Liar, Liar

Here are some tips on effective lying. (I never thought I would write an article like this)

Through out the process of a loved one going through the stages of Alzheimer's there will come a point when you have to lie. There will come a time when you loved one is agitated, or overly concerned about an issue, and you will have to lie. You have to lie, based on the sole reality that they are not in reality.

Thoughts of the Ten Commandments keep coming into my head. So perhaps we should rename this post, something like, Creative Re-directions.

When your love one is looking for a deceased relative, or they insist on going home, it can make you feel like you are going crazy.

Here is a link to one of my first "Ask Dutchy" articles. It contains one of my greatest creative re-directions. This is just one example of the many lies I have had to tell over the years.



Add to that,

1. Your husband is at work and he will be back soon.
2. Your daughter called and said she wants you to eat.
3. The doctor said, "You need to eat."
4. I am sure your son is coming to visit soon.
5. Your mom called and said she will be home in a while.
6. Yes, I checked around the house, and we still didn't find the dog.
7. The check is in the mail...oops, sorry, wrong list of lies.

Please feel free to add comments and list creative re-directions of your own!

Serious Sign of Caregiver Burn out.

Over involvement is a serious sign of burn out.

When you are over involved, you begin to look at the person you provide care for as a series of tasks that need to be performed, rather than, thinking, "What can I do to help them?" You may be in trouble if you can't separate your feelings of anxiety from that person.

A good indication of this would be cringing when you hear then walking, or you think to yourself, "what now?"

Another indication is if you find yourself doing personal care tasks in a brisk and rough manor.

You may begin to spend as much time as possible in the other room, so you don't have to even look at the person you are providing care for.

Or perhaps,you find yourself muttering nasty words, or thoughts under your breath, while providing care.

I know from talking to other caregivers that these feelings are real. These feelings are nothing to be ashamed of, they just mean you need to get help quickly. When a caregiver is at this point they are on the verge of abusing the person to whom they are providing care.


Here are some common forms of elder abuse.

Physical Abuse, slapping, hitting, pinching, pushing, sexual abuse and restraining.

Mental Abuse, calling names, belittling, intimadating, and threatening.

Exploitation, taking money or items that do not belong to you.

Neglect, not providing for the basic needs of the elderly person. Ignoring medical problems or not getting them the help they need.

As caregivers we have a responsibility to protect those we care for, when we can't separate our feelings of burn out from the person we are caring for, we have a potentially serious situation. Be aware of your negative feelings, they are the warning signs that say,"Get Help." ~ Dutchy

Gee mom, I wanna go...home!

When you provide care for a loved one with Alzheimer's, or if you are a professional caergiver, you have more than likely heard these words, "I want to go home!"

I spent quite a bit of time explaining to guilt ridden families that almost all residents with Alzheimer's want to go home. But the reality is, they would want to go home even if they were home.

I can't read the person with Alzheimer's mind, but I can imagine what it might be like. They know they are in unfamiliar surroundings, they don't really know their caregivers, they can't congnitively get back to a place where they are in their right minds. If I were them, I would want to go home too.

When the person you are caring for repeats a statement like this one, or others similar to it, your best option is to gently re-direct the conversation, or provide a physical activity that changes the thought pattern.

I often found that giving them a kiss on the forehead and hug while telling them, I know how they feel, actually goes a long way. One client I cared for would tell me she wanted to go home, I would plant a big kiss on her forhead, and she would say, "Oh my, what was that for?" I would say, "Cause I love you!" That was just enough of a distraction to re-direct her thoughts.


Sometimes you may have to lie! If re-directing or distraction does not work, try a little white lie. I had one persistant little lady who would not be re-directed, she finally stopped asking to go home when I suggested that her apartment was being remodeled, and she couldn't go back until it was done. I told her this, in October, November, and December, before we were finally able to put the subject to rest.

One thing you must never do is correct the person with Alzheimer's when they ask to go home, it will only agitate them further. Saying things, like you have no home, or you live here now, will cause the person with Alzheimer's to become very anxious. Try the suggestions above for a much softer approach! ~ Dutchy

Overwhelmed Caregiver

Q: Sometimes I am overwhelmed by taking care of my Father. He has Alzheimer's. Even the "so called" easy tasks, seem overwhelming...Help!

A: Without knowing all of your particular circumstances, I will only be able to give you a few general tips for handling some of the tasks that are overwhelming you.

At a point when you are asking a question like this it sounds like several things need to be addressed.

A good place to start is by writing down a list of tasks that seem overwhelming.

Consider getting outside help for those tasks that seem too difficult or are causing you the greatest amount of anxiety.

. If it were bathing that seems to put you over the edge, perhaps an in home bath aid, would give you some relief.

Talk to relatives or friends that have offered to help. Let them know that you are feeling overwhelmed, some of them may be willing to pitch in.

Take a break if something is too difficult, unless it has to be done this minute, put it aside for a little while, rest if you are able, and then approach it when you are feeling less fatigued.

Give yourself more time to finish the task. If you are stressed out chances are you are in a hurry to finish particular projects. If you can, slow down and do it at your leisure, when the time permits.

Here is a list of signs that you are burnt out.

Please let me know if there is anything more specific, I will be glad to help! ~Dutchy

Does mom need more Alzheimer's activities??

Q: My biggest challenge is finding any activity my Mother is interested in. We mainly go out to eat each day at lunch (a block from her home is the town malt shop), we then sit on the porch and watch traffic, read the paper, and go for drives in the car around town. She does not like TV or any crafts. She does take care of dressing herself but it is taking longer all the time. Do you have any ideas? Strawberry

A: Hello Strawberry, I love your name!

For someone with Dementia your mother sounds like she is still doing fairly well. You sound like you are doing a good job keeping her busy. In fact she seems a lot more active than some of the ladies I provided care for in my home.

Often those with Alzheimer’s or Dementia have the same or similar likes and dislikes, as they did when they were able too fully function on their own. If your mother used to be the crafty sort, perhaps she is no longer able to follow the methodical process that crafts require, and therefore doesn’t enjoy them anymore. On the other hand she may not have ever enjoyed crafts.

If you are having a difficult time getting your mother to follow simple cues, your mother may be past the crafty type of activities that those who are in the early to mid stages of Alzheimer’s can still participate in. This doesn’t mean that you can’t try something new, but you should pay close attention to her cues. If she has no interest in an activity she probably isn’t comfortable doing it anymore, or is incapable of doing that activity. If she is frustrated, combative, or restless, you may want to try something else.


In regards to your concern over her not wanting to watch TV, many people with Alzheimer’s become frustrated when watching television. Either it is too loud, or they don’t understand the story lines, or perhaps they no longer have the attention span that it requires to watch a show. A nice alternative may be playing soft music that is familiar to her.


As the Alzheimer’s disease progresses into the final stages, you may find that the only activities your mother is capable of doing are those that require complete hands on assistance. For example, you will find yourself doing more and more of the activities of daily living. Spending more time combing her hair, or filing her nails, giving her a good foot massage, or rubbing lotion on her back.


Activities based on keeping your loved one, clean, dry, pampered and comfortable are very meaningful in the end stages of Alzheimer's or Dementia. Providing those with Alzheimer’s the touch they need is considered an activity toward the final stages. Activities like these can have a very calming effect too. Just some things to consider ~ Dutchy

If you are looking for Alzheimer's activities here is a direct link to an Ask Dutchy article that may help in you in deciding what kinds of activities your loved one would benefit from.

A Note From Alzheimer's Author, Deborah Uetz

Years ago, I was a therapist for an Adult Daycare which provided services for Alzheimer's patients. From the moment I walked in each morning until they boarded little shuttle buses at the end of the day I enjoyed their company.

We chatted over morning coffee (most of our conversation totally irrational but pleasant.) I helped each one make an art project and even those who could not lift their hand out of their lap left with a lovely art project. I played the piano and we sang old songs and I really felt so at ease.

Even on the days when Joseph the new client tried to take the plumbing apart (former plumber) or when Mary followed me every step begging me to find her "baby" I was never undone. I had never known Joseph when he was a healthy husband and father and plumber. I only knew him "as he was". I didn't know Mary the dotting mother whose children were now grandparents.
I loved each one just as they were...THEN Alzheimer’s hit my family in 1999.

Dad had always been a real presence. He had always been the boss. He was a carpenter, a WW2 Navy veteran and the disciplinarian when I was growing up. When he became a highly agitated, paranoid, pacing, afraid of the dark, bolting out the door, searching the house for car keys, hiding the mail....stranger...I didn't feel confident or at ease. I experienced a full out adrenaline rush for most of three years. He was Dad. He was the guy who taught me to drive and told me to go to my room when I was in trouble. I didn't know this other fella, the one who would ask me where his mother was (the mother who had died when he was a toddler).

Caring for someone you have known when they were healthy is nothing like trying to wrap your mind around the Alzheimer's care giver experience when it is your loved one. I developed the habit of carrying the portable telephone around with me all day, every step I took because there were so many "Deb, come quick" phone calls. I STILL carry the phone around all day even though Dad passed away almost three years ago.

If you find yourself thinking you must be mean spirited because caring for someone you love seems far more draining and challenging and emotionally depleting, try to stop beating yourself up. That is just the way it is. There is no autopilot when it is our loved one...it is full out, heart racing "waiting for the other shoe to drop" marathon. Be kind and gentle with yourself. Be your own best friend. Take any chance you can find for some TLC. God bless. ~ Deborah

Click here to read about her book, Into the Mist, When Someone You Love Has Alzheimer's Disease

Prepare for Long-Term Care Choices

Several months ago, I was coming out of a gas station when a woman stopped me and asked me what I did for a living. On the back of our van is our web address. On the side wing windows is "Free Senior Home Placement." I explained to her that I am a Long Term Care Consultant. She breathed a sigh of relief. "Great I need you!"

She went on to explain that her mother had fallen and was in the hospital. Her hip had been broken, and she was going to be discharged from the hospital in two days. She was going to require 24-hour care. To complicate matters her mother had been caring for her father who was unable to walk, or feed himself. Suddenly they found themselves in the middle of a crisis.

Families never expect to be in a situation like this. But situations like this happen all of the time. Here is a list of things families should do to be prepared for a crisis.

While your parents are still mentally cognizant discuss with them the kind of long-term options they would prefer. Discuss, nursing homes, assisted living facilities, adult family homes, boarding homes, or in-home care.

Prepare a notebook that includes documentation, such as physicians phone numbers, attorney's phone numbers, bank account information, ministers phone number, power of attorney documents, and their living will.

Educate yourself on the kinds of facilities that are available in your area, or where your parents live.

Contact your local department of social and health services, find out what resources that they have available if you should need financial support. Fill out the paperwork ahead of time, leaving the date and other time sensitive information blank.

Discuss some of these issues with your siblings before hand, so you do not have to deal with family dynamics in a crisis.

Visit facilities and discuss prices so you know what your parents are able to afford. (Note that when the time comes circumstances may be that they cannot live in the kind of facility that they would prefer, especially if they require heavier care than they had antisapated.)

Being unprepared when a crisis hits will leave you scrambling. If you have done a portion of the legwork before hand you can face the crisis before you with a measure of confidence. ~Dutchy

Long-term Care choices

Q: How do I approach my Dad about moving to a long-term care facility?

A: Talking about this kind of change in an elderly persons life is never easy. Assuming your father has most or all of his mental facilties in tact, here are a few things you can do that may help the conversation go well.

It is a good idea to talk to your Dad when there are no other distractions. Set aside a time when everyone is rested. Mention to him before hand that you would like to talk to him, so he is mentally prepared for the discussion.

If your Dad is able, he should be given a chance to have a major role in the decision regarding what kind of facility he would like to live in. He should also be included in the plans to carry out the decision.

When talking to your Dad it is very important that each of you is able to talk without interrupting each other. Let each of you state your opinions and get them out in the open.
If you let him go first he will feel like he has more control. Don't put up objections while he is telling you his feelings. Put your objections in the form of questions, and ask them in a non-threatening manner, when it is your turn to talk. Be careful not to bombard him with those questions, save some of them for a later time.

Don't rush this conversation. Give yourself plenty of time to get everything out in the open. If the conversation is rushed, your emotions and his emotions may escalate. Be patient.

It may take more than one conversation to decide what is best. If your Dad does not like the idea of moving into a facility, take smaller steps and perhaps get someone in to help him with the activities of daily living.

A good approach to the first conversation would be to remember that you and your father are there to discuss options and not make a decision that day.

No matter what the outcome of the meeting is, tell him you love him, and that you are glad you were able to have this talk. If you leave on good terms, he is more likely to seriously consider what you have said. ~Dutchy

Mad Cow Disease

This article is for families who are dealing with denial. For the past year our family has noticed my father in law and his steady decline with Dementia. Our biggest challenge has been with my mother in law and getting her to admit that we have a glaring problem with "Dad."

I thank God that it seems that we have just now come past the hardest part. Don't they always say the hardest part is admitting you have a problem?

My mother in law has been coming around in the last week. I had to write this post about our situation because I am so happy about our progress this weekend. I am fully aware of what is to become of Dad in the months and years to come, I know tough times are ahead. At least now we can deal with them in a more proactive manner.

My family had such a tough weekend with Dad that each one of us decided to post part of the story on the forum. You can read about this weekend at the Alzheimer's/Dementia forum, under the sections entitled, "My Dad Has Alzheimer’s."

Two of my Father in laws' sisters have passed away from Alzheimer's. This has finally led to my Mother in law accepting his condition as, "Diabetic Dementia." My response, is call it whatever you want, just call it something.

In our conversation this morning, I was telling her what the top ten causes of Dementia were. I said, "The number one cause of Dementia is Alzheimer's.... The number 10 cause of Dementia is Mad Cow Disease."

Her response was, "I'd settle for Mad Bull Disease!" We laughed ‘til tears were streaming down our faces. At this point I know we have over come denial.

In the book, Into the Mist, by Deborah Uetz states that, "Denial only becomes problematic when it interferes with obtaining necessary care, taking care of practical issues, avoiding seeking a diagnosis, or when it is used excessively over long periods of time."

I am so glad we are over this hurdle. Now we can start on the next phase of this race.

Safetybath.com

Safety Bath Promotes Independence Safety Bath has been designed to allow ease of access for those unable to bathe in a regular tub, including persons with physical challenges, limited mobility or the elderly. An individual capable of using a walker will have no problem getting into this tub. Imagine the great feeling of independence Safety Bath will give to someone who wants to remain independent while still living in their own home. In addition, Safety Bath will assist the care giver who must often lift or support an individual while helping them into a regular bathtub. Safety Bath is Designed for Safety Safety Bath has a built in no-slip surface on the floor and seat. Safety Bath has a complete set of pressure balancing, scald guard taps which can be adjusted to a maximum temperature setting to prevent burns and provide for even temperature when other water outlets are used at the same time. Safety bars can be added as needed . Safety Bath is Designed for Comfort Seat and back are molded to allow maximum support & comfort Sides provide comfortable arm support Hand held shower included Unique design allows you to sit in chest level water if so desired Safety Bath uses about the same water as a regular bath Safety Bath is Designed for Easy Operation Individuals who once needed assistance are able to bathe by themselves. All controls...tap, hand held shower, pop up drain and door handle are within easy reach. No lifts are required Safety Bath is Designed for Easy Installation No need to renovate bathroom or bathing area Safety Bath is a self-contained unit and can be installed in any convenient location in the home. All plumbing fixtures are supplied. Will pass through any 30 inch door opening- 28 inch with jam removed. We are in the process of setting our home up to provide care for my husbands elderly parents and his grandmother. Currently his 80 year old grandmother has to climb a flight of stairs to get to the bathroom. This is already to much for her. We are looking at the safety bath. His grandmother is really excited. We wanted to know if any of you have ever used this product, please let us know how you like it. ~Dutchy	Picture Gallery Unassisted Entry
	No slip seating
	Comfortable seating
	Easy to reach controls

No Place Like Home

If your goal is to keep a loved one with Alzheimer's or Dementia at home, this list on Alzheimer's/Dementia proofing your home, will be helpful.

1. Regulate hot water heaters to prevent scalding water. The suggested setting is 120 degrees.

2. If you can, replace glass with plexiglass. A woman I knew who suffered from Dementia fell backwards into her china cabinet, cutting her head in several places. Simply removing glass cabinets or glass coffee tables would work too.

3. Keep cabinets locked or use childproof barrier systems. I have seen a person with Alzheimer's spray disinfectant on their arms. They need to be protected like a small child.

4. Keep electrical appliances away from water sources. This might include throwing away blow dryers that your loved one left out in the rain . (true story)

5. Place childproof safety plugs in electric sockets. A confused person may try to stick inappropriate objects in the sockets. Putting in child safety plugs will give you one less thing to worry about.

6. Keep medications locked in a safe place. It is recommended that they be stored in any other room but the bathroom.

7 . Remove poisonous houseplants to avoid their ingestion. I have had ladies with dementia try to eat my candles also.

8. Remove sharp objects such as knives and scissors-place them in locked cabinets and drawers. If your loved one likes to cut material, or wants to help chop vegetable for dinner, do so under close supervision.

9. Put safety covers over stove and oven range knobs. You might want to unplug your appliances that sit on the counters also.

10. Keep swimming pool gates locked.

(source: adapted from, Into the Mist, When SomeoneYou Love Has Alzheimer's Disease)

My Father Wants to Kill Himself

Dutchy ,

My father is 80 years old and has lived a full and rewarding life. He now has been diagnosed with Alzheimer's and the care giving is becoming too much for my 78 year old mother. It's not the illness that is the problem . I think we could cope with that. He constantly complains that he wants to kill himself and has gone so far as to get sharp objects and threatens to cut his throat . He says to wants to blow out his brains, step in front of a truck , jump off a building , etc, you get the picture.

The stress is too much for my mother and we don't know what to do ? There are not a lot of homes that want suicidal patients . Please don't say contact your local government health care unit. They are a waste of time and money . My father was picked up in his home the first time with a gun in his hand. He called 911 and asked for help and the police responded. They took him re; 11550 H&S and he was released the next day. We have since cleared out all dangerous items in the house, but who really knows what can be used as a weapon.... James

Depression in the elderly is often so subtle that it is hard to recognize. Many families, tend to dismiss the thought of mom or dad being depressed, and just attribute their loneliness, complaining or quietness to just plain getting old. In the case of your father, his depression is obviously not subtle.

It has always been said, that suicide threats are a cry for help. This is more than a cry for help. This is obviously a very serious matter. I have asked Deborah Uetz, the author of Into the Mist, When Someone You Love Has Alzheimer’s Disease, to join me in answering your question. Deborah has experienced suicide in her own family and now moderates a forum for families, who are dealing with their loss.

Dear James,

First let me say that you are very wise to remove ANYTHING that could be used to hurt himself. Really think about all of the things that he might use to carry out his suicide threat. You must also make sure that your mother is kept safe. I removed all of the knives from my mother's house because my father was so agitated and didn't understand where he was or who she was.

Is your father on medication? If not, he should be seen immediately. If he is on medication get him in to see his Neurologist and explain what is going on.

He also might benefit from spending some time on a geriatric psych unit. My father spent about two weeks in a unit and he came out a changed man. His agitation was gone and he was at peace.

Now regarding suicide. I lost my brother to suicide two years ago. Any suicide threat must be treated seriously. Here are two ways you can contact a crisis line to talk to someone about his threats.

To contact them by e-mail jo@samaritans.com

To contact them by telephone, dial 1-800-suicide.

It sounds as if your dad feels as if he is a burden on your mother. If this were, his concern perhaps he would agree to living in an assisted living facility or a nursing home.

Above all please deal with this immediately and begin by contacting his Dr. If you are not able to get their attention quickly then you should call the number above.

I am so sorry you find yourself in this most difficult situation. I never believed my brother would follow through...sometimes we are wrong.

Deborah Uetz

Here is a list of signs your loved one may be depressed

Symptoms:

~ depressed or irritable mood
~feelings of worthlessness or sadness
~ loss of interest or pleasure in daily activities
~ temper, agitation
~ change in appetite, usually a loss of appetite
~ change in weight
~ unintentional weight loss (most frequent)
~ weight gain
~ difficulty sleeping
~ daytime sleepiness
~ difficulty falling asleep (initial insomnia)
~ multiple awakenings through the night (middle insomnia)
~ early morning awakening (terminal insomnia)
~ fatigue (tiredness or weariness)
~ difficulty concentrating
~ memory loss
~ abnormal thoughts, excessive or inappropriate guilt
~excessively irresponsible behavior pattern
~ abnormal thoughts about death
~ thoughts about suicide
~ plans to commit suicide or actual suicide attempts

~ If these symptoms are present every day for more than 2 weeks, then depression is likely present.

Most of all our thoughts and prayers are with you ~ Dutchy

Clues

When is the right time to get help for a parent?

The moment you begin to notice that they are no longer able to perform activities of daily living, is the time you need to consider getting them some help.

When parents are no longer able to bathe, they may need a home health aid, in several times a week to assist them. Or perhaps just a bathroom that has been equipped with bathroom safety equipment.

If their home becomes untidy, you may want to hire a cleaning service to come in once a week to help them maintain sanitary conditions, and their dignity.

If they are having trouble remembering to take medication, you might try setting up a medi-set for them. If your parent is still having trouble, you may wish to hire a home health aid, to come in and assist them.


If they are unable to cook nutritious meals for themselves, you may want to have a senior program such as meals on wheels, begin to deliver food for them.

These signs do not necessarily mean that they have to stop living on their own, but they do mean they need some kind of help.

Active Dying

Q: What is it like when someone with Alzheimer’s passes away?

A: Many people have asked me that very question. What is it like at the very end?

The final stage or the eventual passing of a loved one is different for each person. I have described this process to families like this…

Each person comes into the world in relatively the same way. Each is born, however no two birth stories are alike. The circumstances surrounding the birth, what happens in the days, the hours before, or during the birth, are all different.

In the same way the passing of someone we love will be similar to the way others pass, but the events surrounding their passing will be unique.

Many people however, find comfort in knowing what to expect….there are two things for certain, we are born into this world …the only way out of it, is to die. (Please do not read further if this material may upset you.)

The end stage can last for days, weeks, or even a month. Towards the end of your loved ones life the series of ups and downs you may have been experiencing up until this point, will now, be a steady decline.

Here are some signs that your loved one may be actively dying.

1. Increased sleeping. As death nears, the person will spend more and more time sleeping and may be difficult to arouse. What you can do: Let your loved one sleep and rest. Recognize that, at this point, being with your loved one is more important than doing things for them.

2. Less interest in eating and drinking. In the weeks or days before death, the person has a decreased need for food and fluids. What you can do: Offer your loved one his or her favorite foods, but do not force them. Keep the mouth moist with a damp cloth or toothettes (a small sponge on a stick). Keep the lips moist with lip balm.

3. Changes in speech and hearing. As the nervous system slows, the person's speech may be difficult to understand and they may become less responsive to conversation. However, this does not mean that the person cannot hear—there is evidence to suggest that hearing is the last sense to be lost. What you can do: Speak clearly but not more loudly than usual. Carry on all conversations as if your loved one can hear them. Express your love and caring. Say the things that need to be said and encourage others to do the same. Your loved one may be able to understand what you are saying even if he or she cannot respond.

4. Confusion, hallucinations, and restlessness. As the oxygen supply to the brain decreases, your loved one may become more confused about time, place, and the identity of familiar people. Speech may be incoherent and hard to understand. Your loved one may experience visual and auditory hallucinations. He or she may also become restless, pulling at bed linens, trying to remove clothing, or even trying to get out of bed. These symptoms are all normal and to be anticipated. What you can do: Reorient your loved one by gently reminding him or her of the time and day, and by identifying yourself and others in the room. Keep favorite and familiar objects in the room. Provide physical reassurance by touching, holding hands, or gently massaging the back, hands, or feet. If your loved one is experiencing hallucinations, simply be present to what is happening; it may be appropriate to just listen. Provide a safe environment; bedrails may be needed to keep your loved one from injuring herself.

5. Changes in breathing patterns. A first indication of approaching death may be changes in the person's breathing. It may become irregular, with periods of no breathing lasting around 20 to 30 seconds. This symptom is very common and indicates decreased circulation. It is not distressing to the person. Breathing may also sound labored and noisy. This is the result of secretions collecting in the back of the throat. It does not mean the person is in discomfort, but it may be upsetting to caregivers. Zen Hospice http://www.zenhospice.org/what/dying_faq.html#1

Urinary Incontinence

This article is intended to express one of the many challenges caregivers are faced with. It is not meant to demean or show disrespect to those who are suffering from a dementing illness.


Urinary incontinence and bowel incontinence are two reasons families
admit their loved ones into long-term care facilities. In the later
stages of Alzheimer’s incontinence takes a toll on the caregiver.

If you have never taken care of a person with Alzheimer’s or Dementia,
here is a brief description of what it is like to assist them with this
particular activity.

Imagine… a wheel chair must be locked into place, or perhaps a gait belt
needs to be placed around the loved one’s torso to prepare for a pivot
transfer. Maybe they can walk or get out of a chair themselves,
However, there is always the effort of cueing them to do what needs to
be done next. . Now walk into the bathroom by slowly ambulating or
shuffling. If you are wheeling a wheelchair you must align the
wheelchair just right to prevent the brakes from destroying the door
jam? One good push, or 10 more steps and you are in the bathroom.

Once you are in the bathroom, toileting will usually require a standby
assist. You must make sure they don’t fall. They often need someone to
pull down their pants, unfasten their belt, and pull down their briefs.
More often than not a small amount of urine will drip on the floor or
commode while they are in the process of sitting down on the toilet.
Often (if the trip was for a bowel movement), their will be a bit
of “resipooh” or a blossom (a smudge) in their incontinence brief. Or
a smear of stuff that didn’t quite make it into the toilet. This needs
to be cleaned and disinfected.

Their clothing is sometimes wet, too. Urine can drip down the leg and
soil their shoes. The pull-up or diaper needs changing, either
requiring a trip to the bed (more cueing transferring, and more bending
to put on). Or, perhaps you will need to take off the shoes, socks,
pants, incontinent brief, and re-dress your loved one. Sometimes,
they can remain standing while you change them, but you may have to run
to their room to get all the supplies.

Don’t forget wiping, which often includes acrobats, since home bathrooms
weren’t designed to have two people in that itty-bitty space. Following
that, the toilet needs to be flushed and the garbage needs to be
emptied.

You then return with your loved one to his/her favorite easy chair. Just
in case they leak through, make sure there is an incontinent pad placed
underneath them. Wet clothes need to be washed or placed in a special
basket for soiled clothing. ...That was just the first trip to the toilet
today!

Just thinking about this whole process wears me out. It is easy to see why unrinary or bowel incontinence is one of the determining factors in a families decision to place their loved one in a long-term care facility.

Nursing home?

I heard someone say this and I couldn't help but respond. I have paraphrased the statement.

"I suggest to all caregivers that they take care of their relatives at home. Don’t change their environment at all. Keep them in their same rooms and same settings. If you place them in a long- term facility they will deteriorate fast. Because of new surroundings they may get agitated. People with Alzheimer’s need love, not meds. They should be asked to recall their childhood, married life, and relatives. More than medication they need love and caring from a son, daughter, or grandchild."

Dear Sir,
I was just curious, have you had the opportunity to care for someone throughout the duration of an illness such as Alzheimer's?

I humbly accept what you say as your opinion and think that it would be great to keep your loved at home.

However, my deepest feelings and thoughts in response to your post, go to the caregiver. People with dementing illnesses do go hill, with every move or change. As Alzheimer's patients reach the later stages and are at risk to harm themselves, changes need to be made. The facts are people with AD will get agitated no matter where they are. People with Alzheimer's need medication, regardless of where they are. With Alzheimer's you progress and decline, no matter where you are at. In the case of Alzheimer's, love is wonderful, and definatly needed, but it does not cover all the bases.

While those people who seek long-term care for a loved one, obviously need to consider the best possible solutions, there are factors that should be considered on the care givers side of things in regards to keeping them home or placing them in a facility.

1. Is their own health deteriorating?
2. Are they able to physically handle the demands of caring? (90 pound woman caring for a 160 pound man)
3. What happens when their loved one needs 24-hour care? ( Their loved one begins to wander all night long)
4. What happens when friends and family aren't around to help anymore?
5. What happens when they feel like they are going to lose it, emotionally?

When caring becomes too much a loved one, they should not feel the least shred of guilt in regards to placing them. In a perfect world the scenario you referred to will work. And admittedly there are families out there and caregivers who can make it through the entire process without placing their loved one outside the home. They are the exception though and not the rule. Caregivers who decide to place have to know they did the best they could under extreme circumstances.

Things to keep in mind
1. Many of those caring for a loved one with AD are elderly themselves, and cannot keep up with the challenges.
2. Family members that might be available to help may, have careers, and houses, and families of their own to feed.
3. When a person becomes violent, or aggressive, they need meds, and a professionally trained staff or a proper setting to get the help they need.

As far as keeping the surroundings exactly the same, this is a subject that will require a new "Ask Dutchy" But keeping your surroundings exactly the same, can also cause your loved one to become agitated. There are so many things you can do to a home environment to keep them home longer.

As far as bringing up all the things they should be recalling.

You have to use extreme judgement with a person with Alzheimer’s. You cannot pressure them to recall things…you may get a very agitated and frustrated person from doing that. You should not constantly be asking people with memory problems to recall things. If you are doing this with a loved one I would suggest you stop…or it won’t be long before you will need to place them in a long-term care facility.

Long-term Care

If you are moving a loved one to a long- term care facility here is a list of paperwork that you should have ready.

1. A copy of your Medicaid and or Medicare card

2. Copy of any other medical insurance cards you may have

3. A copy of your power of attorney (medical or financial)

4. A copy of any advance directives or living will

5. A detailed list of your personal belongings. (The facility may have it's own form, but you should have all things accounted for before hand, this makes moving in so much easier.)

6. A current list of your loved ones medications

Items 1-4 are documents that you should have prepared long before you are considering placing your loved on in a facility. You never know when an elderly person will be ready for long-term care.

A sudden illness, or a broken bone and you are making choices you weren't prepared to make. Having the paperwork in order will save you a lot of trouble. Make copies of these documents and put them in a place where they will be easy to find, when that time comes.

Dad needs more help

Q: My dad lives in an assisted living facility, how will I know when he needs more care?

A: If you are unsure about whether or not your loved one should remain in an assisted living facility or perhaps they need a higher level of care, here is a list of things you may wish to consider.

1. Is your mother/father still calling you all of the time? This may indicate that their needs are not being met.

2. Has the facility started charging you for extra services? This would indicate that their care level is increasing, you may wish to monitor your loved one more frequently.


3. Have you noticed that your mothers/fathers physical appearance, tidiness, or hygiene has declined in any manner? This would also indicate that their care level is increasing and they needs more assistance with basic needs.


4. Has the facility started calling you more often for you to come and assist your mother/father? The facility more than likely does not have the staff to provide for this kind of personal assistance.


5. Has your loved ones health declined in such a manner that you believe they need more monitoring? A senior’s health may decline quickly, and subtle changes might be over looked, if this is a concern, you want your loved one to be monitored closely.


6. Does your mother/father remain in their room, instead of joining activities? Large group activities that were once enjoyable, may be overwhelming now, a smaller or more intimate setting may be preferred now.

7. Have memory problems or confusion increased? A person who is more confused, may need a smaller environment to feel secure, or need to be watched more closely.


8. Does she seem detached, or depressed? It is easy to get overlooked in a large facility; perhaps a smaller facility with more one on one would help your loved one feel more connected.

9. Does she/he need more hands on assistance with activities of daily living? It is hard for large facilities to provide this kind of service because the staff to client ration is so high.


10. Does she/he need encouragement to eat or drink? Staff in large facilities does not have the time it takes to ensure residents are getting the proper nutrition or hydration, or feed your loved one if needed. (sometimes it can take up to an hour to feed a person with Alzheimer's.)


Your best mechanisms for making a decision like this are your gut instincts and your own judgement. In listing these items I hope I have given you a basic guideline. ~Dutchy

Alzheimer's... Negative Feedback

Q: My mother has Alzheimer's, we have to feed her now, and she is not eating well. I am afraid that if we go off of her actions she will starve to death. Do you have any ideas?

A: When your loved one has reached the stage in Alzheimer's when they require someone to feed them, it is very important for family members and care givers to listen to what they are being told verbally or with their loved ones/clients body language.

A refusal to eat makes us, as caregivers feel a bit uncomfortable. If you stop feeding them you begin to feel like you are just giving up or starving them. A certain amount of guilt is related to the eating issues also, because you tend to feel like you should have tried harder.

To stop feeding someone with Alzheimer’s or Dementia is walking a fine line. Especially when we are naturally nurturing and feeding is what you have always done to make a person feel better. ( you should inform your loved ones' doctor or hospice nurse when your loved one refuses to eat)

Lets take a look at the types of responses you may be getting. These should give you a guideline as to when it is a good time to stop.

1. Your loved one is anxious and agitated at the dinner table, and seemingly does not want to eat. There may be several reasons for this. They may need to use the restroom, or they might not be hungry. Try to eliminate other possibilities, before you decide that they aren't going to eat. Also look at the environment is it too noisy in the room? Do you have the TV on? Things in the environment can greatly affect your loved ones response to eating. Try to feed them again at a later time.

2. Your loved one is shaking his head no at every bite, but is still allowing you to place food in their mouths. Unless you are getting a more definite negative response I would suggest continuing to feed them a reasonable amount.

3. If you’re loved one is holding food in their mouths and is not swallowing. Even though you are giving them a small amount of liquid to cue them to swallow, then this is a definite time you should stop. Try to feed them again at a later time.

4. If you loved one is responding with an elevated negative response, such as pounding on the table or trying to move their head away. You should stop feeding them. Try again at a later time.

5. If your loved one has their eyes closed, and won't open them. Even if they are responding to you, you should wait to feed them at a later time. Or try to get them to drink a protein drink through a straw.

6. If your loved one is taking small bites and taking a long time to chew. This is probably a part of the disease. However your loved one might eat less this way because they tend to feel full sooner. It is ok to continue feeding them. Try to feed them the higher calorie and nutrient dense food first.

7. If your loved one clamps downs hard on the eating utensil or won't let go, This could be a sign that they need to stop eating, or confusion. Use your judgement.

Feel free to make a comment or list any other responses you may be getting. If your loved one refuses meals on occassion this may not be cause for concern. Keep track of the meals they refuse to eat. Contact your primary care physician if they begin skipping meals on a regular basis. This may also be a sign of something more serious. ~ Dutchy