Signs it Might be Time to Consider Assisted Living

In a ‘perfect’, healthy world, everyone would live out their lives independently in their own homes. But in the ‘real’ world this is rarely possible for a growing population of aging seniors. A number of things are impacting the rise in elderly moving into assisted living; we are living longer, adult children often do not live close by to help, and the epidemic rise in dementia and Alzheimer’s in our senior population.

How can you tell if it’s time to consider discussing with your parents that they need to look at assisted living? Here is a short list of warning signs to be watchful of:

• Performing daily tasks has become difficult. Are they starting to wear the same clothes multiple days in a row? Are they no longer bathing or showering regularly? Have you noticed weight loss and suspect they are skipping meals or not eating well? Have they stopped keeping the housework up? Are they spending time in only a few rooms of the home?

• Forgetfulness. Are they repeating the same story and asking the same questions over and over? Do they call you on the phone repeatedly, asking the same questions? Do they sometimes struggle to find the right word in a conversation – or use a completely inappropriate word? Do they have a hard time following simple direction? Have they wandered away from home, and don’t seem to know where they are – or where they were going? Are they too trustful of strangers and vulnerable to scams and elder abuse? Are they forgetting to do routine activities – like bill paying? Are there signs (scorched pans and the smell of smoke) they have forgotten to turn off the stove – or have left something cooking unattended?

• Medication mismanagement. Are they forgetting to take their medications, and/or ‘doubling up’ on them once they realize they forgot? If their medications need to be taken at certain times of the day and under certain circumstances – are they following dosing directions? Are they forgetting to get needed medication refills in a timely manner and often have medication gaps? Do they have expired medications in the home?

• Isolation. Are they losing touch with their friends and losing interest in favorite activities? Have they recently lost a spouse or friends? Are they showing signs of depression, such as sadness, crying and general lack of enthusiasm for life? Are their sleeping patterns disrupted? Are they becoming moody?

• Fear of environment. Are they becoming increasingly fearful of the safety of their own neighborhood? Are they starting to become paranoid and fearful of other people? Are they becoming increasingly afraid to be alone at night and are more dependent upon family members?

• Personal safety. Are uneven floor surfaces and stairs a safety concern for falling in the home? Is there anyone in the home in the event of a fall, or if a medical emergency arises? Is it difficult for them to get in and out of the tub, or off the toilet by themselves? Is there a lot of ‘stuff’ around the home that could cause a tripping hazard?

If it’s possible for a family member to move in and help manage the care and daily activities of an aging parent, staying at home could be an option. If ‘fall risks’ and memory issues are involved, those conditions tend to worsen with time, and managing staying in the home will likely no longer be an option.

If you are considering assisted living as an option, start doing your homework to see what is available in your area. Speak to an Elder Law attorney (very different than an Estate Planner) about ‘next steps’ – such as Power of Attorney (medical and financial), how to pay for assisted living, and how to cut through red tape if your parent qualifies for financial assistance and benefits. 

Don’t ignore the signs your aging parent is in trouble, or engage in ‘magical thinking’ that mom or dad is just ‘having a bad day.’ Taking action, putting plans and safeguards in place, and helping them consider a move to assisted living is the loving choice.

If you have questions, or would like to learn more about assisted living, contact Jenny Andrews at 269.969.4000.

Understanding Alzheimer’s Agitation & Aggressive Behaviors

Why do Alzheimer’s patients become aggressive and sometimes violent?: As the disease of Alzheimer’s progresses, it destroys more and more portions of the brain that store short-term memories, the ability to retrieve information, names and words – and starts to impact speech, balance, and normal bodily functions. In addition all the ‘firewalls’ and mental ‘stop gates’ that help us filter and temper our emotional reactions to external stimulus are rapidly dying and no longer do their job. Growing feelings of confusion and paranoia trigger the ‘fight or flight’ reflex in even the most neutral situations. When this happens the person with Alzheimer’s will often react to their environment in an increasingly explosive and violent way – and sometimes with tragic results. At this stage of the disease families often realize they are no longer able to safely care for their loved one at home, and start to look for placement in a specialized memory care facility.

Treatment for Alzheimer’s aggression: For families still caregiving in the home, you need to evaluate the environment and remove anything that (in an unexpected rage or outburst) can be used as a weapon. This includes removal of firearms in the home, and items such as knives and scissors. Even then, it’s not unheard of for the aggression to become physical, and include grabbing, hitting and shoving. Remember: This is the disease doing this, and has nothing to do with true feelings of the person suffering with Alzheimer’s. Stories of caregivers being pushed out of the home, and locked out by the patient are common, along with grabbing and shoving. 

Consider seeking the help of a  Gerio-psychiatrist for a complete physical and mental evaluation.  A Gerio-psychiatrist may prescribe medication that could help to de-escalate the violent behaviors for a while. Constant adjustments will need to be made as the disease state progresses, and to evaluate how the person with Alzheimer’s is responding to new medications. Every person with Alzheimer’s is different, and every medication acts differently in each person. 

Another important medical evaluation that should be made is to check to see if the person with Alzheimer’s has a urinary tract infection, or UTI. UTIs in seniors are fairly common as they try to ‘control’ incontinence issues by withholding fluids – or simply forgetting to drink enough water. An UTI in an elderly person is different (symptom-wise) than in a younger person, and often the first indication that the person is suffering from an infection is a change in behavior that is often delusional and aggressive. It’s important for your medical provider to rule that out.

Pain is a big trigger for aggression in people suffering from Alzheimer’s. Common undetected infections (along with UTIs) are sinus, inner ear and tooth pain. People suffering from Alzheimer’s often cannot communicate they are in pain, and becoming angry and aggressive is an outlet for their frustration. Always have your health care provider eliminate the chance there is an underlying medical reason for the behavior changes.

Strategies for dealing with Alzheimer’s agitation and aggression:

• Reassure the person. Speak calmly.

• Distract the person with a favorite snack, object, or activity.

• Build quiet times into the day.

• Know what the triggers are.

• Use calm, logic and compassionate reason. 

• Validate their feelings.

• Stick to a regular routine.

• Reduce noise, clutter, or the number of people in the room.

• Ignore the angry behavior – if distraction and support do not work. 

• Maintain a sense of humor.

• Understand there will be ups and downs.

• Try gentle touching, soothing music, reading, or walks

• Debrief after an incident and identify what caused it.

• Remember that this phase will pass.

• If you have to, stay at a safe distance from the person until the behavior stops. Also try to protect the person from hurting himself or herself.

Ask for help: The Alzheimer’s Association has a free 24/7 Hotline manned by a trained and experienced person who can answer any question, coach you through your situation, and help you find local resources and help. 

“The saddest goodbye.” A beautiful, insightful cartoon by Tony Husband

“The saddest goodbye.’ is an extraordinary ‘cartoon’ series illustrated and written by Tony Husband from England. It’s about the long journey of losing his father, Ron, to vascular dementia – very similar to Alzheimer’s (another form of dementia). It’s right spot-on. If you are trying to understand this horrible disease, or if you are on that journey with a loved one now – worth a look, and a possible ‘share.’  http://www.dailymail.co.uk/health/article-2623800/The-saddest-goodbye-Endless-words-written-dementia-But-ANY-match-poignancy-cartoonist-Tony-Husbands-account-watching-steal-away-father.html