Posts Tagged ‘Nursing Home’

How to Behave When Visiting a Nursing Home

Tuesday, February 10th, 2015

Do’s for Visiting Your Loved One:

  • Respect the resident’s privacy. This includes knocking before you enter the room and stepping out into the hall when personal care is being provided.
  •  Be warm in interacting with your loved one. Smile frequently and use therapeutic touch unless the person specifically does not want to be touched.
  •  Keep the conversation positive and refrain from arguing.

Don’ts for Visiting Your Loved One:

  • Don’t take unruly pets or children to visit. If the children are well behaved, however, they can provide extra pleasure to the patient. Take a pet if the person enjoys it, but check with the facility first to find out if they have a policy about pet visits.
  • Don’t wake up residents who are sleeping.
  • Don’t take food or beverages your loved one isn’t allowed to have. Check with the staff first if you have any questions about what’s permissible.
  • Don’t have large groups of family and/or friends visit at the same time. This may overwhelm residents or make them anxious. How many visitors are too many? This will be different for every resident. Observe your loved one’s mood and try to determine if there are too many people visiting.
  • Don’t stay too long. It may tire your loved one and interfere with the staff’s provision of needed care. How long is too long? That depends. Again, it is different for every resident. Look for cues that your loved one may be getting tired or stressed out.
  • Do not interrupt the resident’s activity time. Find out from the staff when activities are scheduled. It may be acceptable to sit beside them and just observe unless your presence distracts them from the activity.

5 Problems Associated With Caring for a Mid- to Late-Stage Patient at Home

Friday, December 12th, 2014

Many people would rather die than place their loved one in an institution. But such placement may actually be the best solution for the person. Although your loved one may have previously stated their adamant opposition to going to a nursing home, many mid- to advanced-stage Alzheimer’s patients will soon forget they were even moved.

Please consider the problems stated below before making your decision:

  1. You’re not an expert at realizing when the person has a significant health problem and may need to see a doctor. Nurses in facilities are trained to recognize physical health problems, and there is a physician assigned to each facility who can immediately initiate treatment.
  1. You simply can’t provide the amount of socialization that a long-term care facility can. People with Alzheimer’s need to be around other people for socialization. Patients living in a facility have the opportunity to interact with staff and other patients on a daily basis.
  1. You can’t provide the frequency and quality of activities a facility can. Nursing homes have specially trained activity directors who devote 100% of their time to providing meaningful activities for residents.
  1. You are not an expert at communicating and interacting with the person. People with Alzheimer’s may exhibit difficult behaviors. Most personnel in facilities receive training for dealing with these.
  1. Placement Will Almost Certainly Be the Best Solution for You and Thus for the Patient. Although you are probably staunchly dedicated to caring for the person at home, providing 24/7 care is exhausting. And you simply can’t provide the best care if you’re burned out all the time.

 

 

 

The Pros and Cons of Placing Your Loved One in a Facility

Wednesday, April 2nd, 2014

Author’s Note: This post assumes there is a decent, affordable facility within a reasonable driving distance. It also assumes that the person with Alzheimer’s is in the mid- late-stages of the disease, and high quality caregiving at home is becoming increasingly more challenging if not impossible.

CONS

People living with Alzheimer’s typically want to remain in their own homes. They want to be in a familiar environment and close to their loved ones.

Family members are sometimes adamantly opposed to placing their loved one in a facility. Some view this almost as a criminal act. In many cases it’s even more difficult because if the person with Alzheimer’s staunchly objects, family member(s) may feel incredibly guilty.

In addition, the caregiver may have promised his or her loved one many years before to never put them in any kind of facility for any reason. Breaking that promise would be extraordinarily difficult. Again, if the caregiver decides to go ahead with placement he or she would probably end up riddled with guilt.

Caregivers may feel they can provide care that is superior to that delivered in a good facility, due to their love and devotion. Although personnel in a facility may indeed care about their residents, they will probably not have the depth of love that family members feel.

Finally, financial issues need to considered. There may be high quality facilities near you but you can’t afford them. In this case you may have no other option than caring for the person at home.

PROS

It takes a large team to care for people living with Alzheimer’s, especially those in the mid to later stages.  They need a doctor on call 24 hours a day. They need a nurse available at all times. They need aides, a social worker, activity professionals, cooks and laundresses.  And they need to be around other people for social stimulation. They need 24/7 supervision and they need to be in a safe, secure environment.

Providing for all of these needs can be done but it’s a full-time job. In many cases the primary caregiver has to work either full- or part-time and thus can’t provide the needed care.

The decision to place a loved one in a care facility can be agonizing, but caregivers need to consider the following: 1) Long-term care placement can be the most loving choice for their loved one and 2) Caring for the loved one is probably seriously affecting their own physical and mental health and wellbeing.  People simply can’t be good caregivers if they are exhausted and burned out all the time.

You may be hesitant because you think the person will never forgive you for placing them in a facility. Most people with mid- late stage Alzheimer’s, however, soon adjust and even forget they’ve been moved at all.

Deciding what to do can be nerve-wracking and heartbreaking, but it’s something you will probably need to do at some point. Take a step back and try to be objective. Consult with friends and other family members.  You may also want to talk with your attorney, spiritual leader and/or your physician and your loved one’s physician (if they are not the same).

Do any of you want to comment on how you arrived at your decision regarding this issue?

Is Alzheimer’s Always Depressing? I Think Not

Saturday, March 29th, 2014

Alzheimer’s is considered a deadly serious disease and deservedly so. But I ask this: Does being ‘serious’ mean that it is horrible and depressing? Yes, it can be horrible and depressing. But is it always that way? I think not. I think to some extent at some times it depends on the attitude of the beholder. Let me illustrate with two hypothetical vignettes.

John is distraught when he visits his wife, Jean. First of all, he finds the facility per se depressing. While walking to his wife’s room, he passes several residents sitting in wheel chairs. Most are either staring into space or else their heads are hanging down and they appear to be dozing. What a waste of human life, he thinks.

Worse still is his wife’s condition. She can’t bathe or dress herself. She needs help eating. She carries a baby doll around with her everywhere she goes. She acts as though it’s a real baby. He has tried and tried to convince her it’s just a doll, and he’s tried to get her to give it up. All to no avail.

Jill is another regular visitor to the facility. Her mother, the past president of a major university, is in a wheel chair and can often be found playing Bingo, which she can’t play unless one of the aids helps her. Her mother’s other favorite activity is the sing-alongs held every Tuesday and Thursday. Most days she doesn’t even recognize Jill.

Jill’s reaction to the situation, however, is very different from that of John. Sometimes Jill arrives during the Bingo game and sits beside her mother as she’s playing. Instead of thinking how much her mother’s mental capacity has declined, she notes that her mother has a smile on her face. Jill is so happy that there are still things her mother enjoys.

Although her mother usually doesn’t recognize her, it’s obvious that she enjoys Jill’s visits. As far as the diapers her mother wears, Jill isn’t upset by them. There’s nothing inherently distressing about diapers. All babies wear them and that isn’t depressing to anyone.

To a great extent, our attitudes about long-term care facilities and people with dementia influence how we view them.

If we are in denial and try to insist that our love one talk and behave like a ‘normal’ person, we will be miserable every time we see the person.

If we focus on what our loved one can’t do rather than what they still can do, visiting will be painful. If we focus on comparing the person’s current mental state to their previous one, we will suffer.

If we think about our own unhappiness rather than on our loved one’s reaction to the same issue, we will never be able to accept the person’s illness. We will never be at peace with the situation.

Sometimes the best thing to do when something upsets us is to ask whether our loved one is upset by it. You may be distressed, for example, because the aids don’t style your mother’s hair very well. But ask yourself is my mother upset by it? If not, then let it go.

Jill enjoys her visits because she accepts her mother just as she is. She doesn’t try to change her. She interacts with her at her level – not her previous level.

No, Alzheimer’s doesn’t always have to be depressing all the time.

Would anyone like to share a positive experience with a loved one living with Alzheimer’s?

 

 

 

 

 

Don’t Sweat the Small Stuff at the Nursing Home

Thursday, October 10th, 2013

Family Members: Don’t Sweat the Small Stuff at the Nursing Home

Sometimes there’s friction between family members and nursing home staff. Before complaining ask yourself if the issue is bothering your loved one or is something potentially harmful.  If not, let it go.

Here are just a few of many examples of “small stuff” and significant matters:

“Small Stuff”

How the Resident Is Dressed: This would include things such as occasionally dressing the resident in someone else’s clothes (unless it becomes habitual) or dressing the person in clothes you don’t think go together well. The important thing is for the clothing to be clean.

How Hair Is Styled: The staff may style ladies’ hair in a new way. But If the resident isn’t complaining go along with it. The thing that matters is that residents’ hair is washed regularly.

Activities You Consider Beneath the Resident’s Dignity: You may object to some activities, especially if your parent or spouse is highly educated and had a serious profession. Look to see if the person is having fun. If so, let it be. Activities can be very therapeutic. 

Teasing the Resident or Showing Physical Affection: If it’s truly making fun of the resident, hurting his or her feelings, that’s grounds for complaining. But if it’s good natured and the resident obviously enjoys it, then don’t object. A related issue is if staff members express physical affection to a person who wasn’t previously openly demonstrative.  Again, it’s OK provided the resident clearly likes it. Touch can be therapeutic.

Significant Issues

Clinical Care: Any notable problems with clinical care should be immediately brought to the attention of the administrator or director of nursing. These might include not following the doctor’s orders, not assisting residents who need help with eating, or leaving wheel-chair bound residents (or any resident for that matter)  in bed all day.

 Safety: Issues such as leaving a medication cart unattended or leaving the call system button away from the resident’s reach. For residents with dementia additional issues apply such as having the unit properly secured or allowing a resident to have sharp, potentially harmful objects.

Personal hygiene: Matters such as not changing incontinent residents in a timely fashion, not keeping bedding clean, putting dirty clothes on the resident, not providing regular showers or not shaving male residents who need help with that on a regular basis.

 

My 3 Biggest Regrets as an Alzheimer’s Caregiver

Monday, August 19th, 2013

Marie & Ed in Love Again

 

In many cases I was successful in finding the way forward when I was taking care of Ed, but in other situations I faltered. Looking back at that period now I have three major regrets.

1.   I Didn’t Place Ed in a Nursing Facility Soon Enough

Ed needed to be living in a nursing facility at least two years before I finally got him into one. I had power of attorney and Ed had an official diagnosis of “dementia.” Therefore I could have taken him even against his will. But I was weak. I was an idiot, actually. I was afraid he’d never forgive me and never speak to me again. I put our relationship ahead of his safety and welfare.

I regret having waited so long. If something had happened to him while he was living alone I never would have forgiven myself. I (and he) was just lucky he didn’t get hurt or lost

2.  I Didn’t Touch Ed Enough

When Ed was living in the nursing home it was obvious that he needed and enjoyed being touched. When visitors came to see him he would almost always hold their hand most if not all of the time. Why I couldn’t see that he needed me to touch him is beyond me, and I have been sorry for it for years.

3.   I Didn’t Visit Ed Enough Near the End of His Life

Near the end of Ed’s life I began to visit less often because I was preoccupied with getting a new job. And so I visited less. Whereas I’d earlier visited two to three times a week, I began visiting only once a week and a couple of times I even skipped an entire week.

So these are the things I wish I could do over. But I can’t. All I can do is hope this article will save someone else from making the same mistakes.

 

Nursing Home Placement: Damned if You Do – Damned if You Don’t

Saturday, June 29th, 2013

Virtually no one wants to place a loved one in a nursing facility. But what if you have to work full-time and can’t provide the required 24/7 care?  What if you can’t afford an in-home care service that could help you out? Or what can you do if your loved one becomes too combative to manage?

You and your loved one aren’t the only people in the equation. Family members may argue strenuously against any decision you make. They may try to make you feel guilty enough to give up any plans for institutionalization.

Sometimes nursing home placement is the best (or even only) solution for your benefit and the benefit of the person you’re caring for. But many people feel like institutionalizing their loved one is a cop out – virtually a crime.

If you do it you may feel terribly guilty. But if the person really needs to be in a facility for his or her own safety and well-being you may end up feeling even more guilty if you don’t do it. If something happens to your loved one – such as wandering off or sustaining an injury from a fire or other hazard – you’ll never forgive yourself.

Ask yourself two questions: 1) Would being in a facility provide your loved one with better care, more personal attention, more opportunities for socialization and – especially – greater safety? and 2) Is taking care of the person at home wrecking your own physical and mental health? If you answered “yes” to either one of these questions it may be time to start looking for a good facility.

People with Alzheimer’s placed in nursing homes typically adjust in time and often later forget they were even moved in the first place.

If you decide not to do it, just remember that Alzheimer’s is progressive. You may need to revisit the issue later on.

Convincing a Loved One to Move to a Long-Term Care Facility

Saturday, March 30th, 2013

Most elderly people who have a clear and compelling need to be in a long-term care facility desperately want to remain in their own homes.

The decision to place a loved one can be agonizing, but caregivers need to consider the following:

  1. 1.      Long-term care placement can be the most loving choice when absolutely needed to ensure the person receives all the necessary care, is around others for social stimulation, and is in a safe environment.

 

  1. 2.      Caring for a loved one is probably seriously affecting their own physical and mental health and wellbeing.  No one can be a good caregiver if they are exhausted and burned out all the time.

Many people flat out refuse to go. In such cases you can try to convince them that it’s best for their own health and wellbeing. If that doesn’t work you may enlist the help of another family member or even the person’s physician to talk with them. People will sometimes pay more attention to the advice of someone other than the primary caregiver.  However, if the person is mentally competent and continues refusing, there may be very little you can do about it unless their health is in imminent danger.

If your loved one has dementia and is resisting placement it can be more complicated, but there are several strategies you can use. First of all try those listed above for loved ones who don’t have dementia.  You may also obtain the services of a geriatric care manager, who can often guide you through the process.

Another approach is to use what is referred to as “compassionate deception.”  You can convince the person to go for a limited period of time, such as a week. Then you stretch it out to two weeks, then three, and eventually they will probably adjust to being there full time. If a loved one is significantly impaired he or she may even forget they were supposed to go back home. Or they may not be aware they aren’t at home.

You may also make arrangements for a facility to allow you to take the person there, saying you’re going to visit someone there or you have dinner reservations there (or some other reason for visiting). Then when you leave don’t take them with you. You will probably feel terribly guilty, but the person will almost certainly adjust. This may take a few days or, in rare cases, a few weeks, but your loved one will probably come to know the facility as ‘home,’ and they are not likely to remain angry with you.

If none of the above suggestions work and you have power of attorney, you may have to enlist the help of law enforcement. According to Hammond, “You should do this only as a last resort. It’s only for the most severely impaired people and the most dire circumstances – such as if the person becomes a danger to him or herself or others.”  Law enforcement typically takes the person to a hospital geriatric psychiatry unit for evaluation and treatment, from where they may be released to a nursing home.

Do any of you have any other suggestions for solving this problem?

Nursing Home Placement Can Be the Most Loving Choice

Saturday, December 22nd, 2012

No one wants to live or place a loved one in a long-term care facility, but sometimes it’s the most loving choice. This is especially true for Alzheimer’s patients in the mid- to late-stages of the disease. They need so much more care than any one person can provide at home, even with people coming in to help.

Does anyone want to share their experiences with placing a loved one in a nursing facility? What was it like for you?

For more on this topic see my Huffington Post with the same title.

What If Ed Never Had Alzheimer’s?

Wednesday, March 28th, 2012

To tell you the complete truth I have to say that Ed was far more contented when he had Alzheimer’s than he ever was before.

When Ed began becoming demented he was frustrated and afraid of his early symptoms. What’s more, he spent a lot of time thinking about death. He was angry and depressed. He drank to excess – starting at noon and continuing all day and half the night.

I couldn’t take care of him at a certain point and we fought constantly about him going to a nursing home. But eventually he became so demented he forgot his opposition to the idea and finally agreed.

He was very depressed and was having delusions and hallucinations, and so his doctor put him on three psychotropic medications.  Within a few weeks he became the most contented, loving and loveable man you’d ever want to meet.  When the cleaning lady came in to empty his trash basket, for example, he kissed her hand and told her how beautiful she was and how lucky he was to have her help.

He became a joy to be with. He no longer worried about death because he didn’t have the capacity to think about the future. And he didn’t stew over any unpleasant things that happened to him because he forgot them all very promptly.

Our love returned to the state it was when we’d first met 30 years earlier. He was a true joy for me, and he himself was very contented – much more so than I’d ever seen him. He knew and experienced joy even on the last day of his life.

What if Ed never had Alzheimer’s?