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

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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.”
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Incontinence is starting to become a factor with my mother. What should I do?

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May 24, 2012

- Alzheimer's Care, Blog, Elder Law Articles

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

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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.”  
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What should I tell my grandchildren about Alzheimer’s disease?

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May 18, 2012

- Alzheimer's Care, Blog, Elder Law Articles

Children handle these types of things differently and can have widely varying reactions, depending on their age, upbringing and personality. They also will devise different ways of coping. But no matter what the age, be honest with them — at a level they can comprehend. Then let your grandchildren talk openly about their feelings. Having someone you know and love with dementia causes grief — in all age groups. A part of a person you love is vanishing and changing each day so it is natural for someone close (of any age) to experience the grief process kicking in. If you are not comfortable with talking with them about Alzheimer’s or letting them know about a new diagnosis, have someone they trust speak with them about it. This might involve using the services of a licensed counselor or a support group, depending on the circumstances. This is a stressful family dynamic and must be handled with care. Everyone is experiencing grief, anxiety, loss, change and, eventually, death. The national office of the Alzheimer’s Association has excellent information for children on its website. Visit it here. There are also many fine books available on this subject. You can find various titles available for everyone from young children to adolescents. They also can be found at the Alzheimer’s Association website Many online book sources. Suitable publications also can be obtained from the American Health Assistance Foundation.  
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I’m a member of the ‘sandwich generation’ and need help now that Alzheimer’s has entered the picture

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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.
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What’s recommended when looking for an in-home caregiver?

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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.
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How likely is it that my loved one with more lucid days and less lucid days with Alzheimer’s?

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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.”
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Can I seriously consider being blessed to be a caregiver?

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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.”
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Does music help aggressive behavior in dementia patients?

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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.”
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Sometimes my mother totally refuses to cooperate with me (for dressing, cleaning up, etc.). But if we call in a familiar nurse-aide, Mom’s a peach and there are no problems. What gives?

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May 3, 2012

- Alzheimer's Care, Blog, Elder Law Articles

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.”
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