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Saturday, July 24, 2010

Mom/Dad Seem to Make Sense... But...

Sometimes Dementia can be very difficult to pin down. It can actually be a "moving target." It can be worse one day a much better the next. If the loved one was highly intelligent before developing dementia, they can finesse it [or cover up] for quite some time. Also, no matter how severe a person's dementia is, that person can pull themselves together and behave perfectly normal for a short period of time. That's why it is sometimes so difficult to convince the doctor or other medical professionals that there is a problem.

Please remember: Anyone who is developing dementia is terrified. One of the unique features of the brain is that while it can immediately tell you of pain elsewhere in your body, it only has a vague awareness that something might be wrong with the brain itself. Most people who have dementia are either totally unaware or only have only a vague awareness that something is wrong.

What does dementia do? In the mild to moderate stages it starts stripping away at social skills. Your loved one may occasionally do or say something totally [seamingly] out of character. What had been personality "quirks" become magnified.

If they were very structured in their routine throughout their life, you might find that they become even more structured. Someone who might have been a detailed person may lose their ability to organize or recognize what are important papers, garbage, etc., so they throw away nothing and will not allow anyone else to throw it away. Sometimes they might spend copious amounts of time going through papers trying to make sense out of them. Even if they ask someone else to tell them what the paper(s) is about, they don't really believe it.

Frequently, the ability to write checks and track money is one of the first signs that the dementia is becoming problematic. Bills may start being paid late or not at all. When you try to discuss a possible solution you are met with agitation and defensiveness.

Over time, your loved one may lose the ability to plan and prepare even simple meals; forget how to use the washer and dryer; lose the ability to clean their home; wear the same clothes for weeks on end; be unable to manage their medication or quit taking their medication altogether.

The worst part is when your loved ones deny they need assistance.

What you can do:
  1. Keep a journal. This can be very helpful to the medical professionals whether your loved one is seeing a doctor or not. It will also help you to identify patterns of behavior.

  2. Encourage your loved ones to get their estate planning papers done if they have not already done so. These include Powers of Attorney (Durable Financial and Healthcare), Healthcare Directive and Will. A Power of Attorney document will allow the designated person to intervene, indirectly if necessary, to ensure important bills and other paperwork continued to be addressed in a timely manner.

  3. Avoid pointing out the problem areas. Nobody likes to be reminded of their shortcomings, especially by their children. Humbly suggest solutions and try to let all but the most concerning problems slide.

  4. Introduce caregivers as "friends" and not "caregivers." This allows your loved one to save face and keep their dignity at a time when their dignity is feeling pretty shredded. This is easier to do when the person designated as power of attorney can set up the caregivers without the loved one's knowledge.

  5. Get the billing addresses changed to the designated power of attorney. This is especially effective if the loved one also has memory problems. What is out of sight is truly out of mind. Do it in slow increments. Have the bank statement addresses changed first and see what happens. If the loved one doesn't miss them, then the designated power of attorney can access the loved one's money to pay the bills. If the loved one does miss the bank statement, then feign an "oops" and change the address back.

  6. Emphasize that you want your loved one(s) to stay as independent as they want for as long as they want. Point out what they are still doing well. Minimize [to your loved one] the problem areas. Ask what they would like you to do to assist and how they would like you to do it.

  7. If you keep running into resistance from your loved one, get a professional consultation from a care manager or someone who specializes in behavior modification.

  8. Remember: You cannot force your loved one out of their home without a court order. If your loved one continues to stay at home and is unsafe, you might need to use some "tough love." That means not rescuing them when they get themselves in a bind and call you for assistance. You will want to plan your "tough love" strategy. Part of this strategy could be calling local law enforcement to do a "wellness check" on your loved one and/or calling Adult Protective Services for their intervention. As a last resort, if nothing seems to work and there are safety issues or extreme self-neglect, you may need to discuss initiating a petition of guardianship for your loved one with an attorney.

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