I am 76 and my husband is 81. We’ve lived in our 4000 sq. ft., 6-bedroom home for almost 31 years. It was once also home to our 5 children, who were all thrilled to each have their own bedroom after growing up in a much smaller tract home in Massachusetts. However, since they were between 10 and 23 years old when we moved to Utah, they do not consider this home to be the “home I grew up in.” Whenever they return to Massachusetts for a visit, they drive by that home, and 2-3 of them have asked to go in and have a look around. We’ve already gotten through the downsizing that upset our kids.
Although we feel nostalgic about our 20 years in Massachusetts and 16 years in that home, it’s this home that my husband and I will miss the most, if we ever have to downsize or move to assisted living. I’m probably already being unrealistic just by saying “if we ever have to.” We already pay to have our yard work done, and we’ve had help with basic housecleaning for years. I consider myself to be in excellent health, but my husband was diagnosed with early stage Alzheimer’s disease about 6 years ago. He’s still considered “early stage,” but it’s only a matter of time before we will need more help and/or a lot less to take care of.
Do It Now!
Nine months before my mother’s unexpected death, my parents moved from “the home I grew up in” to a large condo that held most of the possessions they really cared about. They did most of that downsizing themselves. Dad’s second downsizing took place when, after outliving a second wife, he moved into his third wife’s condo. She had a lot to say about what he could bring with him so, thankfully, I and my 8 siblings did not have to make many decisions about what to keep, only who got what, or what was done with the remaining possessions. A sister catalogued everything of value, and we drew numbers to determine the order we would choose what we wanted from that list and other miscellaneous stuff.
It was a big job, but it made the job much easier when, at age 95, we had to move Dad to an assisted living facility, because his wife could no longer care for him and refused in-home care. Until he died at age 97, one room in his wife’s condo remained the repository for his smaller “treasures,” the things that represented many of the memories made during his long, productive life. It was then that we had to make the tough decisions. I still have a closet full of the things the family thinks should be kept and passed on to the next generation or archived for historians in some way.
What I learned from all of this, and what experts advise, is the more we can do with our things while we can still make those decisions ourselves, the easier it will be for our children, when the time comes to clear out our “family home.” We can get rid of things that none of our children will want, or designate beneficiaries for any items of value that we hope they will hold on to. With the help of an attorney, we’ve made it easy for them to sell our home, but deciding what to do with 30+ years of accumulated memories is a heart-wrenching task.
Downsizing the Family Home: What to Save, What to Let go, by Marni Jameson, published by AARP, is an entertaining and very helpful read for anyone facing the task of deciding what to do with the contents of a home that’s been lived in for years, whether it will continue to be lived in or not. The first chapter is titled “A Tough Call: How to Know When an Aging Parent Needs a New Home.” The author begins that chapter with, “My brother and I had a plan for our aging parents. The plan was that they would not age….They had a plan, too. They would manage just fine, thank you.”
Downsizing doesn’t have to be triggered by the need to move to assisted living. When you or your parents reach retirement age, or when age or other circumstances make a safer and more easily maintainable home seem like a good idea, the best choice might be to move to a smaller home that is easier to care for and maybe in a warmer climate. If you sell the house, then rent a new one, you or your parents can use the profits from the sale to supplement retirement income and pay for needed services.
Jameson summarizes the chapter by saying, “When parents need to move from their longtime home…. the path is neither clear nor smooth. Adult children often need to take the reins.” As she evaluated whether a move to assisted living was right for her elderly parents, she considered a set of criteria she’d found. Her parents’ needs met every one: Safety, health, hygiene, housekeeping, meals and social life. She also acknowledged that other older adults may not need the level of care that her parents did and that moving into a smaller, easier-to-maintain home or one-floor town home could be the answer. No matter where you move, life can be made easier by adding in-home care services, if needed.
At Dakota Home Care, the goal is to provide both medical and non-medical services to keep home an option for everyone. I know I am already a senior citizens who would like to stay in my home for as long as I possibly can. My work for DHC has made me aware of the many options that are available to me and my husband for in-home care of all varieties.
However, we are already being asked why we choose to stay in a home that is obviously larger than we need, except for when it comes to family gatherings. We have lots of what we think are very good reasons to stay. So far our children aren’t pushing us one way or the other. But, as I mentioned, they don’t have the emotional attachment to this home that we do. We have a small start on deciding “What to save and what to let go,” but we need to speed up the process.
We need a plan, and so does anyone who is either trying to downsize for the sake of their kids, or if you are the kids who are suddenly faced with the huge task of getting the family home cleaned out and ready to sell. Jameson’s book has lots of great ideas for how to get started and then keep going until the job is done. Putting the task of letting go into perspective is one of her first tips. “To help yourself let go, tell yourself that the important attachment is not to any object but to the person the object represents.”
Jameson’s Guiding Lights for Sorting can help all of us downsize our stuff, regardless of why we want or need to do it:
- Ask these questions: Do I love it? Do I need it? Will I use it? A no on all three and the item goes.
- Tackling one area at a time keeps the job from seeming quite so overwhelming.
- Choose to keep rather than choose to let go. Take everything out of a closet or drawer. Only put back what you choose to keep.
- Don’t put it off. Purge regularly and often.
- Unpack your stories. It’s not the stuff. It’s about the stories behind the stuff:
- I’d feel guilty of I got rid of that.
- I might need that someday.
- It has sentimental value….Ask yourself what will become of this item in 10 years if you decide to hang on to it.
You probably already know the tactic of separating items into categories: toss, sell (or donate), keep, and can’t decide. Having the mindset that these decisions aren’t permanent yet will help you go faster. Jameson gives excellent advice on how to determine the value of some of the things you might have to sell, and whether to have an estate sale or a garage sale. There isn’t space in this blog to cover all the things that could be helpful when you’re going through a lifetime’s worth of stuff. You can find Jameson’s book on Amazon, and lots of other good tips are in the AARP sources listed below. Don’t wait! Start now!
How does having or not having a pet fit into keeping home an option for your elderly loved one? Is pet ownership healthy or harmful? Numerous studies have been conducted, but the result statistics, either positive or negative, are difficult to prove.
“I’m not a Grinch, but the science is not as clear as most people think,” said Dr. Harold Herzog, professor of psychology at Western Carolina University. “There is little debate about the safety and success of pet programs that bring animals into nursing homes or hospitals for patients to play with and pet, but individual pet ownership may be a different proposition, and it depends a great deal on the strengths and weaknesses of the owner.”
10 Possible Benefits:
Ten possible pet ownership benefits that have been studied may seem obviously positive for the elderly:
- Comfort and companionship that can lessen loneliness and depression
- Increased social interaction: trips to the vet and pet store, walks where other pet owners gather, opportunities for withdrawn seniors to talk about a loved companion
- Reduced stress that could lower blood pressure (increased stress is also a possibility)
- Getting more healthy exercise in a pleasant way, by walking, feeding, brushing, or even just moving to look at pets like fish or birds
According to a new study by the University of Minnesota Stroke Research Center, even having a cat somehow lowered their owners’ chances of dying of heart attack, stroke and other cardiovascular diseases, compared with people who didn’t own a cat.
- Feeling needed and unconditionally loved are common responses from pet owners
- More Tactile (touching) and cognitive (mental) stimulation are healthy for people of all ages
- Having a routine, structure and purpose is required to keep a pet healthy and happy and is good for the pet owner, too.
- Security for seniors living alone could be enhanced by a dog who barks at strangers or can let someone know when its owner is in trouble
- A reduction in Sundowners Syndrome symptoms may be one of those debatable benefits.
It’s true that nighttime can be very confusing and disorienting for people with Alzheimer’s disease. A pet may be able to lessen these symptoms by keeping them connected with reality and occupied during evening hours.
- Prompting better memory and recall of past events
Psychologist Penny B. Donnenfeld explains, “I’ve seen those with memory loss interact with an animal and regain access to memories from long ago. Having a pet helps the senior focus on something other than their physical problems and negative preoccupations about loss or aging.”
Talking about the downside of pet ownership can be difficult, especially if your loved one already has a pet. No one wants to give up their beloved pet. Considerations under those circumstances can be different than adding a new pet to the family:
- Is the health of the pet in jeopardy? Is your loved one still able to feed the pet and take care of its other needs?
- If a visit to the vet is needed, is there someone who can help with a potentially dangerous trip outside the home?
- Does the pet create a fall risk? The sudden movements of a cat or dog underfoot may throw an elderly person off balance and put them at risk for broken bones or other injuries.
“Over 86,000 people per year have to go to the emergency room because of falls involving their dogs and cats, and these fractures can be devastating for the elderly,” said Judy Stevens, an epidemiologist with the Centers for Disease Control and Prevention and lead author of a report on this peril.
- As your loved one becomes less able to take care of themselves, taking care of a pet of any kind might add more stress to their lives, rather than reducing it.
A solution to some of these difficulties that could enable the pet to stay in the home might be to designate a willing family member, neighbor or friend as a pet helper. Even a grandchild or another child who loves dogs, cats, birds or fish might not mind coming in to check on a pet’s well-being, even feeding the pet, letting the dog out or scooping out the cat litter. If you don’t have someone who fills the bill, check with Dakota Home Care to see if companion care or an in-home health aide could be the answer to keeping your loved one and his or her pet together.
If you are considering acquiring a new pet for your loved one, here are eight questions to consider:
- Is your loved one so set in their ways that they will find this change too difficult?
- Has a pet been part of their lives in the past? An experienced pet owners might more easily make the adjustment.
- Does your loved one have disabilities or functional limitations that might make it difficult or even dangerous for them to take care of a dog, or even a cat, a bird or a fish?
- Does he or she have limitations that might put the pet at risk?
- What is the age and temperament of the pet under consideration? For example, senior dogs and cats are more clam, quiet and require less maintenance.
- Is the cost of pet ownership—food, medical care, grooming, transport to vet, etc.—comfortably within your loved one’s budget?
- Is there a backup plan for if or when your loved one may have to spend time in the hospital, rehab or an assisted living center?
- In the event of a pet’s death, will your loved one be severely debilitated by grief or depression?
Make a Pros & Cons list:
Before you decide on either keeping or adding a pet to your loved one’s environment, make a list of Pros & Cons, based on the information above and other personal considerations you might know about. If the decision is to adopt a pet, be sure to choose carefully, with the pets needs in mind, as well as what it could add to the life of the elderly person you are responsible for.
Remember, there are pet therapy home visit services all over the country. Alliance of Therapy Dogs and Therapy Dogs International are volunteer-run organizations with outposts all over the world. A local volunteer will come to your home and bring a trained service dog that is very well-behaved. The dog can play, cuddle, and perform commands during a half hour or one hour session. You might want to try this service before making a life-altering decision.
Unfortunately, guilt is a common and persistent emotion for many, if not most family caregivers, even when they are literally devoting their lives to doing everything they can for the loved one they are caring for. And that guilt can continue even after a loved one dies. A friend of mine, who lost her mother to Alzheimer’s early in 2019, advised me, “I still struggle with guilt from what I didn’t do for my Mom and Dad. It’s a long list. It’s painful. Be kind to yourself.”
Sometimes the guilt comes from what we did and how we did it. Sometimes it’s more like survivor guilt from being able to function physically and/or cognitively in ways that our loved one no longer can. As my husband moves through early-stage Alzheimer’s, I feel guilt for not being patient enough, kind enough, understanding enough of him and what he’s going through. When a loved one is in the early stages of needing our help, no matter what the reason, it’s often hard for us and them to know when help is needed and how to come up with a plan that is acceptable to everyone.
“Don’t aim for guilt-free caregiving,” Barry J. Jacobs advises in an AARP article, Caregivers: Living With Guilt, “The feeling that we should do more and better for one another seems to be built into our species as a group survival mechanism. Guilt is part of who we are. So that discrepancy between what you think you should do and what you’re willing and able to do may always cause some guilt. Let’s accept that as a given, then, and work on tempering the feeling.”
Jacob’s article focuses on how to come to terms with feelings of guilt, and instead feel more pride for being the hard-working, well-meaning caregivers we really are. He gives four tips on how to do it:
- Give up the fantasy of rescuing others by creating realistic goals.
- Maintain balance by taking breaks from caregiving.
- Tolerate ambivalence between wanting to be perfect and still being human.
- Find other motivations than guilt for our actions.
Recognize and accept unrealistic expectations. Not only can we have unrealistic expectations of ourselves, but our loved one might want us to devote more time to their care than our situation allows. For example, if we work full time, still have children at home or do not live close by, our only option might be to bring in some outside help. If Mom says, “But I want you to take care of me!” even more guilt can overwhelm us.
A family caregiver’s ultimate responsibility is to ensure that their loved one is well cared for, even if it’s not in the exact way they prefer. If other family members can join the caregiving team, a caregiving plan tailored to all family members’ needs may be possible. Even friends and neighbors can be involved. A free in-home evaluation by an RN from Dakota Home Care can make you aware of other resources that can fill the gaps.
“Take care of yourself” may be the last thing a guilt-ridden caregiver wants to hear. Maybe what you really need to think about is “How do I take care of my guilt?” One way might be to lower your expectations of yourself and others. Talking about it with other caregivers could help you to put your situation into perspective. Caregiver support groups are probably available in your area. Even having lunch with a friend who has gone through a similar experience can help you to feel better about yourself. Sometimes just an hour or two of respite care for your loved one can give you a more positive outlook.
It’s never true that your own needs are insignificant compared to the needs of the person you are caring for. First you need to recognize the unmet needs that are causing your emotional pain. Needs are not bad or good, but they are real. Acting on ways to meet your needs can make you a better caregiver long-term. Check out some other tips on how to take care of yourself in this Dakota Home Care blog.
Forgive yourself for your imperfections. Remember that guilt is a typical feeling for caregivers. The chances are good that you never will do it all so well that everyone is happy, including yourself. Your guilt may be minimal or it may be immobilizing, but try to find ways to move forward and leave it behind. Doing the best that you can with the resources you have has to be good enough.
You don’t have to do it all alone. Dakota Home Care offers in-home services tailored to your caregiving needs. They include someone to help with personal care, housekeeping, shopping, companionship and preparing meals. If skilled nursing care is required, an RN can be part of your caregiving team. Respite care that allows you to leave home for a while might be all that you need. Call 701.663.5373 today to make an appointment for your free, in-home evaluation.
Most of us make New Year’s resolutions for ourselves that involve some aspect of a healthier lifestyle, including weight loss, better food choices, more sleep and regular exercise. Whether we keep them or not often depends on how dramatic the changes are that we’ve vowed to make, especially when it comes to exercise. Joining a gym and going every day vs. taking a daily 15-minute walk is an example. Alzheimer’s and dementia are not an inevitable part of normal aging, and a little exercise might help keep them at bay, or delay the progression, several new studies suggest.
Starting with small changes is often the best indicator of success, and experts tell us that even these “baby steps” can improve our brain and body function now and in the future. The same strategy can be true for our elderly loved ones or clients. Even a little more exercise can improve brain and body function and even emotional health. Then the question becomes, “How can we help them to see the benefits and get moving?” [For more about safe exercises for seniors, see our blog “Seniors Benefit from Safe, Regular Exercise”]
“Try it. You’ll like it!” can apply to everything from a new food to becoming more active. If you can get your loved one or the person you care for to try adding more activity to their days, they might be able to see for themselves that they feel better and want to do more.
Take a walk: It might be something as simple as asking them to take a walk with you. Set your pace to theirs and help them make goals that can be expanded as strength increases. If you can’t be there every day, ask neighbors or other family members to take turns being the walking buddy. Walking is a weight-bearing aerobic exercise that an elderly person can do at his or her own pace. It can help to build bones and slow osteoporosis. And, by walking with another person or a group of people, an elderly person enjoys social interactions, too.
An elderly friend of mine had a daily schedule of “walking buddies” who helped her get herself and her walker down the 2 steps from her back door to the driveway. She felt much better when on a good day she could walk up the sidewalk just 4 houses, 8 total when she counted coming back, with her buddy-of-the-day walking beside her to be sure she was safe. Just getting out in the fresh air, even in cold weather, was something she hated to miss, and she was very proud of herself every time she could reach her goal.
Join a Group: If they are able, encourage your elderly person to join group or a spa that includes both exercise and socialization. Programs are available through community centers, hospitals and religious organizations. Activities might include yoga, dance, water aerobics or even breathing and relaxation exercises. Some classes teach modified exercises that almost anyone can do. Being part of a group can provide just enough peer pressure to keep attendance regular and enjoyment high.
Consult a Doctor: Some elderly people are afraid to exercise because they believe a health condition prevents them from doing it safely. They fear they might fall or be unable to complete the exercise that has been suggested. These fears can be alleviated by consulting a doctor. Once an elderly person gets the OK from their doctor, they can begin a program with confidence.
A doctor might be able to prescribe specific types of exercise that will be both beneficial and preventative. For example, a person with heart or circulation problems could work with a cardiologist. Someone with arthritis might be guided to an instructor who can work within the person’s limited range of motion. “My Doctor told me it will make me feel better if I do this” can be a powerful and safe motivator.
In-Home Physical Therapy: With a doctor’s prescription, some elderly people qualify for in-home physical therapy. There might be a limit to the number of times the therapist can come, or therapy might continue only for as long as the patient is making progress. For some elderly people, liking the therapist means everything when it comes to doing what’s prescribed.
Provide a Distraction: Many simple, at-home exercises can be done in front of the TV or with music in the background, providing a distraction that makes the time go by more quickly. During a TV show, your loved one could perform exercises for a short period while seated, with lengthy rests in between each exercise. Creating a playlist of favorite music or recording favorite TV shows for replay during exercise periods might change a person’s mindset from “This is something I have to do,” to This is something I look forward to doing.”
Start Simple with a Goal and a Reward: If your loved one has any level of dementia, they might be unable to start activities on their own or remember the prescribed movements. Try to be aware of times during the day when you can encourage them to do simple exercises or just to move from one place to another with you beside them to ensure they are safe. With simple exercises, if they are able to mimic your movements and don’t have to remember what to do, any activity will be more enjoyable. If they are resistant, offer a reward as simple as a star on an exercise chart, a favorite food or something else they love to do, when they complete what you’ve asked them to do.
Mix It Up: Each person’s personality, health and cognitive abilities are different. In addition to professional advice from a doctor, it might take some experimenting to find the type and amount of exercise that that your elderly person can and will do. You might have more success if you very the length and time of a variety of activities. Remember, any amount of exercise is good, no matter how small. If you exercise along with them, it will benefit you, too.
Dakota Home Care Can Help: If you can’t always be there to encourage and help your loved one to exercise or perform other health-promoting daily activities, someone from Dakota Home Care’s professional staff can help. We work with the client, family, home care staff and your physician to provide and implement an individualized plan of care that can include safe, supervised, in-home activities for increased movement. Call us today at (701) 663-5373 to schedule an in-home evaluation. A registered nurse will determine what we can do to help keep home a healthy option for someone in your family.
What better time to discover more than 100 ways to bring more joy into your life and the lives of those with Alzheimer’s than during the Holiday Season! Give yourself the gift of this book.
International speaker and author, Jolene Brackey, makes a powerful, personal and touching case that there can be many moments of joy for those with Alzheimer’s disease and for both professional and family caregivers. As a wife and caregiver traveling the Alzheimer’s journey with my husband, reading this book brought me joy and the hope that my husband and I can continue to experience joy together, even during his “Final Moments.”
I wish I could help you to feel some of that joy just by reading this blog, but as Jolene so wisely says on p. 268, “You have learned a lot by simply reading this book. You’re going to want to tell your brother because, ‘He should…’ You want to tell your mom because, ‘She should…’ You want to tell other caregivers because, ‘They should…’ Don’t go back and ‘should’ on people. Recognize that each person is doing the best they can with the information they have.”
So, besides sharing a few of Jolene’s examples, I can only say, as Dakota Home Care CEO, Beverly Unrath, said to me, “I read the most wonderful book. You should read it!” So I did. I hope you will, too.
Another quote from Jolene: “With short-term memory loss, life is made up of moments. There are not perfectly wonderful days, there are perfectly wonderful moments—moments that put a smile on their face and a twinkle in their eye. Five minutes later, the person will have forgotten what was said and done; the feeling, however, lingers on.”
The book is divided into six sections that don’t have to be read in sequence. Just pick a chapter that stands out to you. I wanted to read them all! Now I have favorites that I know I’ll return to again and again. Because every person with Alzheimer’s is different, you will have your own, but to give you a taste, here are one or two of my favorite insights from each section:
Understanding the Person: When we think about something from our childhood that makes us feel good, we are usually thinking about a moment. People with dementia have these moments in their memory but they can’t pull them out. We can create a moment of joy for them if we know something from their past. We can trigger a memory of that moment, not by asking questions, but by saying something about it. You might unearth a story that you hear over and over again, but it will give the person telling it joy every time.
People Stop Visiting: Family and friends stop visiting for a variety of reasons. They might be scared of the diagnosis and their perception of what it means. They fear what the person will look like and how they will act. They don’t know what to say if they can’t ask questions about the recent past. They want to remember their friend, uncle, father the way he used to be. Jolene gives an example of a letter one couple—the husband has Alzheimer’s—wrote to friends and family explaining “how to visit.” It’s full of great tips on how to make a visit enjoyable for both of them and the visitor. You could write one, too.
You’ve Got Mail: When my Dad’s short term memory was almost gone and the half of my family that lived out of town bemoaned the fact that they couldn’t visit, I urged them to write to or call Dad. Only one granddaughter did. She printed her weekly email to her family and mailed it to Dad with a personal note on the bottom. When it came, I read it to him. He was thrilled, even though he asked every time “Now who is this?” Maybe other members of my family would have done the same if they’d read Jolene’s reminder of how much joy each of us feels in the moment when we get a letter or a package in the mail.
Stop Correcting Them: The person with Alzheimer’s doesn’t know they’re doing anything wrong until we correct them. For example, they might wear the same thing every day, sleep in a room that isn’t theirs, or wear a sweater that doesn’t belong to them. Jolene gives several clever workarounds for what to do instead of pointing out their unacceptable behavior. She explains, “You want to correct the person in the hopes that they will get better. This is a rightful wish, but it’s an illusion. This is a disease that progresses….No matter how many times you correct them, do they get better? Do they change? No.” I know from experience that, in a challenging moment, it’s difficult to remember I am the only one who can change. She suggests, “If you correct them, you just laugh at yourself and think, ‘There I go again.’”
The Facts Are All Off: Anyone caring for or visiting someone with Alzheimer’s has heard outlandish stories that they know aren’t true. Jolene reminds us that even though the facts are off, their feelings are real to them. “Please do not try to figure out their story—the best thing we can do is to respond to those feelings.” A common example is, “My family never comes to see me. They don’t love me.” Rather than arguing with the person, respond, “I’m going to call them and tell them to stop by.” You don’t have to call, but you’ve made the person feel that you understand.
What to Expect: This chapter consists mostly of a list of what to expect from people with Alzheimer’s and why. The bottom line is to “expect the unexpected. Suffering happens when you expect something different than what is.” Here are just three on the list that resonated with me:
- Expect everything to get lost. Hearing aids and glasses get lost….It’s a losing battle to replace them.
- Expect who you’re caring for to walk out of a room completely naked. (My dad did this.)
- Expect that when you ask them, “What have you done this morning?” they will say “Nothing.”
Music Does Wonders: You might have read some interesting studies about music and memory. Jolene’s tips about music include, “Even if they can’t communicate, sing their favorite song.” This worked for me in an amazing way recently. A 94-year-old friend of mine was dying and hadn’t said anything for more than 24 hours. I held her hand and talked about my memories of leading the music in church with her. She opened her eyes and said clearly, “I miss the hymns.” I began singing hymns to her and she would join in with a line or two. Then she lamented, “I can’t sing.” I said, “You’re singing, Margaret! You’re singing.” We sang together for 10-15 minutes until she got too tired and drifted back into her semiconscious state. What a moment of joy that was for both of us!
Quality Connections: For someone with Alzheimer’s, a quality connection is not asking a question. “A quality connection means to stop, get down to their eye level, touch their knee, make eye contact and compliment….the person on an attribute that they like about themselves….Replace ‘you were… with ‘You are…’ Remind them who they are and give them their memories back. It takes thirty seconds.”
“Help Me”: If you have children, you remember them wanting to help, but hesitating to let them do a certain task. You probably thought up safer things they could do that made them feel like they were helping. Jolene says, “People need to be needed, no matter what their age or their physical or mental ability.” Then she gives several ideas that your loved one could do to “help.” I laughed when she said, “You can offer the same projects every day because they don’t remember they did it the day before.”
Late Stages: Jolene’s gives this poignant assurance, “Just because someone doesn’t physically or verbally respond, it doesn’t mean they don’t feel your presence. With all my heart, I know they are still in there. So continue talking to them, even if they don’t talk back. Read to them touch their cheek, brush their hair, lotion their feet, and imagine you are simply wrapping them up with your love.” I got the same advice from Dad’s hospice nurse. On his last day with us, we held the phone to his ear and had family from out of town say their goodbyes. When everyone had their turn, I said right in his ear, “You can go now.” He said loud and clear, “So, you made that decision for me!” He was “still in there.” Those were the last words he said. He waited until I went home to go, though.
Jolene’s profound closing message is “People with Alzheimer’s can teach us how to live. [With them] we have an opportunity to be present in each moment, to neither dwell in the past nor worry about the future.”
If you need more time and help to create moments of joy with your loved one, call Dakota Home Care at (701) 663-5373 to arrange for an in-home consultation. Our staff understands all the stages of Alzheimer’s disease and how to create moments of joy with your loved one, even if you aren’t there.
Everyone at Dakota Home Care wishes you a joyous Holiday Season!
Does your elderly loved one need a hearing test? If it’s been more than a year since they had one, the simple answer is “Yes!” However, several factors can make a correct diagnosis of hearing loss and a viable solution difficult to achieve. Still, there are important reasons to try to improve hearing sooner than later.
A Personal Example
In the past six months, my husband (80) and I (76) both had our hearing tested. Both of us were diagnosed with about the same amount of hearing loss that, we were told by a licensed audiologist, could be improved with hearing aids. Because my husband has early-stage Alzheimer’s disease and arthritic fingers, I wanted to try wearing them first, to see if we thought the improvement in my hearing would be worth the struggle he was sure to have with remembering to put them on and do it correctly.
To make maintenance easier, I purchased hearing aids that didn’t require tiny batteries but could be placed in a charger overnight. I was hoping to be able to hear the television without turning the volume up so much that it was irritating to others, and to be able to hear and more easily understand what my soft-spoken husband was saying. I was excited to try the” by-cell-phone” adjustment feature, but I knew that couldn’t be part of his experience, as he is only able to manage a flip phone.
When I started wearing them, I could hear the TV at a much lower volume level. However, hearing and understanding my husband required some adjustments to my hearing aids by the specialist and my husband remembering to enunciate clearly and speak in a deeper voice, as his speech therapist had taught him.
Observing my improvements, my husband decided to go in to be fitted. In spite of his dementia and arthritis, the audiologist assured us that, with consistent use, he would be able to learn how to put them in, and we brought home a pair like mine, minus the phone app. He noticed some surprising improvements: he could hear his own voice better and spoke more clearly as a result. He could also hear his feet sliding on the floor when he shuffled, and thus his walking improved somewhat. Now, we could both hear the TV on the same volume setting.
However, after two weeks of trying, he still can’t put them on correctly. I have to put them on for him, especially if we are in a hurry. That’s frustrating, but we persist, because both of us know that his ability to hear better positively affects his cognition and hopefully will help to keep his hearing and his mental acuity from declining more rapidly.
Why You or Your Loved one?
If you are over the age of 50, experts recommend that you have your hearing checked every 1 – 3 years. Like an annual physical exam, this can be an important habit to develop. Why? Consider these findings:
- There’s a strong correlation between aging and hearing loss. About 14% of people ages 45 to 64 have some degree of hearing loss. That rises to more than 30% in people who are 65 or older. Gender, family history, race, and occupation can also play a role.
- Hearing loss is often a gradual process, so a person might not realize they have trouble hearing.
- Although hearing loss caused by aging can’t be stopped, hearing aids can slow the impairment, and the sooner you get them the more they can help you to hear.
- Hearing loss affects mental state and overall well-being. It has been linked to social isolation and the ability to enjoy life, which can greatly impact health.
- Having trouble hearing can make it hard to understand and follow a doctor’s advice, respond to warnings, and hear phones, doorbells, and smoke alarms.
- Studies have shown that cognitive abilities (including memory and concentration) decline faster in older adults with hearing loss. Treating hearing problems can be important for cognitive health.
- On average, hearing aid users wait ten years before seeking help for their hearing loss. They experience years of inadequate hearing, and they could have difficulty communicating, a sense of isolation, and increased health risks because of it.
Hearing tests can reveal changes in hearing, and preventative measures can be implemented in time to deter some permanent hearing loss. Click this link and scroll down the page to find a simple test that could help tell if you or your loved one has a hearing problem. Answering “yes” to three or more of the questions is a sign that you should see your doctor. Other signs include:
- Having trouble hearing over the telephone
- Finding it hard to follow conversations when two or more people are talking
- Asking people to repeat what they are saying
- Thinking that others mumble
- Having difficulty understanding women and children or hearing tones at the high end of the scale.
Prior to your hearing test, the doctor should check your ear canals for earwax. A buildup of ear wax can affect your hearing – and hence the accuracy of your hearing test results.
Hearing Loss and Dementia
The symptoms of hearing loss can be similar to some of the early signs of dementia. One condition may mask the other. For example, struggling to follow a conversation could be a symptom of either dementia or hearing loss. Sometimes, because they don’t hear well, older people are mistakenly thought to be confused, unresponsive, or uncooperative.
If a person with dementia has hearing loss, it could make a correct diagnosis more difficult. You could assume that there is no point having a hearing test because they might have difficulties following instructions during the assessment. For example, my husband was asked to count from 20 to 30, but he began counting at one. It’s still important to have regular hearing tests that can be adapted for people with dementia, if needed.
Many older people struggle to use hearing aids correctly. It can take time for a person to get used to a hearing aid, and it will take a person with dementia longer. It is also important to consider whether a hearing aid is the best option – an audiologist should be able to give you helpful advice.
When Hearing Aids Don’t Solve the Problem
Your elderly loved one and your family can work together to make living with permanent hearing loss easier. Try doing these things:
- Tell your friends and family about the hearing loss so they will understand and can help.
- Ask people to face the person when they talk. Seeing their lips move and their expressions might make understanding easier.
- Ask people to speak louder, but not shout. Tell them not to talk more slowly, just more clearly.
- Be aware of background noise that can make hearing conversations more difficult. For example, when you go to a restaurant, don’t sit near the kitchen or where music is loudest.
It will take time for your loved one to get used to watching people as they talk and for family and friends to always speak louder and more clearly. Because every situation is different, Dakota Home Care assigns experienced Home Health Aides and nurse managers to assess and provide in-home care for your loved one, as well as support and education for you and your family. We will patiently work together with you and your family to help care for a loved one with hearing loss and other challenges. We will draft and implement an individualized plan for care and wellness. To receive a free consultation, call (701) 663-5373.
Hearing better is worth the effort. To improve and preserve hearing for you and your loved ones as you age, start adding yearly hearing tests to your list of annual medical exams.
The basics about UTIs can be found in one of our first blogs, Health Wise – Urinary Tract Infections in the Elderly. Because UTIs continue to be a very common, serious and frequently undiagnosed illness in the elderly, today’s blog provides additional information about UTIs’ symptoms, causes and prevention.
The most common reason UTIs often go undiagnosed in the elderly is because the symptoms don’t mirror typical symptoms of UTIs. What can be an easy cure (antibiotics) might not be administered, because your first thought could be that your elderly loved one has a much more serious condition, like dementia or other permanent behavioral changes.
The most commonly recognized symptoms of UTIs are frequent urination, burning pain, cloudy urine, a fever and lower back pain. Because many senior citizens’ immune systems have been weakened by time and are not functioning at optimal levels, they have increased susceptibility to any infection. Their bodies do not recognize or try to fight the infection; thus, no fever, but producing symptoms that can be very different:
- Disorientation, confusion or a delirium-like state
- Hallucinations: hearing or seeing things that aren’t real
- Agitation, depression or other behavioral changes
- Decreased motor skills and/or dizziness that causes frequent falls
Why these symptoms frequently are the result of a UTI in an elderly is something of a mystery. However, as all infections can lead to dehydration which, by itself, can produce these types of symptoms, that may be one reason. Dehydration is common in the elderly for a variety of reasons. If any of these symptoms come on suddenly, an immediate visit to the doctor is called for. Make sure it includes a urine test to determine whether or not a UTI is the cause. A urine test can also help to determine the type of bacteria that is causing the infection and which antibiotic will be the most effective way to treat it.
Anything that introduces bacteria into the urinary tract or blocks the flow of urine and causes urine to stay in the bladder is very likely to cause a UTI. Eighty five percent of all UTI infections are caused by E. coli bacteria. If not treated quickly, it can travel to the bloodstream causing Sepsis, a life-threatening condition. Older individuals are more vulnerable to UTIs for several reasons:
- Not communicating or even recognizing symptoms of illness
- Decreased personal hygiene, such as wearing soiled or disposable underwear too long, or a woman wiping back-to-front
- Urine staying in the bladder for a longer than normal period of time, which can be caused by:
- Lowering fluid intake to avoid the embarrassment of bladder control issues, leading to less frequent urination and a pool of urine being held in the bladder
- A weakening of the muscles of the bladder and pelvic floor, or a prolapsed bladder, causing an elderly person to retain urine longer and to experience incontinence
- Ailments that make it harder to pass urine: diabetes, kidney infections, kidney stones, enlarged prostate
In addition to slowing the process of urinating, diabetes raises glucose in the urine, which also increases the likelihood of a UTI. The inability to urinate properly can necessitate a catheter, which may be difficult for a non-professional to keep sanitary.
Focusing on how to keep an elderly person’s bladder healthy can help to avoid a very troubling illness. Here are some tips you may not have thought of:
- Keep to a schedule, setting an alarm to remind the person or caregiver every 3 – 4 hours that it’s time to urinate.
- Make sure the person wears and frequently changes loose, cotton or disposable underwear and loose fitting clothes that allow air to keep the area dry.
- Women should wipe from front to back especially after a bowel movement.
- Encourage your loved one to drink enough fluids. Water is the best fluid for bladder health. Ask your healthcare provider how much water is healthy for your loved one. Limit alcohol and caffeine.
- Take enough time to fully empty the bladder when urinating.In an elderly person, urine might not come in a steady stream but in several shorter ones.
- Help the person to be in a relaxed position while urinating.Relaxing the muscles around the bladder will make it easier to empty it. For both women and men, sitting on the toilet seat may make it easier to relax.
- You can keep home test strips for UTIs (available at most drugstores) on hand in case your loved ones suddenly begin showing physical or behavioral symptoms. However, over-the-counter tests are not completely reliable. A urine culture performed by a laboratory is necessary to determine the strain of bacteria that is causing the infection and the appropriate antibiotic that must be prescribed to treat it. In cases where infection is recurrent, doctors may prescribe regular preventative doses of broad-spectrum antibiotics.
As people age, they can lose certain self-care abilities that we all might take for granted. A family caregiver or a home care professional can be very helpful, because better health is often the result of better care. Dakota Home Care provides medical and non-medical services that can help you care for your loved one. Because every situation is different, we assign experienced Home Health Aides and nurse managers to assess and provide in-home care for our clients as well as support and education for their families. We work with you and your healthcare team to draft and implement an individualized plan for care and wellness. To receive a free consultation, call (701) 663-5373.
If you live an hour or more away from your aging loved one who needs help, you can probably consider yourself a long-distance caregiver. Even though distance makes it more difficult for you to participate in your loved one’s care, there are resources and tips that can help to make it easier. Even if there is a family member or other caregiver nearby, or your loved one lives in a care facility, there are many things you can do to provide emotional support and even help with care needs via the phone, email or during infrequent visits.
What can I do?
Too often, family members who live out-of-town assume there is nothing they can do to help, leaving a close-by caregiver to feel overburdened and alone. Because this person might not know what they could delegate to you, taking the initiative yourself and volunteering to do things you know you could do can be a big relief. For example, I have a not-so-nearby sister-in-law who volunteered to make regular visits to Dad in his assisted living apartment, assess his needs for personal products, favorite snacks, medical supplies, comfortable pants and other things she could shop for and bring to him. Not having to worry about whether or not he had enough incontinence products, as well as these other things on hand was a huge help to me.
Here are some ideas to get you thinking about what you could do to help, even from a distance:
Ask How You Can Be Most Helpful
Be sensitive to the feelings of any caregivers already on the job. Compliment them on what they are already doing, and then ask them and the care recipient how you can be most helpful. Talk to friends and neighbors who know your loved one to see if they have suggestions about ways to help. Then, if you see or hear about needs that aren’t being met, make suggestions for ways you could fill them, even if only to make the primary caregiver’s life easier.
Research and Identify Services in the Community
Searching online is a good way to quickly find reputable resources that will be there when you can’t. Here are a few potentially helpful places to look:
- Your local Alzheimer’s Association via 800.272.3900 or their online Community Resource Finder.
- Eldercare Locator, 800-677-1116
- National Institute on Aging website
- Family Care Navigator
- Your state government’s website
- Your local senior centers
- Learn about geriatric care managers
- Learn more about long-distance caregiving
Serve as an Information Coordinator
Having one person in the family responsible for sharing information with everyone can be a big help. This could be done by way of mass emails, texts, conference calls, Skype or other information channels. If you are that person, you should:
- Keep a list online or put together a notebook of all contact information for family members, friends and the healthcare team. Include all the vital information about medical care, social services, financial issues, and so on. Make copies for other caregivers, and keep it up-to-date.
- Provide regular updates on your loved ones condition, as well as current healthcare needs
- Report on the findings of doctor visits and medication changes
- Research health problems or medicines to help other family members make arrangements to meet new needs
- Share what you’ve learned about available resources
- Clarify and share information on insurance benefits and claims
Coordinate Care and Services
As part of your job as Information Coordinator, you could keep track of when medical appointments are due, make a call to schedule them and even arrange for transportation to and from the doctor’s office. If the person has memory or cognitive issues, you could arrange for a neighbor or family member to be there to ask questions and take notes. Be sure to get permission/sign a release form allowing the Dr. and other members of the healthcare team to share results with you or other family members.
If other services are needed on a regular basis, you could call to arrange for and follow up on those, too. Meals on wheels, laundry service, transportation to events, help with chores and errands, yard work and even personal care can be arranged through local services. See the Dakota Home Care Website for services we offer and how to arrange for an in-home evaluation.
Make the Most of Your Visits
If you can make only infrequent visits to your love one’s home, it’s a good idea to make a list of care needs you should reassess every time you are there. Become well acquainted with their living situation and healthcare needs so that you will notice any changes that have occurred and what you might do to help. Here are some examples:
- Is there food in the refrigerator? Is it spoiled? Is the person eating regular meals? Could you arrange for groceries or meals to be delivered?
- Are there piles of unopened mail? Are the bills being paid? Could you pay the bills and take care of other financial needs if mail was forwarded to your home?
- Are there changes to personal appearance and grooming? Could you arrange for in-home care?
- How are family caregivers doing who live nearby? Do they have the information and support they need? Could you give them some respite care while you are there or arrange for other breaks?
- Do additional safety precautions need to be taken in the home? Could you schedule and oversee anything you can’t do yourself?
- Is your loved one still participating in meaningful activities and social interaction? Could you arrange for nearby neighbors, friends or family members to ensure this is still happening?
- While you are together, take time to reconnect by talking, listening to music, going for a walk or participating in activities you enjoy together.
Be kind to yourself. Living out of town does not mean you aren’t involved or that you don’t care. Get support by connecting with others who are long-distance caregivers through the Alzheimer’s online community, your church, community organizations and a network of friends, neighbors and family members.
Dakota Home Care Services
The goal of Dakota Home Care is to “Keep home an option for everyone!” We provide medical and non-medical services that can help you care for your loved one, whether you live nearby or miles away. Every situation is different. Dakota Home Care assigns experienced Home Health Aides and nurse managers to assess and provide in-home care for their clients as well as support and education for their families. We work with you and your healthcare team to draft and implement an individualized plan of care. To receive a free consultation, call (701) 663-5373.