Dementia care at home

Dear Nurse Kris;

My siblings and I live a long distance away from my mom. Seeing her means a full day of flying or driving, time off work etc. My mom is recently widowed, lives alone in her large home, has Alzheimers and we worry about her forgetfulness. She says she’s taking her daily medications and eating and showering, but I don’t have any way of knowing for sure. We promised her we would never move her to a nursing home. When we call, she’s forgetful about the day's events, and she’s growing lonely. When we visit, the house is neat, and her story sounds good, but still I feel uncomfortable. I spoke with the government nurse, and she recommends we consider placing mom in Assisted Living. I made a promise to her I would never do this. Mom has always said she would stay in the house until the day she died, and she made all of us promise to honour her wishes. Can you make any suggestions?

Thomas…Trying to sort things out from Alberta

 

Dear Thomas;

You are in a tough spot…you are appropriately concerned about your mom and want to do what’s best for her, and you want to honour her wishes by keeping her at home.

Basically, there are two main components you’ll want to be thinking about; her physical wellness, and her mental wellness.

Let’s talk about her physical wellness for a moment. Cash strapped government health authorities often can only put short periods of care in, up to several times per day. These services can include attention to personal hygiene, bathing, grooming, dressing, meal preparation and medication reminders or assistance or a bath once a week. The costs for this will be based on your mom’s income level, and for some folks, the costs will be high. At times, they exceed the health authority’s grid and they then recommend to families that they seek outside private care services. Your mom may also need more ‘life management’ interventions than the health authority can provide, and if this is the case, then yes, they will recommend Assisted Living as a first step.

Once her needs escalate beyond needing two services in the Assisted Living home, choices will be few and a recommendation would be made to place her in Residential Care (there is no more “Intermediate Care”).
In a recent local case, the health authority nurse found that for an elderly couple living at home and needing extensive services, the cost was essentially the same for both the health authority rates and the private agency. But the difference was that the private care agency could offer many more services for the same price. The private agency service workers could assist the client with paying bills, personal laundry, making breakfast and lunch, taking on outing or to appointments, minor housekeeping, transporting to doctors and other appointments in the caregivers vehicle…something the health authority care givers were not allowed to do. In this particular case, the couple - who met Assisted Living criteria - decided to go with the private agency caregivers, because they could do twice as much for the same price as the health authority was offering.

Let’s talk about your mom’s mental health. Declining cognitive function is common in 10% of adults aged 65 and older, and more than 50% of adults older than 85 have some form of cognitive impairment.  Many families are concerned about what to do. Essentially, there is no magic bullet for stopping or reversing the disease, but there are medications to slow the disease progression, and there are tools to provide quality interactions with families, support persons and caregivers.

I’ve just recently discovered such a tool which address the five aspects that are the most significant aspects of Dementia: communication, remembering, coordination and motor skills, visual and audio sensory perception, and critical thinking and problem solving. Whether you are a caregiver, family member, or friend, this tool should help folks with diminishing cognitive functioning, not only maintain their dignity, but get the most of out every interaction with their loved ones. They have reported feeling a sense of accomplishment and were meaningfully engaged for hours; this activity sparked their creativity and imagination, starts conversations around reminiscing, and basically prevented boredom from setting in. It enhanced their quality of life.

In short Thomas, there is a lot you can do to honour your mom’s wishes. It sounds like Assisted Living is the only option your local health authority can offer, thus if you want to honour your mom’s wishes, you’ll need to go directly to a private agency. Choose one with Registered Nurses who can oversee your mom’s care. Some private agencies offer 24/7 support hours for families and client as well as professional geriatric care management services for folks with dementia.

Good Luck Thomas!

Nurse Kris

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.