Monday, April 4, 2011

Creating Balance in Your Sandwich... How to Avoid Doing the Wrong Things

The sale is over... and the final clean-up has begun.  I have to box up what did not sell and get it ready for the local thrift store... and then meet a driver who will come to collect the items.  That should finish my portion of the business with regard to Mam-ma's house and belongings.  Lest anyone think that this frees me of any responsibilities, there are still monthly bills to be paid... so that involves a checking account... and almost daily phone calls from my grandmother with something she needs... forgot... doesn't like... or has just remembered.

There are still "wrinkles" to smooth - like a mix-up with the pharmacy used by the ALF and over billing... and a few other little things... but nothing major.  This morning our power went out during a thunderstorm and was off for two hours.  I was so thankful that my grandmother was in a place where someone could attend to her and handle such matters... and I wasn't worried about her... or the contents of her freezer melting, and other problems.

Last week, I attended my first "Family Council" meeting at the ALF one afternoon.  The meeting ended up lasting two hours... but it was time well spent.  The speaker was an R.N. who is affiliated with Hospice, and the focus of her presentation was on Hospice care for Alzheimer's patients.  However, the information was appropriate for anyone caring for an elderly person... particularly those with dementia or the onset of dementia.

I learned several things about Alzheimer's patients that I did not know... how they often become obsessed with sorting, and many of them spend hours every day sorting their clothing, packing, and making little piles of their belongings.  The nurse and the ALF administrator said the biggest hurdle with some of these obsessive behaviors is getting the caregivers and family members of these residents to "let it go" and be okay with the disarray in the room and the annoying behaviors.  Another common thing is dressing in multiples... wearing more than one shirt and/or pair of pants.  It doesn't hurt the patients, but it makes some caregivers and family members nuts!  And learning to let this be okay is vital to the mental health of all parties!

I also learned that, even with my grandmother, when we are at the ALF, we must operate in their world.  If my grandmother is focused on something she views as a problem... like what happened to all of her stuff... it's my job to gently change the subject and redirect the focus.  The administrator said that one day she entered the room of an Alzheimer's patient who was packing, and the patient said, "I'm going home today."  She replied, "Great!  Come have dinner with us first - before you leave."  By the time the resident ate, he/she had forgotten about the move.  If I can learn to avoid conflict and argument with my grandmother and gently redirect the conversations when they become argumentative or controversial... then leave it at the door... we will both be happier!

I relayed some of what I learned to my mother, and she said, "Yes, I did it all wrong with my mother."  And while I'm not sure that is totally true, she did argue with my grandmother a lot.  When Grandmother saw my grandfather (who had been dead for years) in the dining hall "with another woman," and Grandmother insisted she had read about their liaisons in the local newspaper, she shouted, "I will not have this!"  And my mother insisted that she was NOT seeing Grand-dad... and that this was totally ridiculous. They argued about this for months. My grandmother had Parkinson's disease... which produces a dementia similar to Alzheimer's.  She thought her baby doll was real... and she called my niece Samantha to almost her dying day.  My niece's name is Jasmine.  There were dozens of these little quirks... and admittedly my grandmother was always quirky... but they escalated as she declined... and we did not handle them well much of the time.

Had we learned to redirect the conversations more and steer Grandmother to more pleasant and less confrontational topics, we might have had happier visits quite often.  There's more to this story, but every little "tool" helps to create a happier environment, so I was glad to gain a few strategies from my meeting... and I hope they will help others. 

Toward this end, here are a few other suggestions that were presented in a hand-out we were given from the National Caregiving Foundation.  I have selected a few that I feel apply to any elderly person - not just those with Alzheimer's.
  • Your care-recipient will be upset about what the future holds. He needs to be reassured that the family will see that he is cared for. He needs to continue to feel that he is a valued family member.
  • Be very vigilant about keeping him as involved as possible in the family's activities and decision-making; this will help him to cope with his own anxiety. 
  • Don't talk about his memory loss in front of him and certainly not as though he is not there; such behavior on your part, can be very upsetting and demeaning for him. 
  • Don't allow him to become withdrawn because he can't remember short term events and conversation very well.
  • Don't be demanding about normal daily activities. An example is letting him dress himself even though it takes time. Be patient; not critical. You can assist him by setting his clothes out in the order of putting on.
  • He will almost certainly still be able to manage simple chores which do not tax his memory, so involve him; it will help him to maintain his dignity.
  • If he tends to get lost when he goes on errands put his name and address in his wallet to make him feel more secure.
  • In the event that he forgets the names of people he knows well, prompt him discreetly, to help him save face.
  • Don't confront him with complex, challenging decisions or questions; if you do, you will almost certainly add to his confusion.
The website for the National Caregiving Foundation offers lots of good information and support.  I encourage you to check them out for yourself by visiting the website.  And remember... it's all about balance.  Last week, in the middle of all of the chaos of the sale and getting things in order, I took an afternoon off to hike six miles with my husband and share a picnic lunch on a sunny spring day.  A few days later, I set aside everything to spend the entire day playing with our little Timothy... hiding Easter eggs, reading books, working puzzles, singing and dancing, and appreciating the wonders and excitement of a 2-year-old's world.  

Thinking about that time made the hectic days that followed so much more manageable.  I hope you are finding ways to create balance in your "sandwich!"

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