Even though the Seniors’ Choice Home Management registration does not allow us to provide transfers or lifting, there is a way we can help a client who has fallen under some circumstances.  This method may be helpful for family caregivers too.  It is especially helpful to prevent back injury to the family caregiver.

If you are with your loved one and sense he/she is going to fall, do whatever you can to protect his/her head and ease the person gently down to the floor.

• After a fall, do not move the person until you are certain there are no injuries.
• If your loved one  lives in a nursing home, assisted living setting, or senior apartment building that has an emergency call system, pull the cord or push the button for staff assistance.
• If there is any indication of emergency help needed (difficulty breathing, non-responsiveness, severe pain, excessive bleeding, etc.,) call 911.
• If you are concerned about whether or not an ambulance is needed, but there doesn’t appear to be an emergency, make the person as comfortable as possible and wait for a few minutes.
• Most people want to be helped up immediately.  If you think the person is not injured, have him/her stay where she is and do the following before starting to help him/her up:

1. Ask again, “Do you hurt anywhere?”  Ask especially about head, neck and back pain.
2. If no pain, have the person move each arm and leg.
3. If no pain, ask person if she/he could help him or herself up if you bring a chair

If, yes, bring a sturdy kitchen-type chair close to the person.  Have him/her roll onto stomach and then slowly get up on hands and knees.  You may provide support for balance.  Steady chair and have him/her put hands first on rung s of chair, then on seat, and slowly pull self up.  Steady client with hand for balance and have him/her turn and sit on chair.  Let client sit for a time and rest before trying to walk.  Then give a hand for balance and help client to a more comfortable place.

The Mayo Clinic defines “sundowning” as a state of confusion at the end of the day and into the night.  Sundowning isn’t a disease, but a symptom that often occurs in people with dementia, such as Alzheimer’s disease.  The cause is not known.  It typically peaks in the middle stages, then diminishes as the disease progresses.

There are some factors that may aggravate sundowning.  They include:

• End of day exhaustion (physical and mental)
• Low lighting
• Increased shadows
• Disruption of the body’s “internal clock”
• Sundowning often occurs a the time of day when there have been significant changes–coming home from work, kids coming home from school, making dinner, shift changes at assisted livings or skilled nursing facilities.

There are some things you can try  to reduce the agitation and increased activity that are a part of this syndrome:

• During the morning and afternoon hours, avoid foods containing sugar or caffeine

• Weather permitting; spend some time (15 minutes) outdoors in the sunlight during the day (remember to use appropriate protection–sunscreen, a hat, sunglasses)
• In the afternoon, a short nap or a period of quiet time might reduce sundowning (avoid napping if sleeplessness is a problem at night)
• Anticipate the sundowning and increase the light level prior to the time it usually starts
• Try some quiet soothing music for 45 minutes before the time the sundowning usually begins
• Make certain physical comforts are met; hunger, feeling to cold or too hot, or other discomforts can increase agitation
• Avoid arguing or asking for explanations

During a period of sundowning, the person you are caring for may be upset and agitated, but they may have no idea why they have those feelings, and the confusion only adds to the agitation.  The best thing you can do is simply stay calm and offer understanding.

Retrogenesis is a theory that suggests that the brain of a person with Alzheimer’s disease deteriorates in the reverse order that the brain developed from birth.   Part of the theory identifies particular stages, each one accompanied by predictable cognitive and functional levels.  For example, the cognitive and functional level of a person in the early stage starts out at about 11 years of age and over four to five years deteriorates to four years of age.  The middle stage, when most of the difficult behaviors occur, starts with a cognitive and functional level of four years of ages and deteriorates to two years, when the need for 24-hour care may be needed.   During the third and last stage the person can deteriorate to the functional level of a newborn.

This comparison to developmental stages in children is useful as a way of understanding the disease process, but it is imperative that caregivers always remember that the person is an adult and must be treated with the dignity he/she deserves and with the respect and consideration due a mature adult who has experienced all that life has given him/her.

Verna Benner Carson, Ph.D., in her article “Alzheimer’s Disease:  A Virtual Tsunami for Country—An Amazing Opportunity for Home Care” in a recent issue of Caring, Vol. XXX, No. 2, says, “A paid caregiver who is knowledgeable regarding the use of strategies to manage a broad range of challenging behaviors—agitation and aggression, resistance to care, wandering, and sexually inappropriate comments or advances, to name a few—will be worth his or her weight in gold to the family.”

I’ve always been impressed with nurses who work in faith communities; they seem to have a commitment and a gentleness about them.  I’ve attended a couple of their educational sessions and find the topics interesting, the speakers well-prepared, and the questions asked and answered of value.

This workshop dealt with assessing client needs, but the difference I noted was that the recommendations and discussions seemed to emphasize paying attention to the strengths and resources of the patient and the family as well as the needs the nurse noted.   I liked that.  We so often look at only what is lacking and overlook what all the persons involved have to make use of.  For instance, once when I was working in a nursing home I learned from a family member that one of our patients had once been an accomplished piano player.  Her daughter was quick to point out to me that now, with her disabling dementia, she no longer played.  One day shortly after that when we were alone together in the community room, I asked the woman if she’d just like to sit with me at the piano for a while.  When I started to play a simple tune with one hand, she put her right hand on the keyboard and began to play a few notes.  I asked her if she knew “Mary Had a Little Lamb?”  She looked at me for a minute and then played the melody with her right hand.  I asked if I could play with her, moved to her left and played a simple accompaniment with her melody.  When we finished, she smiled and clapped.   Over the next few months, we played lots of simple tunes together.  I told the activity staff about it and some of them spent some time with her doing as I did

One of the things I thought about after the workshop was, What is the role of family members during the Faith Community nurse visit?  How can family members add to the value?  One thing that occurred to me is to understand that your faith community can be a great help for you as you care for your loved one.  So be open and honest about what your needs are.  What are the issues that are making care giving more of a burden for you than it needs to be?  Do you have a club or social group that you are missing?  Would some respite care make it possible for you to get out and take a break?  What do you know about your loved one’s life before memory loss that would indicate a strength or an interest that one might draw on (and maybe modify in some way to meet his or her present abilities)  to help the days be more enjoyable?

Do find out what your church or synagogue is offering in the way of help.  There may be a valuable help available to you that’s free and just down the street.

[I was sent this information in a newsletter from attorney, Tim Davis.  He kindly granted me permission to reprint it.  I hope you never are in a situation where you have to use it, but if you do...Marilyn]

The news is full of elder abuse horror stories.  Many are so common they’ve become archetypes.

We’ve all heard stories of a grandmother who was swindled out of thousands of dollars for home repairs that were never made.  Sometimes, the culprit is a family member.  Ever hear of an aging parent whose life savings disappeared thanks to a gambling or drug addicted adult child?

The elderly are particularly vulnerable to scams or to financial abuse.  This can be very difficult to detect, but there are warning signs to watch for to help protect your clients and their families.

What to Watch Out For

The following are several key warning signs that can indicate if an elderly loved one is a victim of financial abuse:

• The disappearance of valuable objects jewelry, antiques, artwork, etc.)

• Withdrawals of large sums of money, checks made out to cash, or low bank balances

• A  new “best friend,” or isolation from other friends and family

• Large credit card transactions

• Signatures on checks appear different

• A name added to a bank account, or joint accounts that are newly formed

• Indications of fear of caregivers

What to Do Next

State laws vary, but some have elder abuse statutes and may be able to get restitution for breach of fiduciary issues.

The National Center on Elder Abuse offers guidance on how to investigate and see justice for elder abuse.  There are state resources as well.

If you suspect someone of being financially abused, there are several actions you can take:

• Report suspected crimes to the local adult protection services unit and prosecutor.

• File a police report

• Explore options at a local probate court if your state has such courts.  (The court can intervene if someone in the family is misusing a power of attorney or role as a guardian or conservator.

• Try to get a temporary restraining order from a court while building your case.

. “Portions of this communication are reprinted with permission from Timothy O. Davis of Hellmuth & Johnson.”

Phone Timothy O. Davis at 952-746-2104.  Email: tdavis@hflawfirm.com, or Susan L. Anderson, Phone:  952-746-2123, Email:  sanderson@hjlawfirm.com

Recently at Seniors’ Choice at Home we received a call from the daughter of a former client.  The client had received services from Seniors’ Choice at Home several years ago.  After we had worked with her for quite a few years, her daughter retired and had more time to spend with Mom.  Now, the client, in her early 90s was wanting someone to spend three afternoons a week with her.

During my assessment visit with her and her daughter, the client asked about the care giver who had been her helper in the past.  I told her that Peggy had retired about two years ago, that sometimes our retirees would tell us they wanted to come back to work, and that I would call Peggy and see how she’s doing.  Maybe she’d be interested in taking just one of the three days.  Of course, I added that I couldn’t promise anything. and also that we had a lot of nice women working for us.

When I returned to the office and relayed the conversation to our owner, he said that he would love to call Peggy.  He said he had been thinking about her lately and wondered how she was doing.  Peg answered the phone when he called, and after a brief  “how have you been” chat, Jim told her about her former client.  She laughed and said she was bored silly  and had been thinking about calling Seniors’ Choice at Home to see if there might be the possibility of any work for her.   Not only did she want to come back to work, but she wanted to take all three days with her old friend.  Peg is in her early 80s.

You can imagine the celebration when Jim called the client and her daughter.  The old phrase, “a good time was had by all” comes to mind.   Jim and I have spent a lot of time grinning about this match “made in heaven.”

Seniors’ Choice at Home is based on the idea of a good relationship between the client and the caregiver.  Not every client is interested in more than the  help with whatever they need–cleaning,  cooking, driving–but when it works, it is a delight for everyone involved!  I love being part of an organization whose business it is to make life better for people.

Check out our website at www.seniorschoicemn or call us in the Twin Cities at 763-546-1599.

In the past week, I have made two home visits to prospective clients of Seniors’ Choice at Home, a non-medical home care service with the goals of:  1) helping seniors stay where they are longer with some practical help; and 2) providing some backup for adult children or other helpers as they try to balance the busyness of their own lives with the help their elderly parents/neighbors/friends need.  In both cases, the elder refused the help because they viewed themselves as OK.  In both cases, the nurse will probably need to involve Adult Protection because of the vulnerable state of the elders and because there is a mandatory reporting law in our state.

It is so common for us as adult children to find ourselves in denial about the reality of a parent’s condition.  No matter how mature and responsible we are, there is still that mystique around our parents being our parents.   It’s even more difficult for adult children who live across the country from  parents.  Sometimes when returning for a visit after a few months, the changes are obvious, but then it’s tempting to chalk it up to “a bad day.”   We want so badly to allow our parents their independence, to respect their right to make decisions about how they live their lives.

David Solie, M.S., P.A., in his book How to Say it to Seniors talks about what he believes is most important to older adults–the ability to be in control of one’s own life.  I agree with him up to a point.  When the decision or change the elder needs to make isn’t a matter of life or death, or when the person is of “sound mind,” it’s wonderful to be able to allow the elder to make the decision.  “Mom, I know this is difficult for you, but you are in charge of your life, you are in control, you can decide what you want to do.”   However, if your mom is lying on the ground struggling for breath, you don’t ask her if she wants you to call an ambulance.

With Alzheimer’s disease and other dementias, parts of the brain are destroyed and no longer function in the way the did in the past.  At autopsy, a diseased brain has lost as much as one third of its normal weight.  There are actually large spaces in the brain where cells have died.  The brain has had a “heart attack” and the person is gasping to think.

When an elder has significant cognitive impairment, when the doctor, the visiting nurse, and/or the neighbors  have serious concerns  about a parent’s safety, it’s time for the adult children to step in and make the recommended changes.   It’s probably one of the most difficult things for an adult child to do.

Recently, a friend of mine has spent some time in a skilled rehab facility after knee replacement surgery.  Unfortunately, her time there has not been the best.  She’s had long waiting times for ice for her knee (more than 1 1/2 hours,) she was left in the hallway when the aide who was walking with her took a personal call on her cell phone, she was having hallucinations from pain medication, and was scared in the middle of the night when a nurse wearing a black hoodie approached her.  A friend of mine who is a care coordinator wrote the following on facilities and expectations:

‘As a Care Coordinator assisting families find appropriate care and            housing for their loved ones I am frequently in the position of recommending a great variety of resources. When clients ask “What is the ‘best’ facility in my community?”, I have a conversation that I like to call “The Myth of the Perfect Facility.” I tell families seeking housing that there are no perfect facilities. I will go so far as to say that there are no “best” facilities. There is the facility, whether that is assisted living, residential care home, nursing home or continuing care retirement community that will meet your loved ones needs, that is affordable and that is in an appropriate location for the family. Some are certainly “better” than others; but, is there a “best”? No, surprisingly, there is not a best. I like to have this conversation again after family tours facilities and gets back to me waxing euphoric about the one place they loved. I remind them that problematic, difficult, unfortunate things, bad things, can happen at the “best” facilities. What differentiates facilities is how they react to those problematic situations. A good facility will listen without becoming defensive. A good facility will respond to family and resident concerns, big or small, with compassion and an action plan. A good facility will follow up with the resident and family and make sure they are satisfied. A good facility grows and changes as they learn from and with their care partners: the families of their Residents.’

Joyce M. Konczyk, LSW

Life Care Coordinator Maser & Amundson, P.A. 952-925-4147 jkonczyk@maserlaw.com

Disclaimer: This has been prepared for general information purposes only. This is information not legal advice. Legal advice is dependent upon the specific circumstances of each situation. The information contained in this presentation should not replace the advice of competent legal counsel licensed in your state.

There is a lot of information about how to care for someone with Alzheimer’s disease, but what do you do if you are worried about changes in your loved one and you are concerned about what’s going on.

Alzheimer’s disease is a brain disease that slowly, but progressively, will erase from my memory everything that I have learned.

It can affect my behavior, my understanding of where I am or who you are, and my ability to understand what is being said to me as well as my ability to tell people what I need, or what is on my mind.  As the disease progresses, I will lose the ability to make safe choices for myself, to plan out my day, to learn new skills, and to understand the challenges that my disease has on those closest to me.  I cannot remember what just happened, even 5 minutes ago, and I often lose the ability to control what I say or how I act.

From “Give Me This Day,” an Alzheimer’s primer by Cheryl Biel, RN

Seniors’ Choice care givers in Minnesota are especially gifted.  They help clients who have significant memory loss with love, patience and creativity.  To learn more about Seniors’ Choice at Home, call us in the twin cities metro area at 763-546-1599, or check out our website:  www.seniorschoicemn.com