Dementia and Alzheimer's Series #5: Driving

There is an excellent, on-going  series of in The New York Times, called The New Old Age.  Written by Paula Span and Jane Gross, the blog series covers a wide variety of topics involved in aging and senior care.  All of the topics are important, but one that concerns us very much, at Support For Home and Senior Care Solutions, is driving.

In an April 2010 article, titled "Driving While Demented," Paula Span points out that "several studies had shown that a considerable number of those with mild dementia — 41 percent to 76 percent, depending on the study — could pass an on-road driving test."  We absolutely believe that.  It does not, however, mean that folks with dementia should be driving.  Rather, it means that we do not have good driving tests!

Every one of us who drives has "gotten away" with periods of inattention or bad judgment.  Some one else avoided the accident we might have caused or there was no one else around.  The point is, even without dementia, driving is extremely dangerous.  When families look at Dad or Mom and consider whether they should be driving, they either forget that or do not want to face it.

One reason they do not want to face it is they might then have to be the "bad guys" and take the keys away from someone who has been an authority in their lives forever.  They do not want to hurt their parent(s).  In our view, this is simply making the wrong choice.

Paula Span includes two very important points in her article, including the standard used by the American Association for Geriatric Psychiatry, as stated by their past President, Dr. Gary Kennedy:

“Our recommendation is that you stop driving once you have a dementia diagnosis.”

Less formally, he relies on “the grandchild rule”: If a patient’s children don’t want the grandchildren in the car when the patient is driving, he or she needs to relinquish the keys before hurting someone else’s grandchildren.

We think that is a good approach.  Assume that there are children who are at risk -- because they always are when we drive -- and let that guide you.

Too often, we talk to seniors with dementia and family members who think that driving is OK, as long as it is just in the local area.  Our response to that is to ask where most non-driving accidents happen: answer, at home, with the bathroom the most dangerous location.  So, being close to home does not improve our safety.  Why would it do so while we are driving?

Another reason that some families want Dad or Mom to keep driving is that they see it as therapy.  "It keeps him stimulated and sharper," we actually heard from one daughter.  With all due respect, NO!  This is part of a larger problem we will talk about in another article, which is that some families are unable to absorb that dementia is truly a disease; that their parent(s) cannot help their behavior; and that it is not going to get better simply by expecting the parent(s) to work at it.
 
Best wishes,
 
Carol Kinsel, Senior Care Solutions

 
 
 
 
 
 
 
Bert Cave, Support For Home

 
 
 

Dementia and Alzheimer's Series #4: Hospital Stays

The following great set of guidelines comes from the Alzheimer's Aid Society of Northern California.  We thank them sincerely for all of the support they provide to Alzheimer's patients and their families and friends.

Almost everyone who has ever had the experience of being a patient in a hospital knows that it can be frightening. It is even scarier for persons with dementia.  Unfamiliar surroundings, food, and caretakers can be devastating
when one is confused and disoriented. Confusion and disorientation affect how quickly and how well a patient recovers.  Providing useful techniques for staff and family visitors can mitigate resulting problems such as anxiety and wandering.  Some suggestions include: 

• Have a caregiver advocate on behalf of the patient. If possible, a family member should remain with the patient at all times. This person can help distract and soothe the patient during medical procedures.

• Use non-verbal techniques and simple language to communicate. Gestures, facial expressions, pictures, and signs are all examples of non-verbal communication. These can be used when cuing the patient to eat or bathe.

• Have a list of patient’s likes and dislikes. Favorite items can provide comfort and distraction. Knowledge of dislikes can help the staff avoid negative reactions and minimize anxiety.

• Studies have shown that the use of restraints tends to increase injuries and causes distress for the patient.  Other methods that can keep the patient safe are distraction, soothing touch, music, or prayer.

• Be sure the patient is not over or under-stimulated.  Patients with dementia have more difficulty communicating when over-stimulated by television or multiple conversations. Conversely, insufficient stimulation may increase anxiety. 

• Be aware of changes that may be occurring in the patient. Some patients won’t express pain or other feelings. Note any physical or mood changes which may indicate a complication or new illness.

• Allow the patient to make as many decisions as he or she can. Guided choices providing some control can limit distress.

Best wishes,

Carol Kinsel, Senior Care Solutions

Bert Cave, Support For Home

Helping Caregivers Be All That They Can Be

From Carlotta Sanchez, Care Services Manager

At Support For Home one of my responsibilities is to make sure that our Home Care Aides receive the proper training and knowledge necessary to give the best care to our clients.  That covers a very broad range of issues, from continuing education credits for our Certified Nurse Assistants and Certified Home Health Aides to the glycemic index for blood sugar impact in diets for our clients.
 
Today, a caregiver had a question concerning support hosiery (compression stockings) and how to properly put them on a client. Support Hose are used to reduce stress on the blood vessels in the legs. They are essentially very tight fitting socks that come in different brands and varieties, which can go to the mid-calf, knees, and upper thighs.
 
For something this basic, there are no classes offered to teach a Home Care Aide how to do this, so they must find a willing healthcare professional to ask about it or go to the Internet, which is what I did. I found an excellent video on YouTube that describes how to easily put Support Hose on a client.  I do not endorse the Internet as the best source for how to be a great family or professional caregiver, but it does have some great insights to help Home Care Aides gain better understanding of the various tasks required.

So, check out the YouTube video on putting on compression stockings.  A great hint is that the gloves in the video can be switched out for dishwashing gloves, which can definitely make it easier to put the hose on.

We are always here to support our caregivers, to help them do their job and realize the talent and potential they have to continually give the optimal care our clients deserve.

Dementia & Alzheimer's Series: #3

Perhaps the most meaningful and moving resources for individuals with dementia or Alzheimer's and for the families that love them are from people who are already suffering.  Their blogs, articles, books and interviews provide insights that we really need to continue to drive us to a cure.  They also are excellent reminders of the dignity of the individual and the respect they deserve. 

One such resource is Mike Donohue's blog, plus his book, From AA to AD, a Wistful Travelogue.  Started in 2007, his blog began after he was diagnosed with Alzheimer's.  One of the critical points he makes -- there are a great many, in a blog with over 250 articles -- is that we tend to focus so much on the cure (the future) that we forgot the needs of now:

AD needs more attention, in so many different ways, than it is getting. There is so much concentration on raising money to find a cure, little more than lip service to the universe of needs of those suffering the disease.

Take a long look at what Mr. Donohue has done for us.  It is worth it.

Just one other suggestion for today, which is actually a novel named STiLL ALiCE, by Lisa Genova.  Dr. Genova is a Neuroscientist who has written about a professor who develops early onset Alzheimer's.  It is a story we should all know and feel.

Best wishes, Bert

Rewards Do Not Always Mean Revenue

A few days ago, our Director of Client Services, Tonja, received a call from a nurse on a case management team who was at a loss as to how to help a client. The gentleman in question lives in a rural area, and is at a rehabilitation facility quite some distance away, recovering from surgery.

The nurse reported that the man was becoming increasingly anxious, thinking of his mail not being picked up and wanting to manage his household business while in the facility.  Support For Home had helped quite a few patients from the rehab facility by providing home care after the patients were discharged.  The nurse did not know what we could do, but she -- and the patient -- needed help.

This was not about home care, so whatever we did was not going to generate an invoice.  There was not going to be any revenue.  To us, that did not matter. 

The Social Worker inside our Director of Client Services took over, and she made a number of phone calls and reached the local senior center, whose representative stated that with written permission, their volunteers who deliver homebound meals in that area could pick up his mail.  The senior center even offered to priority mail his correspondence for free! 

Tonja phoned back the nurse from the case management team, and after providing her with the information she needed to assist her client, she stated, “I always call Support For Home when I don’t know what to do – you always help!”  We just got our reward -- smiles in the office for the rest of the day!

Working together to assist older adults, no matter what their issue: that’s what this industry should always be about, whether that is a nurse who is smart enough to know that not every issue involved in recovery is medical and caring enough to do something about it, or a home care agency that knows not every reward has a $ in front of it or a senior center dedicated to their mission.  We love it!  Nobody told the patient to just get over it or not worry about it.  We all worked together to help, treating the senior with dignity and respect.

Dementia & Alzheimer's Series: #2

One of the on-going goals of this blog is to point to other sites and resources that we at Support For Home believe are useful for both professional and family caregivers.  One of those sites is SeniorsList. 

Not every article they publish is great, but a number of them are.  while you will find our business listed on the site, we do not necessarily think Internet sites are the best way to find home care agencies.  A local human whose business is to know the agencies in an area is a much better approach.

However, as I say, some of the articles are very good.  One that has just been published is "Caring for Someone with Alzheimer's," by Murphy Ortiz.  The author begins by saying something that, from our experience, we all need to let "sink in," and that is -

It's very easy to say "I'll never put Mom in a nursing home" when she's healthy. But if you're one of the many family caregivers of someone with Alzheimer's, that promise may not be easy to keep.

There are still many folks who hold to that promise, but it can be very tough, and there are some critical points we believe family caregivers need to remember.  One of the most important principles, in our experience, is that the family caregiver must be able to be selfish.

Sounds strange, right?  What we mean by that is that we see too many families where the primary caregiver (and secondary ones, too, sometimes) is absolutely physically, emotionally and psychologically exhausted, because she or he is not getting the respite that is vital to being able to go on.

When that respite is missing, provided either by other family or professional home care agencies, the chances of being able to keep that promise are significantly diminished.  It will be more expensive to bring in a home care agency to help than going it alone, but the chances of success, in keeping that promise, are tremendously higher.

As Murphy Ortiz writes,

Learn how to ask for help. You might be trying to do too much yourself. Caring for a loved one with Alzheimer's requires a great deal of patience and sacrifice, and one person can't do it alone. Don't feel guilty asking for help. You'll be doing your Mom more good having help on your side...  Maybe you can ask a friend or family member to sit with your Mom to give you a much needed break. You can also contact a home care agency that can provide someone to assist your Mom with her care. These caregivers can also engage your Mom and participate in enjoyable activities with her.

It is a noble promise, and it is possible to keep it, but it means being willing to ask for help.

Best wishes, Bert

Dementia and Alzheimer's: A Series

In senior care, one of the most frequent conditions we encounter is dementia, in one of its 1000+ forms.  The most "famous" is Alzheimer's, but in any form it is very serious, for the individual and his or her family.

Over the next few weeks, we will be talking about this issue from a number of perspectives: the client / patient, family members, including family caregivers, professional caregivers at home and the facilities who serve people with dementia, including those that provide memory care.  We will talk about the dignity of those suffering and the immense respect we have for them, as well as for those helping.

One of the topics we will be spending time on is the many resources that are available to us on the topic of dementia.  Thankfully, this is a condition that we take very seriously as a society, and there is a great deal of study going on and helpful material that has been published.  We will just mention a few of the "biggest" in this first article:

1. One of the most significant sources is the National Institutes of Health's  National Institute on Aging.  This site has many helpful sections.  One of the most important is their Alzheimer's Disease Education and Referral (ADEAR) Center.  The Center has many publications and links to tools and services that can be very helpful to everyone affected by or supporting someone with Alzheimer's.  The site is updated frequently and well maintained.
2. Also part of the National Institutes of Health is the National Institute of Neurological Disorders and Stroke.  They have an excellent section called Dementia: Hope Through Research.  That Institute has a separate "page" called Dementia Information that is also very useful.
3. The third resource we will mention today, as we get started, is one all of us concerned about this topic should be aware of and with which we should be involved.  That is the Alzheimer's Association.  They have great information, but, even more than that, they are at the heart of the fight.

In future articles, we will include other resources, including some you might tell us about.  We will also have some stories from our own collective experience.  If you have a story to share, let us know.  Thank you.

Carol Kinsel, Senior Care Solutions

Bert Cave, Support For Home

Parents Driving and Other Conversations

Forbes magazine has a good article, entitled "Boomers' Burden: Aging Parents Who Shouldn't Drive".  Driving is only one issue, as our parents age, of course, but it is an emotional and important one.

The article launched a discussion on LinkedIn, with a posting from Dr. Mikol Davis:

Imagine that the phone rings, and it's the police department in the city where your 85-year-old mother lives. She's been in a car accident. She hit a pedestrian, the officer is saying, and your mom is hurt. You feel a rush of fear and guilt. You saw the warning signs, the forgetfulness, the lack of ability to concentrate. Mom really shouldn't have been on the road. You're afraid to ask what happened to the pedestrian. Could you have prevented this?

Our thoughts at Support For Home?

This is an incredibly important question, but it is, of course, part of a much broader discussion that we all have had or will need to have with our parents, as they age.


My own parents' situation was actually one of the drivers (if you'll forgive the pun) for my wife and I leaving Intel Corporation to found Support For Home, our own in-home care company.


Our preference would be that parents continue to be parents, even as we age. They should be driving this discussion, not waitiing with trepidation for "the kids" to bring the issues of driving and support for other ADLs and Instrumental ADLs. If that does not happen in a family, then yes, the offspring must step up in a timely fashion to initiate the conversation and establish some parameters that parents and children can support. Most of these are readily set, in a very objective fashion.


Our parents need to know that their value has nothing whatsoever to do with whether they have a driver's license and that our respect and love is for their lives and character and accomplishments over the course of their lives, not about their current medical state.


So, if you have to have a difficult conversation that will protect your parents and others, even if it may bring on a tear or two at the time, "just do it."

We Screwed Up

Yesterday, I wrote a couple of pieces about customer services and how we must excel every single day.  Our clients and their families deserve that.

What they do not deserve is for us to screw up.  Not in a big thing and not in small things.  Last night I talked to the family of a client about something we did wrong.  We mailed some care worksheets to the client's home, and whoever at the office addressed the envelope misspelled the client's name. 

That is not respectful.  That is not treating our client with the dignity that person deserves.  That is not customer service.  That is not excelling. 

As the owners of Support For Home, my wife and I take full responsibility, and I made that very clear to the family.  It does not matter who addressed the envelope incorrectly.  We are responsible.  We take it seriously.  We will, in fact, be talking about it in staff meeting tomorrow, to create a process that prevents this from occurring in the future.  If that means two people look at material that goes out, even if it is just an envelope, then that is what we will do.

We want to excel.  Our clients expect us to excel.  Every single day is an interview.  Every client is the center of the universe, for us.