Houdini....

Q: My mom is a wanderer. We are looking for a home for her and my sister won’t listen to me when I tell her that it needs to be a locked* facility. How should I handle this? I am only concerned about my mother’s safety.

A: Several years ago I had a family bring their mother to my home for an afternoon visit. Their mother was wonderful. She undressed a bit for us, she ate well, and she had a wonderful sense of humor.

However, after a nice quiet morning and watching her eat a good lunch her complete focus was to leave my home. She would stare blankly ahead and say in a monotone voice, “I got to get out of here, I got to run like the devil.” It took her less than 5 minutes to figure out how to “run like the devil!” She was out the door and down the road in a matter of minutes.

I was watching her, of course. I tried re-directing; I tried locking the door. Unfortunatly,she was determined to leave and she had no problems at all getting the door unlocked. For almost two hours I tried re-directing her, and nothing worked.

When her sweet daughter came to pick her up, I kindly explained to her that the safest place for her mother was a locked facility. I didn't like being the bearer bad news. Bless her daughter’s heart though…she said, “I feel like my mom has just been rejected from a good daycare.” She asked if her mother could come back when she couldn’t walk. About a year later, her mother was able to move into our home.

I am an advocate for smaller home-like environments for the elderly. But, your sister needs to understand that your mother’s safety and well- being have to come before any “ideas” about what she considers a good home for your mom. Placing your mother in anything but a locked facility while she is in this stage of Alzheimer’s would be considered an inappropriate placement, and could lead to a tragedy.

There are several options for families to consider. Some assisted living facilities now have completely locked sections in their facilities for those with Alzheimer’s and Dementia. Many of these places will accept Medicaid payments if you don’t have the funds to pay for care.

There are also Alzheimer’s continuous care facilities that are specially designed for the wandering Alzheimer’s resident in mind. However these facilities are often very expensive and do not accept state funding if you should run out of money.

If you wish to move your mother to a different kind of facility when she can no longer walk, then I suggest you choose a smaller facility.

If you have any difficulties locating a good facility in your area, let me know ~ Dutchy

* An extreme exit-seeker needs to be in a place that is secure for their safety. A home with a lock on the door is NOT a “locked” facility.

Trouble? Shoot!

Several weeks ago I was called in to a home to help them troubleshoot a problem.

For some unknown reason Marge was frazzled by the time she came to the dinner table. She would whine, and cry and hardly touch a thing on her plate. Dinnertime had become miserable for everyone involved.

Marge had a terrible time communicating. She had suffered a stroke and also had mild Dementia. She didn’t know why she was so unhappy and agitated. And she wasn’t able to communicate what she was feeling.

For some reason this one was pretty easy to solve. Problem behaviors stemming from agitation are not always an easy thing to solve.

Several months earlier she had been diagnosed with Diabetes. The family wasn’t required to monitor her blood sugars. I asked about meal times, lunch was served by 12:30 and dinner wasn’t served until around 6:00. It seemed like a long time to go without eating anything, especially with an elderly person’s appetite being so small, and on top of that having diabetes.

I suggested to those who were caring for her that they try giving her an afternoon snack. My guess was that her blood sugars were probably falling too low in the afternoon. When blood sugars drop that low, it can cause one to feel out of sorts.

They started giving Marge a light snack of cheese and crackers in the afternoon. Immediately they noticed the difference and the dinner table became a pleasant place once again. (shewww!)

Sometimes with Alzheimer’s and Dementia caregivers just assume agitation is a just a part of the disease. While it often is just part of the disease, occasionally there is a simple cause for agitation. It just might take a bit of sleuthing to figure it out.

Here are some possible causes for increased agitation in those with Alzheimer’s that may require a minor adjustment in the way things are done.

1. Your loved one may be hungry in the afternoon. Try a mid afternoon snack

2. Your loved one may not like the busy atmosphere and hustle and bustle around dinnertime. Try planning ahead and fixing part of the meal in the morning when they aren’t agitated. This will free you up to be more attentive during this time of the day.

3. Clothing that was put on them in the morning, may be too hot in the afternoon. Try removing a layer.

4. Noise tends to bother those with Alzheimer’s later in the day. They are tired and can’t cope with the being tired and the extra stimuli. Try to play the TV or radio quieter in the afternoon or evening and see if that helps them remain calmer.

5. They may need more lights on in the afternoon and evening. Shadows may cause them confusion. Try turning on the lights before there are afternoon shadows.

6. Make sure the room is uncluttered. Try to keep the area where you loved one is free from clutter.


If you find that none of these solutions seem to be helping, consult your loved one's physician for suggestions, testing for a possible urinary tract infection or perhaps a medication adjustment.

Chatty!

If you knew me on a personal level you would know that I am a tad bit chatty. It is great attribute for teaching, consulting and working with families. However it proved to be a bit of a challenge when I was providing care for those with Alzheimer's.

Several months ago I came across an artilce, entitled "10 Tips for Communicating With A Person Who Has Dementia." It is posted in the Basic Care section on our forum. Please visit our forum if you would like to read other artilces with tips and ideas to make the challenging activites of daily living and basic care easier.

I have found that the most useful tip for communicating with a person with Alzheimer's or Dementia is tip number 4. (Ask one question at a time; those with yes or no answers work best. ) As a chatty person, I almost found this one impossible to master.

With a little practice you can adapt your communication skills to help your loved one .

10 Tips for Communicating With a Person Who Has Dementia

We aren’t born knowing how to communicate with a person with dementia—but we can learn. Improving your communication skills will help make care giving less stressful and will likely improve the quality of your relationship with your loved one. Good communication skills will also enhance your ability to handle the difficult behavior you may encounter as you care for a person with a dementing illness.

1. Set a positive mood for interaction. Your attitude and body language communicate your feelings and thoughts stronger than your words. Set a positive mood by speaking to your loved one in a pleasant and respectful manner. Use facial expressions, tone of voice and physical touch to help convey your message and show your feelings of affection.

2. Get the person’s attention. Limit distractions and noise—turn off the radio or TV, close the curtains or shut the door, or move to quieter surroundings. Before speaking, make sure you have her attention; address her by name, identify yourself by name and relation, and use nonverbal cues and touch to help keep her focused. If she is seated, get down to her level and maintain eye contact.

3. State your message clearly. Use simple words and sentences. Speak slowly, distinctly and in a reassuring tone. Refrain from raising your voice higher or louder; instead, pitch your voice lower. If she doesn’t understand the first time, use the same wording to repeat your message or question. If she still doesn’t understand, wait a few minutes and rephrase the question. Use the names of people and places instead of pronouns or abbreviations.

4. Ask simple, answerable questions. Ask one question at a time; those with yes or no answers work best. Refrain from asking open-ended questions or giving too many choices. For example, ask, “Would you like to wear your white shirt or your blue shirt?” Better still, show her the choices—visual prompts and cues also help clarify your question and can guide her response.

5. Listen with your ears, eyes and heart. Be patient in waiting for your loved one’s reply. If she is struggling for an answer, it’s okay to suggest words. Watch for nonverbal cues and body language, and respond appropriately. Always strive to listen for the meaning and feelings that underlie the words.

6. Break down activities into a series of steps. This makes many tasks much more manageable. You can encourage your loved one to do what he can, gently remind him of steps he tends to forget, and assist with steps he’s no longer able to accomplish on his own. Using visual cues, such as showing him with your hand where to place the dinner plate, can be very helpful.

7. When the going gets tough, distract and redirect. When your loved one becomes upset, try changing the subject or the environment. For example, ask him for help or suggest going for a walk. It is important to connect with the person on a feeling level, before you redirect. You might say, “I see you’re feeling sad—I’m sorry you’re upset. Let’s go get something to eat.”

8. Respond with affection and reassurance. People with dementia often feel confused, anxious and unsure of themselves. Further, they often get reality confused and may recall things that never really occurred. Avoid trying to convince them they are wrong. Stay focused on the feelings they are demonstrating (which are real) and respond with verbal and physical expressions of comfort, support and reassurance. Sometimes holding hands, touching, hugging and praise will get the person to respond when all else fails.

9. Remember the good old days. Remembering the past is often a soothing and affirming activity. Many people with dementia may not remember what happened 45 minutes ago, but they can clearly recall their lives 45 years earlier. Therefore, avoid asking questions that rely on short-term memory, such as asking the person what they had for lunch. Instead, try asking general questions about the person’s distant past—this information is more likely to be retained.

10. Maintain your sense of humor. Use humor whenever possible, though not at the person's expense. People with dementia tend to retain their social skills and are usually delighted to laugh along with you. http://www.caregiver.org

Alzheimer's Handbook

Q: Dutchy,
I am just starting this journey with my mother. Is there a handbook or manual I can get?

I have been all over the internet reading info, but I would like something at my side I can reference. My sister and I live in CA and mom in ND.

We are at the stage in which the car must be taken away, mom needs to move into a care facility. She just lost her husband (our stepfather). As moms doctor said..."when Dean was alive the two of them made one whole person." Now mom is lost and her health is declining more rapidly.

I could sit and read your blogs all day, but as you know one does not have the luxury of time, so if you know of a book/manual/guide etc. that I could buy I would appreciate it.

Thank you, Joan

A: Joan, many families are going through the exact same scenario that you are now facing with your mother. Like you, they are looking for a place to begin.

There are several books on My Care Link, that we recommend for families caring for loved ones with Alzheimer’s and Dementia.

Two of my favorites for overall basic handbook or manual types are The 36-Hour Day, and A Family Caregiver's Guide to Planning and Decision Making for The Elderly.

Paul, a good friend, recommended The 36-Hour Day to me. I was having difficulties with providing care for his mother-in-law. She was a very stubborn woman who had been diagnosed with Alzheimer’s. She refused to do just about anything, especially bathe. During the night she would push her commode, like a walker, across the wood floor. It created an indescribable sound. My room was just across the hallway from hers, and I was suffering greatly from a lack of sleep. At one point we even had to remove the furniture from her room because she began to use the chairs as toilets. (I’ll stop there!)

Even though I had attended classes on Alzheimer’s and Dementia and was a “Dementia Specialty” home for the State of Washington, nothing could have really prepared me for caring for those with Alzheimer’s and Dementia, except providing care for those with Alzheimer's and Dementia. (nothing is better than hands on experience)

The 36-Hour Day has served me well as reference guide for many years now. I know you will also benefit from reading this book.

Some of the topics covered are; Nursing homes and living arrangements, caring for yourself, problems of mood, medical problems, characteristic problems of Dementia, and Research in Dementia.

Here are a few other books that you may find helpful:

Voices of Alzheimer’s
Talking to Myself A Caregivers Journal
The Caregivers Essential Handbook

If you have any other questions, please feel free to ask. ~ Dutchy

Dry Cracked Feet.

Q:My moms feet are all dry and cracked, do you have any ideas on how to help this?

A: I sure do. Here is a post from our forum on this very subject. As you will see, your mother is not alone in this problem.

While I know this isn't exactly a pretty thing to discuss, for some odd reason I got to thinking about this while I was trying to sleep the other night.

One of the hardest hygiene issues the elderly have to face is foot care. There are several reasons for this, such as diabetes, poor circulation or poor nutrition.

Over the years I have tried numerous products and techniques for keeping my ladies' (in the adult family home) feet looking and feeling great. Often times I would have a bed-ridden person who could not soak their feet in a shower. By the way, just for your information, it is not good for elderly people to soak their feet for very long. It will damage their new skin, while sluffing off the old.

So drum roll please...the best product to use for elderly dry, cracked, or just need a good scrub, feet is...Satin Hands by Mary Kay.

On a fluke I decided to try this on one of my ladies. She hadn't been able to have a real shower in about three years, and washing and lotion, just weren't doing the job. With this Satin Hands product there are a few stages, 1. A hydrating cream. 2. A buffing cream. 3. Is a cleanser that takes all the yuck off. 4. Rinse with a washcloth and tub of water. 5. Top this off with a really nice mild lotion. (You should never put lotion between the toes-it could cause a few creatures to start growing)

I found that there were several benefits to doing this little process with my clients. They loved how it made their feet feel. We got to spend a bit of time chatting, while they felt pampered. Their feet felt so good afterward, and looked so good too, that they loved the comments, (wow, your feet look great)

This whole process takes about 10- 15 minutes. Not long when you consider how great the elderly person feels afterwards. Both inside and out!

Also, I don't sell Mary Kay, so this isn't a shameless plug to promote a business, this stuff just really works! Come to think of it though, I do have a friend who does sell Mary Kay...so if you are curious and want to try Satin Hands- even if you are a guy- send me an e-mail and I will connect you. Also one last note, Satin Hands is awesome for hands too! My e-mail address is director@mycarelink.net

One of our favorite "posters" on our forum, also swears by "critter soap" to read his post click on "critter soap" Or click on "Yikes! Toe Nail Fungus". Don't let worry over a loved ones feet keep you up at night. ~Dutchy

Senior moments?

What are symptoms of Alzheimer's disease other than memory loss?

Outside of the memory domain, you may have changes in the ability to carry out your daily functions. So if you formerly handled the finances for the family—you took care of the checkbook, you paid the monthly bills, you did the taxes or prepared the material for your tax preparer—and now you're starting to have difficulty, that might be significant.

Loss of navigational skills is another symptom. We all take it for granted that we can get around town, we know how to get to the grocery store, to the golf course or the restaurants. But if you're starting to get a little disoriented and getting lost in previously familiar environments, that would be a sign there are cognitive difficulties associated with Alzheimer's.

People may also have a change in their ability to concentrate on events. So, formerly, you could sit through a two-hour movie without a problem or watch television programs, or read a novel. And you just don't do that anymore.

If you are conerned about memory loss. Please check out this web site, where I found this helpful information.

Or read a personal entry on our website concerning our dad and his memory loss.

Pastrami on Rye

Everyone is talking about the "Sandwich Generation” I wanted to jump in here before the sandwich cart rolled away.

I was just on the phone with a friend who is feeling like the mustard in the sandwich. In other words....

Caught in between
Spread thin
Looking yellow

At 47 she is dealing with her own health issues, raising her 16 year old son, getting a daughter off to college, and caring for her 74 year old mother who is in the beginning stages of Alzheimer's. My friend takes her mom to all of her appointments, pays her bills, makes sure her mother has enough food to eat, and is now looking into long term care options.

If you have a friend who is caught in between here are a few ways you can help:

1. Listen, be there for her to laugh with and cry with.
2. Encourage him to hang in there
3. Make her a casserole, to pull out of the freezer on a hectic day
4. Print out articles on caregiver burn out that encourage his self-care.
5. Send him little cards of encouragement
6. Offer to help out with running an errand
7. Send her to a spa! (when I was a caregiver I particularly enjoyed spa gifts!)

Protecting your parent

One of the most important factors in determining whether or not your parent or loved one is ready for long-term care, is what I call their risk factor.

Although making the ultimate decision as to what kind of long term care facility they need will require much more thought.(or a session with a long term care consultant) Here is a list of risk factors you should take into consideration when you believe it’s time to make some changes, but you are feeling a little unsure.

1. Is my mom at risk for falls?
2. Is my mom at risk for overmedicating herself or under medicating herself?
3. Is my mom at risk for malnutrition or dehydration?
4. Is my mom at risk for exploitation?
5. Is my mom at risk for injuring herself or others while driving a car?
6. Is my mom's overall physical well being at risk, due to poor hygiene?

When you were younger and unable to protect yourself, your parents stepped in to protect you from harm. You need to think of yourself as being in their shoes now. As tough as it may seem you need to make the decisions and step in before there is a car accident, a broken bone, a hospitalization for over medicating, or before your mother gives her money to a stranger. Don’t let indecision or feelings of guilt override what needs to be done. ~Dutchy

You can lead a horse to water…

To Elaine and all the other tireless caregivers out there,

I have no doubt that somedays you get sick of hearing advice, or having others tell you what to do, when it comes to caring for your loved one. And here I come to add another two cents worth.

Keeping a loved one hydrated is challenging at times; just do your best, that is all you can do.

"...I’d say hubby is in stage 6. He is dehydrated. I’ve read all you wrote on feeding but he still won't drink. Like they say,You can lead a horse to water, but you can't make him drink…" Elaine, Florida Keys

As caregivers I am sure you have all heard the following phrases
1. he/she needs more water
2. You need to make sure she gets more fluids
3. Her skin turger is poor
4. Push those fluids
5. We need to keep him hydrated

We know, We know!

Here are a few tips to help you out
1. Keep water in the refrigerator, for those that like it better cold

2. Set the water in front of your loved one while you are preparing the meal

3. Add a slice of lime and make it , a bit more refreshing

4. Use a straw. Some people actually drink more liquid through a straw, use a straw for soup broth’s too

5. Try freezing juice and serving it as ice chips

6. Try serving liquids in fancy glasses, and making toasts!

7. Ice cream is considered a liquid, offer it after a meal, and wash the ice cream down with water

Here is a great drink recipe for orange juice slush. This is so delicious; I can’t imagine anyone refusing to drink it!

Put all ingredients in the blender

1 cup water
1 cup milk
10-12 ice cubes
1- 6oz can of orange juice concentrate (we have tried cranberry, or raspberry too)
¼ cup of sugar (may substitute with Splenda or Stevia to taste)
1 tsp. of vanilla extract

Blend ‘til ice is crushed
Serve

Keep in mind... you can't make him drink! ~ Dutchy

Is it time for a Hoyer lift?

Q: Hi Dutchy I really enjoy your site. Very helpful. I hope you can help.

From the Alzheimer's/Dementia website I’d say hubby is in stage 6. Lately he has fallen a lot. Just gets shaky in the knees and falls in slow motion. I’m usually there to break the fall. None of the falls have resulted in injury but I feel it's just a matter of time.

Anyhow my question is how do you get Alzheimer's/Dementia patient up? The other night it was nearly one hour because he can't follow my instructions. In the daytime I can call a neighbor but at night it's just me.

Thanks again for your insight and help. Elaine

A: Thank you Elaine for your wonderful question!

As the caregiver, you need your health and lifting someone by yourself, is the surest way to get an injury! I'm glad to hear that you don't try to lift your husband by yourself!

It may be time for you to get a lift in your home. I have used a Hoyer lift to get a fallen resident off the floor. After checking the your husband from head to toe for possible injuries it should be fairly easy to roll him onto a sling. Using the hoyer lift you can raise him to a bed, or wheelchair. It is a bit time consuming and sometimes seems like a lot of effort, but if it saves your back it is well worth it.


The second suggestion I have for you is to have him roll on a mat or a very cushy blanket, cover him well, and wait until morning to get help with getting him off of the floor.

Things for you to consider:

Is it safe for your husband to continue walking?

Can you get a doctors order for physical therapy, to help him maintain the strength he does have?

Does he need to start using a wheelchair?

With a wheel chair could you try pivot transfers and use a gait belt to help him stay steady.

Would it be possible for the doctor to prescribe something a bit stronger so he will sleep through the night hours?

Is it necessary for him to get up at all during the night?

If he needs to use the toilet, would a bedside commode help eliminate falls?

Would it be a good time to look into wearing attends?

While none of these question/solutions are extremely palatable, when you are caring for a loved one in the later stages of Alzheimer’s a caregiver has to consider all options and make tough decisions.

Let me know if I have helped you. ~Dutchy