There are so many signs of dementia, Alzheimer’s Disease and other types of memory loss. After working in this business for nearly ten years, I can spot many of the signs within minutes of meeting an individual. Sometimes families seem more concerned with the “diagnosis” than what is really going on with the individual. By diagnosis, the family wants to give the medical condition a name. It is dementia? It is Alzheimer’s? I find that this concern is personal for family members who see an aging parent and then see themselves as the aging parent. They wonder if they too will be diagnosed with dementia or Alzheimer’s. To me, regardless of the specific diagnosis, the individual deserves to be treated with dignity and as a person. I meet so many caregivers that treat their family members like children. Most clients I know want to be treated like an equal or like a friend. Laugh with them, treat them like a friend, don’t treat them as a diagnosis.
Archive for July, 2008
Ever met an older individual who doesn’t seem to be managing well? By this I mean that they seem to be neglecting simple daily tasks like bathing, eating good meals, keeping their house. And when the subject is brought up, there is a great deal of anger and denial and usually the words “I can do everything by myself, why don’t you just leave me alone.” It’s usually these situations I find most difficult and heartbreaking for two reasons. The individual clearly needs help but in some cases is unwilling to acknowledge that a little help could make life easier. Those that accept help usually improve and do well and admit that having someone around to help is good. The second reason is that the family, if family exists, feels helpless or has reached their limit in dealing with the individual. According to various studies on aging, mental illness and elder abuse, vulnerable persons who neglect themselves usually have a number of medical and psychiatric problems. This relates to persons of all ages, however my experience show that dementia and depression are significant factors with an older adult not providing good self care.
Ever have one of those moments when you’d love to “mind someone else’s businesses”? Over the years I’ve usually found this to be a bad idea even if the information, in my opinion, would be helpful. I was at the gym yesterday and took a shower after I finished my routine. There was a woman in the shower area with two young girls, probably 5 or 6, and she was allowing them to play in the shower. It took all of the restraint I had not to say something. While I took my 2 minute shower I thought of all of the articles I read about people in Africa using one gallon of water in an ENIRE MONTH, all of the articles about drought and water usage and the photos of dehydrated and malnutrition among children. And here this mother was allowing her children to waste many gallons of water. And not only that, she is teaching them that this type of water usage IS OK. I wanted to say something about water usage in Africa, about conservation, I wanted to turn this woman into the gym police, I wanted to do something but I took my shower, shut my mouth, got dressed and left. What good would it have done? This mother obviously had no concept of waste or water conservation or what she was teaching her daughters. I’m sure she doesn’t allow them to play in the shower at home, why allow it at the gym? Sometimes I just don’t understand other people’s logic and I’m sure sometimes other people don’t understand mine.
All nursing homes, personal care homes and assisted living facilities have an ombudsman appointed by the state government. The role of this individual, whether paid or voluntary is to represent the residents and the families when concerns arise. In many cases these facilities have a family group meeting once each month. In all honesty, these can be nothing more than complaint sessions and a way for families to vent frustrations. A more effective manner of using the ombudsman is to request a meeting with family members and the executive director of the facility or another appropriate person who can see that changes are made. All facilities have the name and contact information of their ombudsman posted throughout the facility. If you don’t see the posting, ask the receptionist or other staff and they can direct you. You can also contact your local area agency on aging for the long term care ombudsman department. A helpful website is www.ltcombudsman.org
Carrying over from yesterday, families must learn to advocate for their family members in nursing homes, and, individuals who have no one to advocate for them, if finances permit, should hire an advocate or care navigator. Many people don’t want to complain about receiving substandard care or waiting an hour for staff to respond to their call button. One of my clients wanted to take a shower more than the obligatory two times a week that her nursing home offered. She also wanted to use the toilet rather than soiling herself, but it sometimes took the nursing home staff 45 minutes or longer to get to her and by then it was too late. After conversations with facility staff and little response, we discussed this request and several others with the executive director of the facility and the long term care ombudsman (see tomorrow’s post). Since this time, many issues have improved, however my client “feels bad” that she got some of the nursing assistants in trouble and several of the nursing assistants actually confronted her. My client feels as if they will be glad when she leaves.
Ever had a family member in a nursing home, often called a “skilled facility” or an called an even nicer term, a “care facility”? Because of the state of health care today, individuals are transferred to nursing homes when they previously would have remained in the hospital. There are several difficulties with this occurrence. All nursing homes have a doctor on call who typically visits once a week or perhaps more. Unless there is a severe medical emergency, your family member will have to wait to see the doctor on call when he or she usually visits. There are many instances of families having a health concern about a family member and then waiting for the doctor on call only to find out that had they waited any longer, their family member would have died. Individuals in nursing homes or their family members must be the “squeaky wheel” today to ensure that their family members receive the care they need.
I suppose at some point, divorcing because of the health issue of a spouse becomes a practicality, however sad this sounds. I know of many older adults who have divorced because of social security and income tax issues. It seems that sometimes the “system” forces us to make changes because they affect our health or our financial status, our future or both. I certainly would not want to spend all of my savings and retirement money paying for health care costs for a family member, leaving me needing at the end of my life. This keeps taking me back to long term care insurance and all of the people, young and old, who question why it’s necessary. It’s necessary for the obvious. Most of us cannot afford to pay long term health care costs regardless of how and when they occur. Most of us have difficulty paying the co-pays for our insurance and our deductibles. Health care expenses are a major reason that some individuals file bankruptcy.
In many cases over the course of a marriage, it’s likely that one partner will suffer health, physical and/or psychological issues. This affects the healthy spouse in many ways. One spouse described the fact that “the person she married” was not the person she lives with today. But, she is choosing to make the relationship work in a situation that is far from ideal or what she pictured their live would be like when they first married. Many times the spouse suffering from health issues is so focused on themselves that they cannot begin to comprehend how the illness or issue affects their spouse. In these cases where it is very difficult to discuss the issues, counseling or support groups for both spouses individually can be helpful until they reach a point where they can come together to discuss the issues.
Let’s continue yesterday’s post regarding divorcing a spouse that requires substantial medical care. The differences are substantial based on the financial state of the married couple. For couples with low income and savings the unhealthy spouse most likely goes on Medicaid or public assistance depending on the state where the couple lives. At least in Colorado, the “community spouse” is entitled to retain a personal home and an amount in savings of about $104,000. In this case considering that the long term future of the healthy spouse is in jeopardy, what’s your opinion? Is divorce, whether real or not, the option to protect the healthy spouse?
Multiple Sclerosis, Parkinson’s disease and Alzheimer’s disease can be debilitating at any age. However it seems that the younger one is diagnosed the more tragic, the more consequential to the rest of a life; especially if there is a healthy spouse. More frequently today, the healthy spouse is opting out of the marriage and the agreement to remain together “until death do us part”. If there were no provisions for life insurance that can be redeemed to cover the costs of care or no long term care insurance purchased the physical and financial demands of caring for a loved one diagnosed at a relatively early age – fifties or sixties can be devastating. Many bankruptcies today are caused by unplanned and unexpected health events. With the cost of care in a nursing home averaging $75,000 per year, most families do not have this much saved for retirement, let along for a long term care event. And imagine the affect of care on a retirement plan for the healthy spouse. All the years of savings can be wiped out short term and difficult to replace even after many years of work. In this situation, what is the right thing to do? How can the healthy spouse be protected? Is the answer divorce?
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