New Post: How does one retrain the elder with Alzheimer's who has slept until noon daily all of her life and is now moving to assisted living without a caregiver? This 81 year old female, widowed 2 years, depressed, and lives alone with her cat scores mild depressive in GDS and mild dementia on Folstein. She is aphasic with very poor memory, bad kidneys, heart disease, incontinent and is followed by a psychiatrist with Celexa. Up until recently she had caregiver five afternoons a week and attended an Alzheimer's Day Center, but family recently cut back hours to 4 hours/4 days a week and now want immediate placement because three days a week she will stay in bed all day without meals or medications. Has four children who live out of town and she wishes to live with them. They are very busy people and because of mom's 30 year history of manipulation and threats of suicide are reluctant to see her through her dementia. This is unacceptable to her and spends time crying when not watching TV into the wee hours of the night. Has a Life Alert type watch and upstairs neighbors who take her to church once a week but don't socialize much anymore. Plan is for her to move to an ALF with her cat in May but funds are now limited due to economic downturn and there won't be any money for extras at the ALF. I am interested in knowing exactly how does one retrain someone in an ALF to wake daily for meals, meds, bathing, and dressing without paying for extra help. Your comments are welcome
Olga@agooddaughter.com
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This is a tough one! If the family places her in an ALF that specifically handles Alzheimers residents they will know how to deal with her. However I doubt a regular ALF without paying for additional services will deal with this type of resident and the family will end up having to relocate the person again. Which is expensive and stressful for everyone concerned."
ReplyDeleteIs she on medications that is causing this sleepiness? Is she really a Nursing Home Candidate versus an ALF candidate? Is there someone that can pop in on her to make sure she eats, takes meds and changes patch but not necessarily requires to be paid? Church group? Neighbors? I feel that religious groups have volunteers that are willing to do these things, if instructions are given? As a home care nurse, before even talking about any type of placement elsewhere out of the home, I look for community resources in order to maintain a person in the comfort of their own home.
ReplyDeleteGood comments Maria.
ReplyDeleteWe did try a friend who was visiting (retired R.N.) but that didn't work. We went over her meds list with a senior care pharmacist but her meds aren't the culprit. Family states she's done this for 35 years. We recommended a live in because she really shouldn't be alone at night. Perhaps a nursing home might be a better fit, but that would probably lead to serious depression. Thanks for your comments
The Children don't understand the disease. They need to be educated so not to have unrealistic expectations of mom's behaviors. Her day night tranference can't be adressed without consistant individual attention from a dementia specific trained caregiver.The children also need to learn the difference between regular AL and memory care AL. Mom is going to the wrong place. Also the children need to lose the guilt. I suggest "Coping with Alzheimer's, A Caregivers Emotional Survival Guide by Rose Oliverand Frances Bock.Tha book gives the children their best chance of knocking down the guilt so that they can make good decisions.
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ReplyDeleteVery insightful comments. Thanks
ReplyDelete"Typically when we care for people with dementia, it is our goal to accomodate their needs rather than attempt to retrain the patterns of a lifetime. I would first look for an ALF that can accomodate her preferences while supporting her with medication management, meals, etc. I don't know what has already been tried with this person. If the depression is not currently being treated, medication may help. If her caregivers can tap into her interests, perhaps they can arrange activities that would engage and stimulate her, thereby enhancing her mood and increasing her energy level."
ReplyDeleteHer daughter came in from out of town and decided where to relocate her. I was brought into the picture after the deed was done. We have a companion that takes her to an excellent Memory and Wellness Center twice a week and takes her shopping, hairdresser, lunch, flea market, casino, beach trips the other days. They have a wonderful relationship. She is depressed and does receive medication from a geriatric psychiatrist. But she wants to die because her ethnic background dictates that "we take care of our own" and "her children don't want her." Family has decreased the number of companion visits to see if mom really needs help the other days. Time and time again, she has proven she doesn't get out of bed, take meds, or eat on those days. I have cajoled, counseled, talked about her rights, discussed negligence and responsibilities with these adult children to no avail. They will only do it their way. This is why I am posting this to see if there is anything I could have missed.
ReplyDeleteGuardian Medical Monitoring has some technology that may be of interest to you regarding this client. It's called VTC
ReplyDelete(Virtually There Care). It is designed to allow seniors and people with A/D to live as independent as possible in the place they want to be..home. VTC uses the latest video technology and connectivity to offer a greater sense of safety without the loss of privacy or integrity. A typical VTC system consists of 1 to 4 cameras that can be viewed live, with encrypted user name and password, from any computer in the world. Three days of scheduled events, such as medication delivery and caregiver arrival times, can be captured and stored in the video library for quick reference and review. Integrated motion sensors can be programmed to record movement in specified areas. The system includes a Personal Emergency Response System that is tailored to the needs of the client. Additional cameras, pendants and optional two-way voice communication may be added to meet specific requirements. Includes several alarm modes for known hazards, such as falls, fires, wandering and much more. VTC saves money by reducing in-home care and associated expenses. If you would like to know more about our services and products, please feel free to call me. I hope the information I have submitted helps.
Thank you. The family is very aware of the Guardian products and has an automatic dispenser from Guardian. I will present your ideas about the Virtual Care system. Is it pricey?
ReplyDeleteYou may want to consider addressing the depression first and then determining if AL is the next best step. Often times when medication is no longer as effective for treating depression, the signs and symptoms intensify which would account for change in sleeping and eating patterns. Additionally, depression can intensify effects of dementia - it can actually cause people without dementia to appear as though they have dementia. Another avenue to consider is hydration and potential urinary track infection. Without proper hydration medications are not as effective, thinking is not as clear, and the downward spiral starts. After a good medical review (by a geriatric physician!) the next logical step would be home health therapy (covered under Medicare - you would need the physician to write a prescription) to help determine her true level of function. The Occupational Therapist would also be able to help establish the safest home environment and routine - or help make the recommendations for the next level of care or intervention - all based upon that lady's needs and the family's resources.
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