat this process with the diligence of hiring an employee (which is, in fact, what you’d be doing). Check references, do a background check, get to know the prospective caregiver, see how she or he interacts with your loved one, and don’t be afraid to ask the candidate back to check interaction a second time. You should ask your loved one for input about the candidate. Sometimes people with dementia have keen senses of perception and intuition.
  • Private duty home care — This is for single services or groupings of them on a spot basis. Many agencies offer workers who provide these types of services, which can include bathing, taking to appointments, shopping, sitting, meal preparation and other day-to-day needs.
  But again, it can’t be emphasized enough: If you have family members, friends or others you trust who are willing and able to help, use them.
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How can I keep a sense of humor while caring for someone with Alzheimer’s?

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June 1, 2012

- Alzheimer's Care, Blog, Elder Law Articles

It is important to keep a sense of optimism. Another reason to keep a good sense or humor is laughing increases endorphin activity in the brain and makes you feel better. Don’t worry if you think you might have lost your sense of humor forever. It just needs exercise, like other parts of your body. There are numerous ways to do this. Determine what makes you laugh … and then give yourself permission to do it! Try to laugh — a lot and as often as possible. Here are some tips on how to make it happen:
  • Keep a humor file. This might include jokes from the Internet or friends’ emails, newspaper cartoons or anything else that makes you laugh. Keep it in a “go to” place so you can pull it out after especially stressful days.
  • Listen to humor on radio. There are some satellite services nowadays that offer several channels of all-comedy routines.
  • Go to comedies at the theater or cinema. Include your loved one who has Alzheimer’s as long as you can.
  • Consider buying comedy DVDs or videos, or checking them out at your local library. Watch them with your loved one. Laughing together is extremely healthy.
  • Allot time to read humorous books or articles or the comic pages in a newspaper, even comic books if that’s what you like.
  • Invite a friend over and talk about old times. You also can involve your loved one in the conversation.
  • Post humorous photos, cartoons and anecdotes around the house. Be sure to locate them in areas you spend a lot of time.
  • Surround yourself with happy, healthy people who exude optimism and don’t take themselves or life too seriously. It does rub off and affect others.
  • Journal funny things that you might come across during the day, such as something someone said or did — especially your loved one. Later, you can read them and laugh again.
  • Whenever you or your loved one does something funny, laugh. Laughing (at our selves in particular) is fantastic medicine.
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How do I handle things when the rest of my family isn’t helping take care of loved one with Alzheimer’s?

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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.
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How can I keep my mother (who has Alzheimer’s) busy when she expects me to keep her entertained all day?

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May 29, 2012

- Alzheimer's Care, Blog, Elder Law Articles

It’s not uncommon for an individual with Alzheimer’s to get very attached, or “clingy,” with the person most responsible for his or her care. But that doesn’t mean all of that person’s stimulation has to come directly from you. Try some of these ideas:
  • Play music with a fast pace
  • Let her walk as much as possible
  • Exercise videos with simple instructions are available from numerous companies
  • Have her shred old documents or clip coupons
  • Have her feed a pet
  • Direct her to get mail from the mailbox and open the junk mail
  • Have her set the table while you make lunch.
  • Bake cookies. She can help stir or put the dough on cookie sheets (while you set the oven)
  • Get her some exercise through activities such as batting a balloon or pulling weeds
  • Let her help at whatever level she can. One example: She can hold a grocery bag while you unlock the door to the house
  • Ask a friend to visit and take her for a walk, read to her or play with a ball. Anything that will give you a break for a while
  • Get audio books from the library. People with Alzheimer’s often like to be read to, especially if they’re no longer able to read themselves. You might have to sample different subject matter or genres before finding a good combination. Humor usually speaks to anyone.
There’s also a good publication with suggestions: “Hundreds of Activities for Men and Women with Alzheimer’s Disease and Related Disorders,” by B.J. Fitzray (published by Rayve Productions in 2001). This and other helpful publications are available online at http://www.ahaf.org. Another good site to check is http://www.alz.org, the Alzheimer’s Association website.
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