Visiting a loved one at a long-term care facility.

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Your Dad lives in a long-term care (LTC) facility and you’ve found that these visits really take a lot out of you and your Dad.  You’re bored, your Dad is bored, and you’re beginning to wonder if these visits are even worth it.  Do you want some encouraging ideas to make your visits beneficial to everyone involved?  Here are some suggestions that might take the hurt out of the equation.

ACKNOWLEDGE THAT THE LTC FACILITY IS NOW YOUR DAD’S HOME.

Southern Oregon CCRC where my Dad lived.

The longer your Dad lives in this LTC facility, the more it will feel like his home.  That’s a hard pill to swallow when you’re accustomed to visiting him on his home turf.  His new normal is his 200 square foot (if he’s lucky) LTC apartment.  Remember how painful it was for your Dad to move away from the family home to his apartment in the facility?  One can not minimize the difficulty of downsizing a lifetime of emotional attachment to a household of personal objects to a mere few that will fit in his small living space.  Respect for the remaining space allotted to him will go a long way towards making him more comfortable when you invade that space.

HOW I ADJUSTED TO MY DAD’S LTC LIVING SITUATION.

My distingushed Dad in the 1980's.

I would never attempt to offer any advice if I too hadn’t been through what you’re going through.  At the age of 84 my father was diagnosed with Alzheimer’s.  Dad lived in a Continuing Care Retirement Community (CCRC) in Oregon state.  At the time of his diagnosis he was living in a decently sized one-bedroom apartment “on campus” and for a few years was able to function quite well in that space.  When I visited from Seattle, it was pretty challenging coming up with ways in which to engage him and make my visit a valuable time for him.  He was still active, however, so we went on picnics, took walks, shopped for needed personal items, and our days were filled with purposeful activities.  As his disease progressed, however, he moved to the dementia unit of the CCRC and shared a room with another gentleman who also had dementia.  Now what?  I certainly can’t visit him in his room, and the common areas were populated with other residents who presented challenges to creating a valuable visiting experience for both my father and me.  Visits outside the CCRC campus became more and more difficult as my dad’s ability to function outside of his routine rapidly decreased.  How could just sitting with him in the dementia  unit’s living room make any difference in his day?

IT’S NOT ABOUT YOU – IT’S ABOUT YOUR LOVED ONE.

Well, it is about you, to be sure, but if your loved one’s experience is a good one, chances are your experience will be equally as satisfying.  Depending upon your loved one’s executive function, your activity options may not be limited at first.  You’re still able to take your loved one to movies and museums.  You’re able to go out to dinner and attend family gatherings.  You pick your Dad up, he’s happy to go with you, and your time with him is about as normal as it gets.  If Dad is physically or cognitively impaired, however, your activity options decrease considerably.

BEING PRESENT WHEN YOU’RE PRESENT.

I think you’ll be amazed at how far a smile and a pleasant attitude will go when visiting your parent or other loved one.  You’re of the opinion that you have to be doing, doing, doing to have a successful LTC visit.  If being active is a thing of the past, I encourage you to simply be present when you’re visiting Mom, Dad or your spouse.  Does he still like to read or watch TV?  There’s no reason why he can’t continue to do that while you sit nearby and use your laptop or read a good book.  When was the last time you had nothing but time in which to do so?  Consider this down-time as some sort of blessing in disguise.  Does Dad like certain types of movies – or one in particular – that you can put in the DVD player for his entertainment?  Watch that movie with him even though it’s the 100th time you’ve done so.  It’s difficult for us to define the movie-watching experience as quality time spent with Dad, but for him it may be just what he needs that day.  I know very well how slowly time passes when visiting a loved one whose world has been significantly diminished.  But imagine, if you can, being your Dad’s age and unable to come and go as you please.  When you visit him, you bring the outside world to him and give the day a whole new meaning.

WHY VISIT DAD IF HE DOESN’T RECOGNIZE ME ANYMORE?

This is one of the most challenging times for a son, daughter (or spouse) to go through when our loved one’s cognitive levels continue to decline.  (Please check out other articles on this subject under this Blog’s “Alzheimer’s/Dementia” tab for additional encouragement.) You’ll be doing yourself and your loved one a favor by not trying to force him to recognize you.  The Alzheimer’s Association suggests that it is far easier for you to walk into his or her world than it is for him to be present in yours.  When you walk into his room for a visit, simply announce yourself, “Hi Dad, Irene is here for a visit.”  You don’t even need to qualify your name by saying, “your daughter, Irene.”  Your title is not as important as who you are when you visit him.  Smile.  Speak in a lively tone – not loud, just lively – and let him feel your friendliness and your love.  Caregivers can’t give your loved one the love that you have for him – only you can.  As difficult as it is to seemingly have lost your identity with him – and it truly is difficult – the fact remains that you are his/her daughter/son/spouse and only you can love him like a family member can.

I sure don’t own the franchise on ideas to employ when visiting at a LTC facility.  What has worked for you?  What do you suggest?  Your ideas may be just the thing that helps someone else weather this difficult time.

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Baby Boomer Dating: a pick-up line that backfired

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A divorced man in his 50’s finally felt that after 3 years, he was ready to put himself out there again. It didn’t go so well. “I went to a singles bar,” he told a friend, “walked over to this 30-something year old woman and asked, “Where have you been all my life?”

She said, “Teething.”

Alzheimer’s Heartache: young family members adjusting to a grandparent or parent with dementia.

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The 7-year-old child says, “I don’t want to visit Grammy anymore.  She doesn’t remember me and she scares me!”

My daughter in 1st grade. Would she have been able to handle visits with her Grandpa at that age?

This is a major dilemma with adult children whose parent has dementia.  It’s difficult for the adult to reconcile their parent’s disease progression – and they have a fairly comprehensive understanding of the disease that is robbing them of their parent.  Now imagine a child’s inability to comprehend the disease.  All they know is that Grandma seems upset when the child visits and on top of that, no longer recognizes him.  When one considers that adult children sometimes dread visits with their mother or father with Alzheimer’s or other dementia, it seems easier to just let those visits slide for the younger members of the family.  My daughter was an adult when her Grandpa was diagnosed with Alzheimer’s.  I can only proffer a guess at what I might have tried in order to make her visits with him a comfortable experience.

Should parents force their children to visit the person whom the child has started to fear?

Forcing anyone to do anything isn’t always the best strategy to follow.  In these circumstances, it could almost be considered cruel.  My grandparents lived in a different country than my family.  Us three kids saw our grandparents maybe six times before they died.  Having the opportunity to live near an older relative would have been a novelty for me as I’ve always envied those who grew up with Grandma and Grandpa nearby.  With that said, however, I acknowledge that close proximity alone in this situation is not a sufficient motivator.

How can grandchildren still maintain a relationship with their Grandma and Grandpa?

The distracted visit – visiting but doing his own thing as well.  If the parents are able to provide some sort of distracting activity while visiting Grandma, the child might get more accustomed to their grandparent’s behavior.   The child casually observes how mom and dad interact with Grandma – while still being able to watch their favorite video or play with their hand-held electronic game – and gradually feels more secure being there.  Over time, but certainly not immediately, he may realize that Grandma is no longer someone to be feared and may attempt his own interaction with her.

Parents visit without the child and provide engaging updates to their child when they get home.  Parents can keep their child connected by telling him the funny/cute thing Grandma said that day when they visited and also making the child aware of the positive things that are happening in Grandma’s life to balance out the overwhelming negative that pervades it.  Who knows, this reporting tactic might actually lead to the child’s “distracted visit” next week.  Curiosity may be just the ticket that gives the child the desire to see Grandma.

There’s SO much more that needs to be said on this topic.

I haven’t even addressed the issue of early-onset dementia that thrusts young children and teens into an extremely challenging relationship with a parent whose disease robs their children of the guidance that their parent might normally provide during their adolescence. What can you, the Baby Boomers and More Blog audience, contribute to that very unfortunate, and ever-increasing reality, in today’s world?

I’m very much looking forward to what you can add – successes and failures – that will benefit those of us searching for advice and guidance.

Baby Boomers: what topics interest you?

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Irene writing on lanaiWhat do you want to read and comment on?  I thoroughly enjoy this blogging experience but it’s not satisfying enough for me to have a one-way written conversation.  My family would be the first to say that once I get going, it’s hard to shut me up.  (As of March 2016, I’ve posted 700 articles.)

But I want to enhance my own Baby Boomer experience with your wisdom, advice, successes, even failures.  It’s in those practical experiences that we grow the most.

So I sincerely covet your input as to what would draw you to my “Baby Boomers and More” Blog more frequently.  What topics interest you enough that you would provide comments and even contribute your own articles that I’ll press/link to my own Blog site?

Truth be told?  This is not just my site – it’s out there for everyone.  I hope you’ll be candid and honest with your input.  Bring it on – I’m good and ready for your Baby Boomer Blog ideas.

Preserving your loved one’s dignity.

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The more a person becomes dependent on others, the more protection he needs.  A person with dementia needing the assistance of others is considered a vulnerable adult.  He can’t defend himself or speak up for himself.  He can’t demand exceptional care, courtesy, and respect.  As his advocate – that’s where you come in.  When he doesn’t have a voice – you step in to be that voice.  Your reward will be great if you succeed in doing so.

Part of what I do in my working life is to advocate for vulnerable adults by doing what I can to promote dignity and quality of life for those I have the privilege to serve.  As a family member, or good friend, to an adult with dementia, your task is a monumental one because along with your caregiving role, you must also excel at the task of advocacy.   In my blog article, “Be an Advocate for your Loved One” posted on this blog November 14, 2011, I discuss the various ways in which you can advocate for your loved one.  This current article is the last article in my “Understanding Alzheimer’s and other dementia” series and it addresses the issue of dignity and privacy.

My dad in the 1960's; a former Marathon runner

As those of us who have, or have had, loved ones with dementia we know without a shadow of doubt, that our loved one’s current condition does not reflect the pre-Alzheimer’s/dementia person.  A grandmother who previously never spoke the “F-word” now speaks it as though it were just another word in her vocabulary.  A previously modest and distinguished gentleman now routinely removes his clothes in front of others, and/or may be inclined to grope his caregivers or other residents.  A former globally recognized businessman, sought after for his abundant knowledge in his field, now needs others to feed him and has lost the ability to string a meaningful sentence together.  Our loved one’s new normal is shocking to those of us who are close to the person with dementia, and completely foreign to those who are not.

Keeping people informed about your loved one’s condition.

Those who definitely have an attachment to your loved one: friends, coworkers, close neighbors, and of course family members, will probably appreciate knowing what’s going on with him.  It’s important to use discernment when deciding who needs to know – and who doesn’t.  And thanks to e-mail and texting, we can update people immediately and thoroughly with no need to pick up the phone.  That’s truly a bonus, isn’t it?  You’re already stressed and emotionally drained by your situation so having to conduct numerous telephone calls and provide the same update to several people would be prohibitive at best.

But with the ease of e-mail comes the temptation to be too thorough in the e-mail missive.  You’ve already discerned who needs to be kept updated; now you need to use judgment on how much you say and how you say it.  Does your neighbor really need to know about your husband’s incontinence?  How would it benefit your mother’s former coworkers to learn that their former Marketing Executive now drools throughout the day and can no longer feed herself?  More to the point – ask yourself this question: How would my spouse/parent/partner/sibling/friend feel if they knew I was providing all the gory details of their dementia progression to those near and dear to them?  The answer, I believe, is obvious.  If they could, your loved one would say, “Please don’t let everyone know what I’ve been reduced to.”  Showing respect for your loved one includes protecting her privacy, and thereby her dignity.  And I’ll tell you from experience – those on the receiving end of the information would rather you be brief and not overly descriptive.

Celebrate the uniqueness of your loved one.

My dad in the 1960's "fixing" the toilet. He always was a jokester!!!

Your loved one is not just some generic living and breathing person in the Early, Middle or Late stage of Alzheimer’s.  He may not be able to do everything he previously could – maybe he’s not even able to speak – but you can still celebrate him as a human being.  Everyone mourns what’s been lost; hardly any one celebrates their loved one’s remaining attributes.  I learned a lesson from my father during the middle stages of his dementia.  I was quick to finish his sentences, or rush him along by answering people’s questions for him.  My dad didn’t have to use words to express his displeasure when I did that.  He slumped in his chair, looked at me, and let out an exasperated sigh.  I stopped right then and there and made no further attempts to rush him as he conversed.  Doing so would take away one of the abilities he still had – talking and getting his point across.  It may have taken him a long time to complete his thought, but he still had the ability to do so.  Please don’t take away the remaining vestiges of your loved one’s independence and abilities.  If you feel compelled to feed your loved one just because they take a long time to eat their meal, you’re training them to rely on you for that assistance when they could have been doing it on their own.  Who cares if it takes 60 minutes instead of 15 to finish a plate of food?  If they’re still able to feed themselves – celebrate that ability.  Don’t take it away for your own convenience.

Walk into their reality – don’t force them to enter into yours.

We’ve all experienced conversations with our loved one wherein he or she talks about things that didn’t really happen, although they are convinced that they did.  What’s the harm in agreeing with them and going along with their story.  Your wife says, “Didn’t you enjoy that trip to the Grand Canyon we took with the kids a few years ago?”  O.K. – first of all you don’t have any children, and second of all, you’ve never been to the Grand Canyon.  Instead of trying to convince her of what’s real – and making her feel bad/ashamed in the process – talk about the great view, or how all the kids fell asleep in the car and missed the entire gorgeous spectacle.  I can guarantee that if you change your paradigm regarding this development, both you and your loved one will be better off.  The Alzheimer’s Association has a great adage that they offer us caregivers to help us along the way.  If you don’t insist – they can’t resist.  I challenge you to go with the flow instead of trying to paddle upstream.  Don’t cause contention.  A little make-believe goes a long way and harms no one.

AARP magazine reviewed the book Dancing with Rose: Finding Life in the Land of Alzheimer’s by Lauren Kessler. This memoir by Ms. Kessler is portrayed as “an  Alzheimer’s tale that’s warm, uplifting, even hopeful – qualities not normally associated with the illness.  This odd dichotomy – joy atop a ravaging disease – makes this book a refreshing standout.”  Alzheimer’s and other dementia have the ability to peel away a person’s former mask to allow what’s underneath to surface – pleasant or not.  What Ms. Kessler learned in her journey with her mother is that “if viewed from a different perspective, Alzheimer’s is not the end of personhood.”

Yes – dementia changes who your loved one is.  It oftentimes reduces him or her to childish, and then infantile behavior.  But they are still a person.  They are no less worthy of your respect and your compassion.  This hardest task of your life will end some day.  In the interim, may you be merciful to your loved one and may those with whom you are associated support you along the way.

Long distance caregiving: Part II

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Whether your aging parent lives in a long-term care (LTC) facility or in his or her own home, if you live more than an hour away from them, you’re their long distance caregiver.  What are you doing to protect them, and yourself, during this trying time?

As I mentioned in Part I of this article, published December 3, 2011, bridging the gap between you and your parent can be a difficult task.  Being able to monitor your parent’s day-to-day  life from a distance, especially when a parent has dementia, is a frightening task, and it’s one for which you need suitable support.  What follows are suggestions gleaned from my experiences with my father.

If your parent lives in a long-term facility:

  1. If you haven’t done so already, meet all the department heads entrusted with your parent’s care.  Do what you can to be on record as the go-to person.  If you are your parent’s health care representative and/or financial representative, make sure that the facility has the appropriate legal documents in your parent’s file.  Whether a crisis arises or you simply need to discuss your parent’s condition, making sure the staff know of your legal authority to discuss care will make your, and their, job a smoother one.  If you don’t have those specific legal documents in place, and if your parent is still able to designate you as the approved contact regarding care, do so as soon as possible.
  2. When it’s time for your parent’s care conference, a time when the resident – if able – and care staff discuss the resident’s plan of care, be present by phone.  This is a more common occurrence than you may think.  Share your observations of your parent’s behavior, phone abilities – or lack thereof – and don’t be shy about asking detailed questions about your parent’s care, regardless of how intimate the details.  As your parent’s advocate, you have the right to question the staff’s care plan – and you should.
  3. Meet your parent’s primary care physician.  Be sure that he/she has it on record that you are your parent’s health care representative.  Being able to talk to my father’s doctor to discuss all of his medical conditions, as well as all treatments, including medications, kept me in-the-know and enabled me to keep my siblings informed.  My brother and sister were also a big part of my dad’s life and they were also long distance caregivers.  They told me time and again how appreciative they were that I was on top of dad’s care, and that I was able to keep them informed at all times.

If your parent lives at home and is in the early stages of dementia:

  1. Follow point 3 above because even if both of your parents live in the home, you probably can not rely on them to be on top of their own care.  The parent without dementia is the on-site caregiver, and at his or her advanced age, might not be able to adequately function on his own behalf, forget trying to do so for his spouse with dementia.  If your parent is living alone without the presence of a family member, you have no choice but to nurture a relationship with his/her medical team so that you know what treatment your parent is receiving; what medications have been prescribed; and what long-range care goals should be addressed.
  2. Engaging the help of trusted friends, church members, and neighbors might provide some sort of care continuity as they do drop-in wellness checks of your parent.  If you have people who are able to provide this type of observational visiting, I suggest you utilize web services, such as the following, that can help get you organized: Lotsa Helping Hands, which is “Free, private, web-based communities for organizing friends, family, and colleagues – your circles of community – during times of need.  Easily coordinate activities and manage volunteers with our intuitive group calendar”; or Caring Bridge which is “Free, personal and private websites that connect people experiencing a significant health challenge to family and friends, making each health journey easier.”  Additionally, Caring From a Distance provides resources that are available in your parent’s local area: “Whether you live across-the-world or an hour away, you and your family face special challenges.  Where can you find the local resources they require?  How can you, your family, and friends communicate in an emergency?”

What if the burden is too much for you to bear?

You’re in good company.  If I had been familiar with the services listed above I think my caregiving journey would have been a smoother one.  But believe it or not, this type of caregiving challenge is one that is relatively new in the grand scheme of things.  If you’re losing ground as your parent’s long distance caregiver, it might be time to consider the services of a Geriatric Care Manager.  The National Association of Professional Care Managers is a non-profit resource that can put you in touch with someone who might be able to provide the bridge you’re looking for.

Consider the cost of managing your parent’s care from a distance:

  • time off from work;
  • driving and flying time to your parent’s location;
  • hotel accommodations, food and other travel expenses; and
  • the emotional and physical toll on yourself.

Paying a Geriatric Care Manager to manage your parent’s care, whether he lives at a long-term care facility or in his own home, may greatly pay off in the long run.

Whatever you choose, and which ever direction you take, I hope you will carefully consider the best option for your particular situation.  As I’ve said in past articles, only you know what is the best fit for your family.  Consider all the alternatives and move forward confidently.

Long Distance Caregiving: Part I

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Numerous authority figures are entrusted with your loved one’s care – most of them a fraction of their age.  If you can’t be a physical presence for your loved one what will you do to bridge the gap between physical absence and an effective long distance presence?

My mother and my daughter, circa 1976.

My father was diagnosed with Alzheimer’s at the age of 84 and died in 2007 at the age of 89.  By the time of his diagnosis he had been living in a Continuing Care Retirement Community (CCRC) for seven years.  His wife, my mother, died a month before they both were to move to this CCRC located in Oregon state.  My mother was truly looking forward to the move with my dad but on September 24, 1994, she was granted the wish that she had thrown into the universe many years earlier – that when her time came, she wanted to die in her sleep.  My father still moved to the Oregon CCRC because at the age of 77, he knew he still had a valid reason to move there.  Both he and mom didn’t want to be a burden to us three children, so moving into a retirement community that would meet all the needs of his aging body and mind was dad’s gift to us.

Dad, myself, and his wife Barbara on his 87th birthday.

A few years after my mother’s death, dad married a resident of the CCRC and they had a wonderful late-in-life marriage.  Dad’s wife, Barbara, died from complications of Parkinson’s in 2003 so once again, dad became a widower, but this time his biggest challenge was that he was in the early stages of Alzheimer’s disease.  He was still able to live semi-independently in an assisted living apartment at the complex and he was able to perform his activities of daily living (ADLs.)  Of us three adult children, the job of being dad’s caregiving team leader quite naturally fell to me.  I had worked in the senior care industry for several years so I was quite familiar with caregiving lingo and body frailties, not the least of which was Alzheimer’s and other dementia.

Dining room at my father's facility.

Initially, the miles that separated us wasn’t all that challenging.  He was still active, was fully capable of getting himself up in the morning, taking his medications, getting to the dining room, etc.  Us children would call dad frequently – and he still had the ability to call us – and we continued our visits throughout the year and although his dementia was obvious to us, we knew he was in good hands and that he was functioning quite well.  The staff was very attentive to him and if they had concerns, as his health care representative and financial power of attorney, they kept me abreast of the latest, the greatest, and the ever-increasing not-so-greatest.

The not-so-greatest happened one frightful evening.  Dad called me telling me that he felt very agitated and he couldn’t stop walking around his apartment; he couldn’t settle down; he didn’t know what was going on.  I asked him if he had recently taken any medication and he replied, “Just some cough syrup.”  “How much did you take?”  “I don’t know.”  So while I had my father on my home phone line, I called the front desk of the facility on my cell phone and told them that my father was having an emergency in apartment #94 and a nurse needed to get there immediately.  I kept my dad on the phone and told him that a nurse was on the way to see him and that he would be taken care of very soon.  The nurse arrived quickly, and the emergency was averted.

Bottom line?  We now knew that dad was no longer capable of managing his own medications.  He took way too much cough syrup that evening and it caused his heart to race, resulting in extreme agitation.  This precipitating event was the start of his noticeable decline and medication management became the first ADL for which my dad needed assistance.

The above example barely scratches the surface of what many of you are dealing with.  Your long distance eyes and ears seem thoroughly ineffective and you’re concerned about your loved one’s well-being.  There is hope for the long distance caregiver.  It’s not the same as being there, but this hope somewhat bridges the long distance caregiving gap.  Part II of this article, published December 4, 2011, addresses some practical steps you can take to help in your caregiving journey.