Ignorance is not bliss with a dementia diagnosis

From the Alzheimer's Association today came a Huffington Post article written by William E. Klunk, M.D., Ph.D. Citing the Alzheimer's Association publication 2015 Alzheimer's Disease Facts and Figures, and reflecting on his own patients with dementia, Dr. Klunk encourages doctors to more universally disclose dementia diagnoses. Revealing the truth about dementia diagnoses will ultimately aid research for prevention and cures ~ and help families address the issues they now face. William Klunk's article, For Most People With Alzheimer's, Ignorance Is Not Bliss is an article you'll identify with if your loved one exhibits dementia symptoms.

What will you say at your loved one’s funeral?

I surely don’t wish to be morbid. I didn’t want my father to die, and now I don’t want my mother to die. Plus, I’m sure others are wiser about this joy topic than I. But attending two memorial services for two dear men in two months has given me pause. In both memorial services, joy was palpable. Not just joy that the men are now with Jesus—but also joy in having known them and in telling their stories. Perhaps the Lord will take me next, but if not … When the time comes for my mother’s or my husband’s or a sibling’s memorial service, I want the very best memories to bubble up when I share stories.

I think only two habits assure that what bubbles up ISN’T the time Bambi borrowed my ivory sweater without asking me and spilled mustard on it; the wedding anniversary dinner Fred blew off; or the gnawing suspicion that Mommie Dearest always liked Bambi best.

Habit number one is to walk in forgiveness—not sweep hurts and disappointments under the rug, but talk with God about them and if He prompts, talk with the person about them. Remember all Jesus has forgiven me for, and forgive others.  “… love covers over a multitude of sins.” 1 Peter 4:8

Habit number two is to follow the golden rule of opinions. Think about others as you would have them think about you. I don’t much like it when someone assumes the worst about me. For example, that just because I haven’t finished a project yet, I’m obviously procrastinating or uncaring about a deadline; that if my coat is on the floor of the closet, I (what a slob) must have thrown it there; or that if I haven’t called, I don’t care. I would much rather people simply be excited about my project and if they must worry about its completion, approach me with compassion for any delays I might be facing; figure oh, dear, Jane’s coat must have slid off the hanger she put it on; or be confident I do care and will call. Wouldn’t you rather be given the benefit of the doubt and not judged? Finally, brothers, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable—if anything is excellent or praiseworthy—think about such things. Philippians 4:8

In caregiving situations, emotions often run high. Your dad with dementia refuses to give up the car keys, and you are scared for his and others’ safety. You’re also frustrated about how to accomplish what you know is the right thing to do at this time. As you proceed with the plan and his car gets sold, your dad experiences grief and possibly shame. Then you feel so very sad for him and his loss of freedom. Misunderstandings are bound to show up somewhere in this emotional mix. You might consider him stubborn; he might think you’re mean. Accusatory words may be spoken. Both habits one and two, mentioned above, would be preferable in this situation. Maybe the car key story could end up being an endearing story related at your dad’s funeral. Maybe not. But at least you’d communicate love to your dad throughout this hard transition.

Caregivers of aging parents face so many emotionally charged situations. Sometimes with dementia, Parkinson’s, and other diseases comes clinical depression. As an older person loses control of bodily functions, he or she may sense despair or a loss of dignity. Adult children with lives of their own must take time to become educated about their parents’ challenges and available resources. Siblings acting from childhood scripts may unwittingly open old wounds and flounder adapting to teamwork in the new normal with Mom and/or Dad. Involved family members may be angry over decisions made by the person with health care power of attorney. If you’re caring for a loved one, you could probably add at least 97 examples of emotional situations you’ve encountered.

Thinking the best of others and forgiving hurts will go a long way toward

• smoothing out what is usually a fairly uneven, rocky path;
• truly making a loving connection with your aging parent;
• and maybe even ending up with more joyous stories to remember and honor Mom and Dad.

How to Choose In-Home Care

Over the years, our family has used three agencies for home health care for both Dad and Mom. In all three cases, we chose agencies based on personal and professional recommendations from people my mother knew in her assisted living community. My mother’s advisers were more experienced than we kids were, and we had good—not perfect—in-home care from all three agencies.

My mother may not use one agency again, however, because the nursing supervisor aggressively, repeatedly, tried to upsell my mother on services she didn’t need. We nicknamed her “the barracuda.” The barracuda’s agency provided good service but will lose our future business. Although frequent supervision of home care workers is important to look for in an agency, a comfortable, open rapport with the supervisor is also critical.

No in-home care is perfect, and you need to be able to communicate and solve problems with the supervisor. If you have time to meet several times with each prospective caregiver supervisor, give yourself that gift. Ask pointed questions about typical problems and how they get solved and—better yet—prevented. If the person who initially comes to your house to sell the agency’s services is not the supervisor, please don’t sign on the dotted line until you have established that the supervisor is someone you can easily work with.

Choosing in-home care is worth careful research. Only recently have I read that the home health care industry is largely unregulated, which places extreme importance on an agency’s internal safeguards. What background checks do they perform on workers? Criminal records in just your state or other states as well? Are they licensed and bonded? What if the worker charges personal items on your credit card? Who is liable if the worker is injured in your home? What if Dad suffers adverse effects because the worker gave him the wrong medication? Who pays if the worker and Mom are in a car accident? What training does the agency give each worker? Ask these questions!

And do check the agency’s website for a list of services provided. If you want light housework, be sure that’s on the list. Even if it is, you might ask the supervisor to expand on the agency’s idea of light housework. Vacuuming and dusting the whole house weekly? Washing windows twice a year? How about cooking? Can you expect the worker to plan meals and list groceries needed? Inquiring about this helps the supervisor choose a worker with initiative and organizational strengths. Your questions should result in a better caregiver match for you.

To start your research, check out AARP’s article, Types of In-Home Care Providers. This will help you know if you need a medical professional, a home health aide, or home care aide. This article discusses paying for care as well. A related article, Choosing an Agency for In-Home Care, gives you additional questions to ask to safeguard your family in this important decision.

Last but not least, I highly recommend using an agency. Resist the temptation to just hire an individual on your own, no matter how nice or highly recommended the person is. If the injury and theft legal liabilities mentioned above are not enough to convince you, consider your liability with the IRS if you fail to get an employer identification number; withhold Medicare, Social Security, and other taxes from your employee’s wages; and pay your portion of payroll taxes.

What It Takes To Be a Caregiver

If you’re caring for a loved one, you know what it takes, but Today’s Caregiver reminds us afresh. I like this short article because the author, Aida F., affirms the blessings amid the challenges. She encourages us to tap the strength within, as a marathon runner might in training and remaining focused on the goal.

Top 10 Ways for Caregivers to Spend Dollars Wisely

Small caregiving expenses add up quickly ... An $8 lotion for Mom's rash doesn't do the trick, so you try a different brand at another $8. The second lotion doesn't bring the desired comfort level, so the doctor prescribes a generic cream; your copay is $4. That's $20. Dad's usual salad dressing has begun to give him indigestion, so you plunk down $3 or $4 a couple more times to find a dressing that doesn't bother him. How many compression sleeves, at $29 a pop, for arthritic hands, knees, and elbows have you gone through? You page through assistive-aids catalogs and haunt aisles of medical supply stores to find grab bars you can affix in the existing bathroom. Cha-ching. Whether it's your money or your parents' money paying for these things, you need to purchase wisely.

In the current Caregiver.com newsletter, Kris Maxham, staff writer, offers 10 of the most helpful ways to spend your limited resources. They include legal advice and respite ideas for you, and alerts and alarms for your loved one. It's a great list ~ check it out here.

Spiders and weasels and worms, oh my! (with apologies to Dorothy)

A few years ago I wrote a post about “other duties as assigned” parts of a caregiver’s job description. I had just swept my parents’ porch free of a wiggle of earthworms after a massive rainstorm. [Although “a prickle of hedgehogs,” “a chattering of chicks,” and “a sneak of weasels” are on lists of collective terms for animals, I find no listing for worms, so how about “a wiggle of worms”?]

Here are a few more concerns of caregivers:

   A friend hears her sister’s complaints of exhaustion after living with their infirm parents for months. In addition to providing relief by visiting their parents’ home and sharing in the frustration of encouraging unwilling parents to do their physical therapy exercises, my friend invites her sister out once a week to have fun together. My friend and her sister might be called “a team of sisters,” and sometimes, “a party of sisters.” 

  My mother’s live-in caregiver, who lives in her lovely finished basement, complained of big spiders down there. After finding a spider inside her pillowcase, she refused to sleep in the bed and took to the couch. Her getting less than adequate sleep worried me, because she needs to be alert to any cue that my mom needs her. My stoic mother, however, is not afraid of spiders and doesn’t understand why anyone fears them. She offered the caregiver a can of bug-killing spray, but the caregiver had health concerns about that, so she wouldn’t spray it. Google and I partnered for the cause and found a natural remedy, which required my buying peppermint oil. By the time I bought it and offered to mix it in a spray bottle for her, the caregiver said the spider crisis was over and she was back sleeping peacefully in the bed. Let’s see … “a creep of tortoises,” “a slither of snakes,” nothing for spiders … how about “a crawl of spiders?” And certainly now, even one bottle constitutes a surplus of peppermint oil.

Another friend and her siblings have reached the ends of their ropes tag-teaming visits to their mother’s apartment to help her get dressed, make sure she hasn’t fallen, and is taking her meds. They realize their mom needs more help than they can provide. My friend thought she’d find it at A Place for Mom but didn't find a good fit through them. She’s talked with some facilities and learned about their specialized units for older folks with varying issues. Those weren’t good fits for her mom either. She did learn some lingo though. Now she and her sibs know their dear mother does not need assisted living; rather, she needs what the industry calls supportive living. So now they’ll contact Visiting Angels. Oh, and during this research, they’ve been in touch with federal and state agencies to learn what care is covered. Since I don’t think my aging brain could keep straight the complexities of working my way down such a long list of resources, I’ll call my friend’s family “a saint of siblings.”

The collective term for an endless list to research? How about “a flow chart of lists”? “An infinity of lists?” “A fog of lists”?

A Bittersweet Season

Recently friends recommended a book by Jane Gross, A Bittersweet Season: Caring for Our Aging Parents ~ and Ourselves. Here is a list from the book's description on Amazon.com of some topics covered:

Finding Our Better Selves
The Myth of Assisted Living
The Vestiges of Family Medicine
The Best Doctors Money Can Buy
The Biology, Sociology, and Psychology of Aging
Therapeutic Fibs

To see the whole description or buy the book, click here.