Spouses often have made a “promise to never put a loved one in a nursing home” and as an adult child we have trouble asking our parents questions about personal finances or relationship issues. As an adult child we have trouble at times with this promise as well. Talking to our loved one about needing more help with their care than you can provide is very difficult. One way to open this conversation is to ask if the spouse (parent) has any concerns about care that you could help with. Reference information such as my radio show or articles you have read which will provide useful tips. Recently my radio show addressed this issue with Niki Gewirtz, Executive Director of Belleview Heights, Alzheimer’s Special Care Center in Denver, one of the best person centered care communities I have ever had the privilege to work with and we discussed this very issue.
Here is a link to this show: https://www.cruisin1430.com/media/audio-channel/dementia-resilence-4917
You can also click on radio podcasts link on this website and listen to all past shows, complete with a description of each shows content.
As a family member, you might use an idea to mention that you are looking in to new financial information and ways to strengthen retirement options for yourself, and ask what desires they might be considering or preset accommodations such as long term care insurance, as they age at home, which you can honor when the time comes. This is non-confrontational and can open the dialogue of the “promise.” As a person with Alzheimer’s progresses with the disease their needs will change, their cognitive ability will lessen and caring for them will often require more skilled care than families can provide. The spouse will often deal with their own health issues from a mental and physical stand point. Statistics show that caregivers often “wear out” and die before their loved one. When the promise was made, none of these issues were at hand, therefore nullifying the promise. Warning signs are wandering, incontinence, becoming non-ambulatory, leaving the stove on or catching items on fire. Not understanding dangerous items in the home could be very harmful such as cleaning products and ingesting them. Loss of motor skills is taxing and can become very dangerous for the caregiver. Behavior issues can be addressed on a different level with redirection skills I offer, but the ideas listed previously are above and beyond this care. Using a doctor as a reference is also helpful when it is time to change from home care to assisted care, and makes the news easier to deliver and possibly receive.
When choosing a community, many will tell you they provide person centered care (PCC). One way to know for sure is to use these little tips: When visiting or calling a care community, use a stern tone and ask this question, “If I move my dad into this community and I come in at 10:00 am to see him and his hair is not combed or combed poorly, his clothes are not buttoned correctly and he hasn’t had breakfast, how are you and your staff going to explain this?” If the answer is focused on stressing to you how they will ensure that he is showered 3 times a week, and they will make sure he is fed every morning, AND the staff will make certain he is dressed and groomed properly…RUN!!!!!! In a PPC approach, the correct answer would be if your dad dressed himself, or groomed himself, we will shower him with kudos as we focus on what he can still do and is able to accomplish on his own or with little assistance, even if slightly askew. We will honor his preferences for showering at the time of day when he usually showered when he was well, or after he has enjoyed a fun activity or a calming experience and is feeling content. We will try not to create a trigger for him which will turn him from a calm state to discontentment. If your loved one enjoyed a bath in the evening before bed, this should also be honored. You might even be invited to come and assist him with grooming as a bonding and/or visit experience. If he wakes up in the morning and is hungry and ready for breakfast, we will entice him with the morning menu. If he wakes up and wants to stay in his room, we will circle back until he is ready to eat, even if that is lunch time. We understand it may be uncomfortable for you, but we are working in his Alzheimer’s reality and what is comfortable for him.
Places that demand a person be bathed on a 15-minute systematic schedule or forcibly groomed can end in devastating results. Places that demand each person be moved to the breakfast room can also cause people with dementia to fear caregivers in a professional setting. Those who don’t comply are often considered “behavior problems” and are physically moved against their will or medicated so that they comply. I hear this from people who work in facilities, which I train in weekly professional caregiver classes. I also experienced it with my own mom’s care at her first facility. Professional caregivers are assigned a certain number of people and if they do not complete the systematic corralling or having, say their 12 people assigned to them, showered between 5 am – 10 am, they will lose their jobs after 3 issues. I call these TASK CENTERED APPROACHES, and that is why I call them “facilities.” These places also have high turnover. All communities/facilities offer activities. Ask if they have a log of the activities or if the activity director can tell you how many steps are involved in each activity. If they can’t answer quickly or the answer is higher than 3-5 for lower functioning residents and not higher than 10 steps for higher functioning residents, again this is a serious red flag.
One question you can ask is about the longevity of the staff. Does the Executive Director speak to you and answer your questions; give you the tour, or is it a sales person? Do they manage by walking around or by assignments? Is there an outside area for the residents? This may be important. Do they have activities, and yet also keep their people active? Do they honor the idiosyncrasies each of us have with our personal traits and routines at our deepest levels? These are very important questions to ask and will help you make this difficult decision. Also ask how they will help the family adjust to this move and life changing event. Do they offer lectures or support groups, and exit strategies after the move in? It is much harder for the family to adjust than the person with Alzheimer’s.
I hope this information is helpful and I look forward to hearing and addressing any other questions anyone might have.
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