Our nurses have compiled the following list... Do any sound familiar?
Ten Tell-tale Signs That Your Aging Parents Need Help
Not paying household bills on time or at all; Bills and important documents are not put away in appropriate places and left lying around
Not recognizing need for, arranging, or scheduling necessary household repairs and maintenance; Lawn not mowed, trash disposed of, and mail retrieved with any regularity
Driving safely becoming an issue such as increase in violations, accidents, easily becomes lost in familiar areas, and signs of deteriorating vision
Not preparing meals, eating at regular times, or missing them completely; Poor selection of food is often on hand or old outdated food left in refrigerator
Declining personal hygiene as indicated by unkempt hair, dirty or lengthy nails, poor oral hygiene, body or urine odor, unshaven, and wearing same clothes over and over
Lack of interest in keeping up with housekeeping chores like laundry or cleaning or simply complains that it is too difficult or tiring to continue doing them
Losing track of medications, missed doses, mistakes like overdosing or interactions resulting in health concerns if not hospitalizations
Reluctance to leave the house, run usual shopping errands, visit friends and family, sleeping long periods, and uninterested in usual hobbies or activities
Getting up and down stairs and in and out of home becoming difficult; Walking unsteady on level ground, complaining of dizziness, and falls are likely or have already occurred
Not making sound decisions that are likely to cause self harm or danger to others such as leaving the stove turned on or cigarettes burning and not recognizing an emergency or knowing the appropriate response


Convincing Mom or Dad to Get In-Home Help
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When asked about their preferences for living arrangements, it should come as no surprise that many of our parents would like to remain in their own homes and actually the majority of them do so. If this is the case with your parents or aging loved ones, then you may be faced with how to go about making this a viable option. Bringing in outside help is frequently NOT a choice that many older folks are agreeable to, in spite of the obvious need. They often express that help is not needed and are very capable of managing on their own. Understanding that their perception of any outside assistance is often seen as a threat to their independence or an invasion of their privacy is foremost. My experiences helping families with coming to grips with these issues and problem solving have left me with some ideas and suggestions that you may find worth a try.
When your parents or older loved ones are both living, and in their own home together, direct your attention to the less needy one. For instance, suggest that his/her spouse would be the one to benefit from outside assistance even when they both might. By allying yourself with the more independent parent, you may ultimately be able to get them both to accept the help they require.
Another approach might be to suggest hiring a caregiver to manage some household chores and NOT actual "hands-on care" or personal assistance. Often times this is seen as less threatening to a loved one's independence and will serve as a means to "get the caregiver in the door". Place the emphasis on getting help handling the heavy housework such as vacuuming, bed linen changes, and possibly even yard work due to some declining physical limitations. Or suggest help with food shopping, travel to Dr appointments, and other errands when driving is no longer an option. In this manner, you might have your parents accept help they would not have otherwise been agreeable to. Your hope is that they will see the value in having assistance and develop a trusting relationship with their caregiver. The expectant outcome is that they will become more open to the idea of allowing he/she to provide other types of assistance such as personal care when needed.
When your parent or loved one is living alone or with you, focus the attention on YOU as the caregiver needing the help and NOT your loved one's need for assistance. Emphasize that you would be the one to benefit from such help as many parents place concern for their children' welfare before their own. Suggest that bringing in a housekeeper for instance, would alleviate your worry about managing daily household chores such as cleaning, shopping, meals, and laundry. Or should a nurse aide come in to assist your loved one with bathing and personal care, you would have more time to manage other household responsibilities. As a working caregiver, suggest that by having a companion/assistant stay with your loved one, it would relieve you of worries and concerns while away. Remember to downplay them as the cause for getting help, but instead stress that YOU, the caregiver, are the reason that assistance needed.
Another idea might be to seek the help and advice of a trusted professional who is someone your parents hold in high regard. They might surprise you by their willingness to accept the advice of a long time family physician, a former or current home health nurse, or a family friend in the medical field, prior to your own input. Employ their trusted status as a means to relay your concerns and advise your parents in the right direction.
In many families, your conflicting role as the child and caregiver thwarts your well-meaning attempts at helping your parents. The basis for your actions should not be confused by misguided guilt. Therefore do not take their rebuttals personally or offensively, but rather focus on a necessary means to an end.

Practical tips for Alzheimer's caregivers
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 Each person with Alzheimer's disease experiences its symptoms and progression differently. Consequently, caregiving techniques also should vary. The following tips may work for you as you adapt them to your specific situation.

Assess independence In the early stages of Alzheimer's, your loved one may still be able to perform the tasks that allow a person to live and function independently. Inevitably, though, as the disease progresses and cognition declines, these responsibilities increasingly will fall to you.

Frustration, agitation and even aggression are common reactions when tasks that once came easily become difficult for someone with Alzheimer's. As you help your loved one with eating, bathing, grooming, dressing and going to the bathroom, find ways to make his or her limitations less frightening and frustrating for both of you. Try to:

* Involve your loved one in tasks as much as possible. Some people can still choose an outfit if they're given only two choices, rather than a closet full of clothes.
* Reassess the level of assistance that's required daily. For example, can your husband shave by himself if you set out his supplies? Or can he shave by himself if you turn on an electric razor and put it in his hand? Or does he need you to provide assistance with the entire task?
* Strive for balance between periods of rest and activity. Minimize activity later in the day when your loved one is more likely to be tired.Create a safe environment Alzheimer's disease impairs judgment and problem-solving skills. You can modify the home environment to help your loved one maneuver within it as easily and safely as possible. Here are some suggestions:
* Remove throw rugs, extension cords and any clutter that can cause your loved one to trip and fall. Avoid rearranging the furniture.
* Install locks on cabinets that contain medicine, alcohol, guns, toxic substances, dangerous utensils and tools. Install handrails to prevent falls.
* Make sure there is a first-aid kit, a fire extinguisher and working smoke alarms in the home. If your loved one is a smoker, don't allow him or her to smoke alone, and control the matches or lighters yourself.
* Remove plug-in appliances from the bathroom to avoid the risk of electric shock, and set the temperature on the water heater no higher than 120 F to prevent burns.
* To reduce the risk of wandering, put a slide bolt high on every door that leads to the outside or to a stairwell, or use a deadbolt that requires a key. Never leave your loved one alone when you use these measures. If your relative can no longer drive, control access to car keys and keep the car out of sight.Adjust your expectations It's important to have realistic expectations of your loved one's abilities and behavior. Consider these tips to help you modify your expectations:
* Allow more time to accomplish everyday caregiving tasks. Simplify the tasks and provide instructions one step at a time.
* Try not to worry about the way things "should" be done. If no danger results from your loved one's actions, refrain from correcting them.
* Try to stay flexible. If your loved one refuses to do something, back off and try again later using a different approach.

Most tasks don't need to be done immediately. You're more adaptable than is the individual with Alzheimer's.Limit distractions Along with a sense of routine, a serene environment can reduce some behavior problems. Noise, large groups of people, changes in surroundings or pressure to perform a task can cause anxiety and further compromise your loved one's ability to think clearly.

To help limit distractions:
* Shut off the television and limit background noise to soft music without commercials.
* Encourage visitors to call before they come, and limit the number of people at gatherings. You may want to encourage short visits so that your loved one doesn't feel overwhelmed.
* If your loved one attends a large gathering, reserve a quiet room for him or her to relax in.

Keep track of the stimulation from music, television, conversation and meal preparation. If it's getting too noisy, tone things down or encourage your loved one to rest in the quiet room.Promote communication Your loved one's ability to use language to communicate decreases as the disease progresses. You may have difficulty understanding what he or she says. You may also find it difficult to speak to your loved one in a way that he or she can comprehend. Either of these situations can be frustrating and may make your loved one agitated or even aggressive.

Behavior often becomes the route by which people with Alzheimer's communicate their feelings and needs. To understand a behavior, consider what your loved one may be feeling. For example, if your wife is in a care center and is asking to go home, imagine what home may symbolize to her. Home is often associated with comfort, familiarity, safety and belonging. If you can make her surroundings at the care center more homelike, she may calm down. If your wife is pacing, it might mean she is tired, feels hungry or needs to use the bathroom.
Above all, your approach to communication should include patience, understanding and listening.


An Old Lady's Poem
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When an old lady died in the geriatric ward of a small hospital near Dundee, Scotland, it was felt that she had nothing left of any value. Later, when the nurses were going through her meager possessions, they found this poem. Its quality and content so impressed the staff that copies were made and distributed to every nurse in the hospital. One nurse took her copy to Ireland. The old lady's sole bequest to posterity has since appeared in the Christmas edition of the News Magazine of the North Ireland Association for Mental Health.

... And now this little old Scottish lady, with nothing left to give to the world, is now the author of this simple, yet eloquent, poem traveling the world by Internet. Goes to show that we all leave "SOME footprints in time".....

An Old Lady's Poem

What do you see, nurses, what do you see?
What are you thinking when you're looking at me?
A crabby old woman, not very wise,
Uncertain of habit, with faraway eyes?
Who dribbles her food and makes no reply
When you say in a loud voice, "I do wish you'd try!"
Who seems not to notice the things that you do,
And forever is losing a stocking or shoe.....
Who, resisting or not, lets you do as you will,
With bathing and feeding, the long day to fill....
Is that what you're thinking? Is that what you see?
Then open your eyes, nurse; you're not looking at me.

I'll tell you who I am as I sit here so still,
As I do at your bidding, as I eat at your will.
I'm a small child of ten ...with a father and mother,
Brothers and sisters, who love one another.
A young girl of sixteen, with wings on her feet,
Dreaming that soon now a lover she'll meet.
A bride soon at twenty -- my heart gives a leap,
Remembering the vows that I promised to keep.
At twenty-five now, I have young of my own,
Who need me to guide and a secure happy home.
A woman of thirty, my young now grown fast,
Bound to each other with ties that should last.
At forty, my young sons have grown and are gone,
But my man's beside me to see I don't mourn.
At fifty once more, babies play round my knee,
Again we know children, my loved one and me.
Dark days are upon me, my husband is dead;
I look at the future, I shudder with dread.
For my young are all rearing young of their own,
And I think of the years and the love that I've known.

I'm now an old woman ...and nature is cruel;
'Tis jest to make old age look like a fool.
The body, it crumbles, grace and vigor depart,
There is now a stone where I once had a heart.
But inside this old carcass a young girl still dwells,
And now and again my battered heart swells.
I remember the joys, I remember the pain,
And I'm loving and living life over again.
I think of the years ....all too few, gone too fast,
And accept the stark fact that nothing can last.

So open your eyes, nurses, open and see,
...Not a crabby old woman; look closer ...see ME!!



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