Anyone caring for a loved one with Alzheimer’s knows that angry, aggressive outbursts are one of the disease’s greatest challenges. Often, caregivers think in terms of managing these episodes once they occur. How can I redirect their attention elsewhere? Is there medication mom or dad can take? These solutions can be helpful, but it’s even more effective to find the cause of the outburst, in order to prevent such incidents before they even occur.
There are five common reasons why someone with Alzheimer’s disease may become upset. The problem could be one specific thing, or a combination of factors.
Their Surroundings: Is there something about the environment that’s making your loved one uncomfortable? Are they too hot? Is there some noise that’s bothering them? Are there too many people around? Frustration with being unable to control what’s happening or even communicate that they have a problem with it may make them upset.
Physical Difficulties: Your loved one’s agitation may be caused by some kind of a physical impairment. Check to see what might be wrong. Is there some kind of irritation or pain that’s bothering them? Are they having digestive problems or are they tired? These kind of problems may cause your loved one to lash out with a tantrum.
Psychological Issues: It’s common for Alzheimer’s patients to develop mental health problems such as depression, anxiety, or delusions. If you suspect this might be the case with your loved one, take them to the doctor. Medication can make an enormous difference in these situations.
Interpersonal Problems: Alzheimer’s patients are very sensitive to the tone you set, and thus are likely to react strongly to feeling rushed, forced, or otherwise rudely treated. Be gentle and calming in your approach and try not to talk down to them. Be alert for your own frustration and do your best to keep it in check. Ask them to do things rather than issue commands.
Disappointed Expectations: Because you know what your loved one used to be capable of, it’s easy for you to ask them to take on a task that might be too difficult for them. When they realize that they are not able to carry out the assignment that you gave them, they’re likely to have an outburst. Be careful to keep in mind what they’re capable of, and remember that rather than learning and growing, as we normally expect from people, they are instead in decline. What was possible a few months ago may no longer be.
If you’re finding that your loved one is frequently aggressive or agitated, consider these root causes when trying to address the problem. If you can prevent such incidents from happening in the first place, you’ll both be better off.
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Mom keeps misplacing her keys and dad needs to ask you the same question three or four times before the answer seems to sink in. Is this the beginning of dementia or just a normal part of the changes that come with aging? Here are 5 signs to watch for to get a sense of whether you should be concerned.
1. Forgetfulness. We can all be forgetful from time to time, but it doesn’t mean we’re developing Alzheimer’s or dementia. It’s normal for mom or dad to forget someone’s name if they don’t see them that often or to misplace the TV remote. The key to knowing whether or not it’s dementia is the severity. Knowing how your loved one usually acts, does the forgetfulness seem unusual? For example, few of us would forget about a conversation that happened just 15 minutes ago. Another thing to keep in mind is that those in the early stages of dementia have trouble with short-term memory. If mom can’t seem to keep new information in her head, that may be a sign.
2. Lack of focus. Does dad forget where he is or is he taking longer to do familiar tasks? That may be a sign of dementia, as is having trouble with time and place in general. Look out for confusion between the past and the present, not understanding how time is passing and being unable to explain how they got somewhere.
3. Misplacing things. Just as with being forgetful, we all sometimes put something down and then lose it. However, a person with dementia will be unable to think back through their day to where they may have lost the object. They may also put things in unusual places: for example, mom’s glasses will turn up in the microwave. Those with dementia are often convinced that they remember where they put something, and may accuse someone of moving or even stealing it.
4. Trouble with everyday tasks. Dementia can result in a person forgetting how to do familiar things. Can mom no longer make her famous lemon meringue pie? Is dad forgetting the rules to bridge? Keep an eye out for your loved one asking someone else to do favorite tasks for him or her.
5. Trouble with words. Dementia patients often cannot think of the correct word to use, even for basic objects like a pair of glasses or a watch. They may use a placeholder instead such as “thingy” or something even stranger such as calling the refrigerator the “cold closet.”
The only person who can really give you a definitive answer about whether your loved one has dementia is their doctor. Dementia patients suffer a range of symptoms, and only a trained professional can make sense of what your loved one is experiencing. So if you
suspect that dementia is the culprit behind new behaviors, talk to your parent about making an appointment together.
With everything going on in December, taxes are the last thing we want to think about. But this is a crucial time if you’re looking to save some money when you send in returns in a few months. You probably already know to make sure you’ve used up your flexible spending account or to contribute to your IRA, but here are a few other things you can do during the year-end crunch.
- Decide whether or not you (or your parents) will itemize deductions. Run the numbers to decide whether you’re better off taking the standard deduction (which is $5,950 for single filers or $11,900 for those who are married filing jointly). If you are going to itemize, look for opportunities to increase the amount of deductions before the year is over, since all deductions will lower your tax bill. For example, if you make a larger-than-usual donation to charity you’ll reap extra benefits. This may motivate you to do a little holiday cleaning, and take unused clothing or furniture to The Salvation Army or Goodwill. These organizations will provide you with a receipt, and you’ll be able to claim the item’s fair value as a deduction.
- Make large gifts now. If you or your parents want to give someone a large cash gift, write the check and make sure it’s cashed before January 1. You can give as much as $13,000 to an individual without being required to pay gift tax.
- Make an extra house payment. Here’s a trick for maximizing your deductions if you’ll be itemizing next year. Make your January mortgage payment early. As long as you mail it by December 31, the payment will qualify for this tax year.
- Review medical expenses. How much have you and your parents paid for medical care out-of-pocket? If your medical expenses are greater than 7.5 percent of your adjusted gross income, you can deduct them on your tax return. If you are close, you may be able to find ways to get care or purchase supplies that will put you over the edge.
- Consider claiming your parent as a dependent. If you pay more than 50% of your parent’s expenses, and their gross income is less than $3,800 (not counting disability payments, tax-exempt income, or Social Security), you can claim them as a dependent. Again, if you’re just shy of qualifying, see if you can make up the gaps in the last few weeks of the year.
There comes a point when you are caring for a loved one, when you have to ask yourself what is the best decision for me as well as for the person I am caring for. Whether you decide to continue to care for your loved one or start to explore other options such as a professional care home, take the time to insure your own personal health and well being. There is a reason that during the safety briefing on a plane they tell you to put your oxygen mask on first, then help your love ones. If you don’t take care of yourself you have no way to care for someone else. “There is a cost to caring,” states Charles Figley, an expert in trauma and researcher in the field of burnout; he comments that compassion fatigue is something that can occur when caring for someone long term. Take a moment to examine how you feel and see if you may be experiencing any level of burnout or even compassion fatigue and then take the time to explore ways to best care for yourself as well as those you love.
Before we go much further, let’s briefly explore the difference between burnout vs. compassion fatigue. Figley describes burnout as the end result of a gradual process of wearing down. It is the long-term consequences of unaddressed compassion fatigue, resulting in emotional exhaustion and a diminished sense of personal accomplishment and achievement. Recovering from burnout is often a more lengthy process.Compassion fatigue is often a result of the daily care we do, and is a more immediate specific response. It is often characterized by emotional and physical exhaustion; symptoms resembling depression; and usually a shift in a person’s sense of hope and optimism about the future value of the care they are offering. This may not be a constant feeling, but it something that comes and goes. The recovery from compassion fatigue is often less lengthy then burnout.
Are you isolating yourself, bottling up your emotions, having nightmares or even physical ailments? Do you suffer from compulsive behaviors such as over eating or over spending or have difficulty concentrating. Do you feel stressed out or depressed? These are symptoms of compassion fatigue. There is no cure for compassion fatigue but by practicing good self care techniques daily can help you to be physically and emotionally healthy and decrease these symptoms.
A self-care plan begins with you. It begins with being kind to yourself, becoming aware of how things are effecting you (both physically and emotionally), setting boundaries, expressing your needs, taking actions to aide yourself, surrounding yourself with individuals that listen and support you and being able to listen and support others around you. Although when you care for someone it seems like you have no time, you need to take the time to have healthy eating and exercise habits. Get plenty of rest and hydrate yourself. Develop good time and self management skills even if it means saying no. Have a support system, take breaks and try to enjoy a balance in your life. Do not give up all of your friends and hobbies. Pick your battles and even though it is hard, consider professional care givers, if not on a regular basis then consider short term help. You can sometimes schedule breaks, where you use a professional care giver in the home or facility for a few weeks a year, allowing yourself to have time to decompress and feel better before you can no longer care for your loved one.The biggest travel day of the year, the day before Thanksgiving, is almost here. For families with an aging loved one, that brings up the question of how to get that person to the feast. Whether travel means just a few hours by car or a plane ride, here are some tips for making sure your voyage goes as smoothly as possible.
1. Talk to your loved one’s doctor. Make sure that it’s OK for them to travel before you take off, and that the place where you’re headed is somewhere they can handle. Your doctor will let you know if there’s any special preparations you need to make in advance, and can also give you advice on medication to take if problems with anxiety or other issues arise. Make sure that you fill your loved one’s prescriptions before you go.
2. Do some advance planning. Think through your trip with your loved one’s limitations in mind. Are you renting a car? Then make sure you’ve requested a minivan or other vehicle that will be easy for them to get into and out of. Make sure you can fit their wheelchair and any other bulky equipment. If you’re flying, put in a request for seats meant for the disabled and notify the airline of any dietary restrictions. Also request a wheelchair so that you have some help navigating the airport. Contact both your hotel and airline to make sure they are able to handle any medical equipment that your loved one needs. Request a hotel room at ground level.
3. Be realistic. You may need to scale down on your usual travel routine. Keep things simple. For example, consider renting a cabin in the woods that’s just a two-hour drive away, rather than going to Europe or planning anything that will require a lot of walking (such as visiting an amusement park). Do your research in advance to make sure the location is properly equipped to have your loved one as a guest. Put plenty of padding in your schedule and don’t overload on the activities: it will likely take much more time to do things than normal.
4. Make sure you have necessary supplies. Special stockings can help if your loved one will be sitting for long periods, so that their extremities don’t go numb or a blood clot forms. Make sure you have protective gear for the sun, and especially that you have enough water since seniors are more susceptible to dehydration. Make sure medical information is with you at all times in case there’s an emergency.
At the final stage, Alzheimer’s disease begins to affect a person’s physical as well as their mental capacity. At this point, the person will require intensive, round-the-clock caregiving: assistance with dressing, eating, using the bathroom, and other ordinary tasks. The goal at this point is to make sure your loved one is comfortable and that they maintain as much dignity as possible.
At this stage, communication becomes difficult, and the person loses the ability to have a conversation. They might need assistance in order to walk, and their muscles might become rigid or possess abnormal reflexes. As the disease progresses they will likely also become unable to control their bladder or to swallow. At this stage, it is important to watch for infections; there is an especially high chance of pneumonia.
Due to the extent of your loved one’s needs now, this is the time when you’re most likely to need to move the person to a facility where they can receive the proper care. This is a decision that will require lots of research and education to make sure you’re making the right choice. On this website, we have many different resources to help you find the right Alzheimer’s care solution.
Though they have trouble speaking, your loved one is still “there.” They feel emotions such as calmness, fear, and love. They can also still use their senses to perceive you and the world around them – this is their primary way of interacting. Your main focus will be on providing for their physical well-being, but try to find ways to connect with them. You might read to them, look at old photographs, play music they might like, give them some potpourri to smell, or make them a meal they would enjoy. Think about the basic life pleasures that many of us take for granted – these are the kind of things your loved one can take pleasure in at this point.
This stage of the disease is one that is difficult for caregivers, both on an emotional level and on a physical level too. As the end of your loved one’s life approaches, you might be feeling sad, relieved, or numb to any feeling at all. These reactions are all normal. Receiving guidance from a bereavement specialist, therapist, clergy member, or other support can help you address these feelings in a healthy way. It is important to confront your grief.
For seniors in delicate health, forgetting to take medication or taking it improperly can have more dire consequences than one might think. The federal government estimates that 10% of hospital admissions are due to taking medication incorrectly, and over 125,000 people die each year as a result of this problem. Almost a quarter of nursing home admissions might be due to seniors having trouble with taking their medication. Unfortunately, this is an alarmingly common problem, with over half of all seniors taking medication incorrectly. Half of those, in turn, make the kind of mistakes that could have serious ramifications! When we consider this information in light of the challenges of seniors with dementia, it’s clear that this is a problem caregivers and family members need to be alert about.
There are many devices and solutions available to help keep loved ones on track. One simple remedy is buying a pill dispenser or a similar device. Your local drug store probably carries basic versions that will both organize pills and sound some kind of alarm or another reminder. There are also more elaborate and expensive systems that might, for example, call a designated caregiver if the senior has missed a dose. There are even smartphone apps for this issue. Drug companies themselves are also trying to help, with phone calls to seniors who are taking their products.
However, studies have shown that these methods don’t solve the problem. Sometimes this is because the devices are too complicated for seniors to use, or because they are not equipped to handle the typical senior’s complex medication regimen. And these systems often require input from a senior who may no longer be organized or independent enough to do what’s needed. Even if a loved one sets up the system initially, snafus like dead batteries or a malfunction could cause that effort to be useless.
For this reason, the best solution is to have a family member or other caregiver help the seniors with managing their prescriptions. A human helper can also address when forgetfulness is not the issue so much as unwillingness or lack of understanding about why a particular medication is important. This can be a particular concern for dementia sufferers who are determined to hang on to control and demonstrate their independence. Ideally, there would be some kind of gadget or gizmo to make this problem go away, but this is one issue that requires a human touch.
Let’s say that your mother has granted you power of attorney over her finances, and she has recently become unable to manage her own affairs due to dementia. Upon looking into her accounts, you discover that she has several thousand dollars worth of debt. Can the creditors come after you personally for this money?
No, they cannot. This holds true even if you have power of attorney. The only way you can be responsible for your parent’s debt is if you were also a co-signer on the loan. But, those of us who feel duty-bound to do the right thing may want to make sure that the bill gets paid anyway. Here are some things to consider before you proceed.
What type of debt does your loved one have? Depending on who the creditor is and the conditions of the loan, the rules for paying back the debt or your sense of obligation might be different. A bank loan is going to be relatively impersonal. The bank will be business-like if there’s a problem with the account, and if everything’s in order will probably not hassle you to repay the whole loan quickly. However, if your mother owes money to a contractor who also happens to be a family friend, and he needs the money, the debt will be much harder to ignore.
Is there a way to contest or renegotiate the debt? For example, was your mother taken advantage of by an unethical salesperson? Did she put a doctor’s bill on a credit card rather than working out a payment plan directly with the office? Can items be returned or recurring services canceled?
Explore different ways of addressing the problem. It’s always worth calling the creditors to see if more favorable arrangements can be negotiated, and the Consumer Credit Counseling Service can help you with working things out fairly. Also, examine your parent’s finances carefully to determine if a source of funding is available. For example, they may qualify for a reverse mortgage that can help you get the debt taken care of quickly. And if your parent has passed away, the matter is as simple as using whatever funds remain in the estate to pay what you can, and then notifiying whoever has not been paid that there are no more assets.
If there’s no money available to pay the creditor and your parent is still alive, you can simply try asking them to forgive the debt (though they may not buy that there are no assets unless your parent is on Medicaid). Your parent can also declare bankruptcy. You’ll of course want to speak with a lawyer before considering this step.
Few of us are comfortable leaving debts unpaid, but if you follow the steps above you will have done your due diligence to get creditors what they are owed.
Most people have fond memories of at least one of their grandparents. These are some of our most cherished relationships. It’s important to both your children and your parents that they make the most of this relationship while they still can. During this difficult time when the family struggles with dementia or the poor health of your parent, strong grandparent-grandchild relationships are vital and can be very nurturing to them both. Often people leave children out during times of illness, but if this happens they can miss out on the chance to help a relative who needs them.
As adults, we want to feel that we are valuable and that we’re making a contribution to our world. That’s what makes old age so tough – we can begin to feel that we’re no longer relevant and that we no longer matter. Kids, on the other hand, want to be recognized for what they do well, especially when they’re teenagers.
Kids today often don’t know much about history, and this is where a good relationship with their grandparents can really benefit them. They have much to learn about where they come from, and about things that happened before they were born. Even if your parent thinks your family history is unremarkable, your kids are likely to be curious and glad to know where they came from.
And kids, in turn, know quite a few things that grandparents don’t. They may be able to set up your mom’s new DVD player faster than you can say “Gone with the Wind” or they are pros at doing that cool new dance everyone’s talking about. Even a sullen teenager may be more receptive to assisted living visits if you find some way to incorporate their talents. Maybe they can build an online photo album with treasured images to share with their grandparent. Or, if they were just in a school play, maybe your child and their classmates will agree to volunteer to perform a few scenes to entertain the assisted living residents. (Won’t mom be proud!)
Make sure that both grandchild and grandparent know what they can contribute to the other, and ask each of them privately to help you by contributing their knowledge and spending time together.
By each of them sharing what they know and what they’re good at, grandparents and grandchildren can meet each other’s emotional needs. So getting them to spend time together can be good for your parent, good for your kids, and ultimately, good for you because everyone’s happier and a little less stressed.
When thinking about how to pay for assisted living, one option that seniors and their caregivers forget about is the ability to turn any active life insurance policy into a long-term care benefit plan. This little-known option has actually been in existence for decades, but few people take advantage of it.
Once a person reaches old age, life insurance is nice to have but not crucial, as more often than not they don’t have any dependents. However, long-term care is a major expense at this point in time. This option gives seniors the flexibility to use this investment for needs that are more pressing. The benefit can be used with any type of life insurance policy: term, whole, or universal.
In some ways, this benefit is similar to regular long-term care insurance (though the two are not exactly the same). Once the life insurance policy is converted, ownership of the policy shifts from the policyholder to a benefits administrator entity. The benefits administrator takes over responsibility for paying the monthly premiums on the policy. An account is set up from which the benefits administrator pays a specific amount, based on the value of the policy, towards the original policyholder’s long-term care needs. Often the monthly payment is flexible – for example, if the value of your policy is $24,000, you might be able to choose to receive $2,000 per month for 12 months, or $1,000 per month for 24 months.
It may not be a large enough amount to pay the full assisted living bill, but it can yield a significant monthly sum that will go a long way towards defraying costs. In many cases, the long-term care benefit is worth much more than the cash the policyholder would get by simply surrendering the policy.
Taking this option doesn’t mean completely forgoing the benefits of life insurance. You are often able to keep a small funeral benefit worth around one or two thousand dollars.
There are several reasons why this route may NOT work for you. For example, if you have a small policy of $10,000 or less, you’ll likely find that it’s better to choose the cash surrender value or simply keep the life insurance. Also, in some cases the cash surrender value may be larger than the long-term care benefit. Finally, in order to use this option you must have an immediate need for some form of approved long-term care. Payments are made directly to the long-term care provider, not to you.
If this seems like a possible option for you or your loved one, speak with a financial advisor who specializes in helping seniors.