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Memory Care

AnnaMarie Barba is the director of Summer House, a memory support neighborhood within Walnut Village, a continuing care retirement community in Anaheim, Calif. owned and operated by Front Porch, Southern California's largest not-for-profit provider of senior living communities.
Crystal Roberts has served as National Memory Care Director since July 2006. Ms. Roberts has 15 years experience in Senior Healthcare in assisted living, memory care and skilled nursing. She has a background in operations, acute care nursing and quality services. Prior to joining senior healthcare she worked as a nurse in acute care.
Q:

I have a mother with dementia. She paces back and forth, requires frequent attention and lately has been getting quite agitated and yelling irrationally at times. She lives with my 85 year old father in their long time home. He's getting to the point of exhaustion, but is worried that she will react very negatively if she is put into a nursing home or memory care, separated from my father. What would be your advice? Second, are there ways to search for places that have nursing homes AND regular assisted living on the same premises? Memory care without medicaid is not affordable for us. 


Anjon from DC
A:

Although there is a strong possibility that your mother will be quite agitated with the move, you must look at the greater picture of “Is this going to improve the health of you father?” and, ultimately, “Will your mom be in a more stimulating and positive environment?” It is never an easy decision to make when you know that you are at a point of having to place a loved one in the care of others in a community environment. Safety is what I tell all prospects that you must first look at. Secondly, it is just as important to look at the health of the spouse or person who is providing the caregiving. Caregiver burnout is a growing concern in the healthcare community. Your mother may not need assistance with the basics such as toileting, grooming or dressing, but mentally and emotionally your father has to provide for your mom and that can be exhausting. Having agitated moments and yelling at your father for no apparent reason is a common issue and it takes not just skill but patience to deal with.

Your mom has energy from what I can see by the comment of pacing back and forth. Your father needs to be able to provide activities and stimulation for her so she can exhaust some of that energy without the use of medication to slow her down. You want her to be able to walk and explore life around her and thrive as much as she can because you are looking at a future that becomes a much smaller world for her. Having her in an environment that allows all that is what is in her best interest and also your father’s.

I have been in this field long enough and moved many residents into assisted living and have seen my share of residents become extremely agitated and upset at the beginning. But it works itself out. You have to keep in mind that she has dementia, so finding redirecting techniques and being very creative when explaining to her why she is in her “home” is why we are here – that’s our job. It can take a few weeks and even up to a couple months for someone to really adjust to their new environment depending on where they are within their disease. Here at Summer House, a memory support neighborhood at Anaheim’s Walnut Village retirement community, I have a nice blend of early-to-end-stage dementia/Alzheimer’s residents and they have all posed a different challenge when they first arrived. It is my responsibility to make sure that I provide as much comfort and education to the families as possible to help ease the transition. I would contact your local Alzheimer’s Association chapter or a skilled nursing facility nearby for referrals on assisted living communities that accept Medicaid. There are not as many around as private pay communities, but usually within a given county you can locate one.

If I can end by giving you one piece of advice: Look at the whole picture and not what is happening in the present. When looking into the future a bit, look to see if her quality of life would greatly improved if she were in a place where she is able to thrive and be among others she can relate to. Families have told me time and time again that it gives them such pleasure and peace to see their loved one be able to be all that they can while they still can.

 

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Q:

My sister, 69, recently suffered a fall that triggered her getting a new pacemaker with a defibrillator and numerous med changes. While all her neurological tests have come back showing no dementia or Alzheimer’s, she is struggling with her short-term memory. I believe this could be medication related (she takes about 16 daily) and/or combination with poor nutrition. Short of hours of research on my part (layman), how can I make some determinations about how and when to take these meds? I have visited drugs.com and entered the meds and looked for interactions. Nearly all of them moderately interfere with one another. I need help! 


Kathy from CO
A: Answered by AnnaMarie Barba

Based on your information, it is safe to say that the short-term memory loss is most likely due to the use of multiple medications, known as polypharmacy. I am not sure the reason why a pacemaker was implanted, but that alone would not be a cause for increased memory loss. If she did not sustain a traumatic brain injury from the fall then the use of multiple medications—especially 16—can without a doubt have an effect such as memory loss/confusion. There are certain classes of drugs, such as beta-blockers, psychotropic and hypertensive medications, that have confusion listed as one of their more common side effects. As we age, our body's ability to metabolize a single medication becomes slower. The obvious side effect you would see is confusion and/or just a sense of “not feeling” balanced. Your sister is in a high-risk category for experiencing multiple side effects due to the increased amount of medications she is taking. Another factor is that you listed her nutritional intake as poor. It is very important for her to stay hydrated and maintain an adequate amount of calories.

I would recommend taking all of her medications to her cardiologist and primary physician, and neurologist if there is one, so they each have a clear picture of what she is taking. If this has already happened, what needs to be looked at is what medications are life sustaining and possibly stop the others. This can allow for a clearer picture if it is in fact the use of multiple medications causing the memory loss. Keep in mind that it is not just prescription medications that have side effects of memory loss, but many over-the-counter medications as well. 

 

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Q:

My mother, who has been very active all her life, has been in memory care for about 3 weeks now. She used to enjoy bus rides and lunches in assisted living but since being in memory care her outside access is limited to maybe one bus ride a week. Since she is advancing in her disease her level of anxiety had increased greatly. The coordinator of the facility feels that mom needs get accustomed to her new environment and limit outside stimuli but my mother's agitation is increased since she feels "trapped." I have a private caregiver that comes twice a week to take her out, but the facility thinks this is detrimental, saying that she becomes more aggravated when she returns from these trips out.

Sometimes she does and sometimes she doesn't! So, I don't know if my mom staying IN more is the answer, but all the "professionals" seem to think this is the best way for her to acclimate! I just don't know what to do anymore.  


Marie from CA
A: Answered by AnnaMarie Barba

Without having met your mother or been able to observe her, it appears that she is in a transitional state with her dementia, hence her move to a higher level of care. The care staff at her community does not seem far off in stating that her anxiety increases or that she is more agitated when she comes back from the outings, as it appears that she is having a difficult time with the "change of scenery," thus causing the anxiety to kick in.

In my experience I have residents go from multiple outings off campus to outings within the community. I will have them go on the outings to see how they react and if I feel it is too distracting for them then I will refrain from them for awhile until I feel that the person has adjusted to their new environment. Unfortunately, sometimes outings are really no longer an option because it causes the person too much emotional distress. Although they may not be able to tell you where they live, there is a deep sense of security within their own environment and removing them from it and then bringing them back at a later time can be really distressing.

One recommendation is to see if the private caregiver would be allowed to attend the outings with your mom so she could be there to help with the transition back to her environment. Caring for the "whole person" with dementia includes, but is not limited to, fulfilling and stimulating them with different sights, sounds and tastes. I believe that your mom should still be engaging with the outside world, whether it is a scenic drive, walks along a garden pathway or even something as simple as having a snack on a comfy bench on the patio. The care staff should know your mom's likes, dislikes and triggers. It is with their expertise that they should be able to find ways to redirect your mom when these moments occur.

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Q:

My dad has times when he does not know who I am and other times he is fine. Can I do something to help his memory? Also he does not want to do anything but sleep all day. I can't get him to work on a puzzle or interact in any way. Just a few minutes of conversation a day and that is all he wants. Sometimes he walks great, and other times he will ask for help with walking with his walker. When I say “just walk,” he tells me he has forgotten how. Is this possible?


Nancy from CT
A: Answered by Crystal Roberts

Dear Nancy,
When someone you love does not recognize you it can be very painful. Due to the nature of the illness, people with dementia will invariably forget. It’s important you don’t forget that this is a problem caused by the illness. There are some things you can try. Before speaking to your dad, address him by name, then introduce yourself with your full name and relationship. You can also try having photos in the house with the names of each person clearly written on the bottom to help him identify individuals. One of best things you can do is to not argue with him when he forgets—this will only upset both of you and lead to unnecessary stress.

As for the sleeping all day I would take him to the doctor just to have all of his medications reviewed and to rule out any medical problems. It is very important to keep the doctor informed of any changes. After both issues have been addressed, try to encourage him to do things he likes to do such as walking or getting out by offering him something good like ice cream or a candy bar—whatever he really enjoys the most. I find that sometimes a hot fudge sundae can help motivate people to do just about anything!

You mentioned that he tells you that he has “forgotten how to walk.” People who have dementia may not understand the actual words you are saying. This is also part of the disease. If he does not understand, visually show him what action you want him to do or just assist him in walking. Try not to draw attention to the fact he does not know, as this will only embarrass him and upset both of you. With all of the things you’re going through, just remember it is the disease’s fault, not your dad’s. Nancy, if no one has told you lately, thank you for taking such good care of your dad.
 

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Q: Holidays have lost a lot of their joy since my mother developed Alzheimer’s. Should we give up all our family traditions?
A: Answered by Crystal Roberts

Holidays are important times the of year for families to come together, and keeping our loved ones living with Alzheimer’s involved in family traditions continues to be critically important. By incorporating them in their favorite activities and taking steps to prepare both the senior and other family members for celebratory events, families can create new memories while fostering a connection with seniors on a deeper level. Caregivers should take the following steps in order to prepare the person who is living with Alzheimer’s as well as tailor holiday celebrations for Alzheimer’s patients. Talk about and show pictures of the people who are coming to visit. People with Alzheimer’s may recognize faces of family members and friends, but may be unable to recall names; in this case, name tags are helpful. Incorporate favorite traditions from the past—play familiar holiday music and serve favorite traditional holiday foods. Slow the pace of the activities to allow the person with Alzheimer’s to comprehend as well as enjoy the sensory pleasure from the activity. If there is no interest when an activity is first introduced, try again later. Prepare for distractions beforehand to divert attention if problem behavior occurs, and have a "quiet" room if things get too hectic—have a familiar person stay with them so they don’t feel isolated or left out. By following these suggestions and making important adaptations in holiday celebrations for Alzheimer’s patients, the holidays can still be enjoyable for all family members and leave you with positive and lasting memories of these times spent with your loved one.

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Q: My parent is now in an assisted living facility for Alzheimer’s patients. How can I make visits more enjoyable for both of us?
A: Answered by Crystal Roberts

Visiting your loved one once they have moved into a community for those with dementia or Alzheimer’s may not be easy and sometimes may feel overwhelming to you. First, be prepared for the fact that an individual with Alzheimer’s may perform at one level one day and differently on another day. In advance of the visit, try to prepare yourself for the possibility that your loved one may not recognize you.

Begin each visit by introducing yourself and calling your loved one by name—calling someone by their name can help put them at ease, assuring them that you are a familiar person. Come prepared to participate in activity that interests your loved one such as walking, looking through a magazine, doing a manicure, etc. These shared experiences may make the visit more rewarding for both you and your loved one. Visits can be especially difficult when a loved one can no longer interact as they once did. Activities that engage their senses may be the most successful. Try listening to music and/or singing familiar songs, participating in spiritual practices, looking at familiar pictures, sharing a snack or just sitting and holding hands. When it comes to chatting, avoid rushing your loved one during conversations; often they need extra time to respond. Also avoid open-ended questions that may put your loved on the spot such as, “What did you have for breakfast?” Try making statements that help prompt your loved one to answer a simple question. For instance, you might say, “I heard you were gardening this morning. You have always loved planting flowers. Did you enjoy yourself?”

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