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Eldercare

In May, our guest expert in Le Club's Ask the Expert segment was Caroline Tapp-McDougall.

Caroline is the publisher of Solutions magazine, a Canadian publication dedicated to the wellness of seniors, their caregivers and their families.

She is also the author of a book entitled Complete Canadian Eldercare Guide. She has a background in health-care communications and extensive editorial experience in the areas of health, wellness and medical writing.

She is also a respected speaker at conferences and events across Canada. Caroline and her brother provide care for her mother, who is stroke-disabled and living in a long-term care facility. She is also the mother of three, and resides with her family in Toronto.

Here are Caroline's answers to your questions about Caring for Older People:

Q: My elderly father had a bad fall recently and had to go into the hospital. When he was assessed there, the doctors said he was dehydrated and showing signs of malnutrition. I felt like they were sizing me up for elder abuse, and I felt terrible but also angry; I am not sure what I could have done differently.

Our family has tried to get him to go to a nursing home (he refuses). We had people into the house to assess him, and they always found him 'competent' enough to live alone. We had nutritionists come to the house, we set up Meals On Wheels for him (which he often refuses to eat), had Community Care people to help bathe him and clean the house (but sometimes he won't let them in), and a physiotherapist who gives him exercises that he never actually does.

At least one family member visits him nearly every day. We do his shopping, sort his medication, cook for him, and do his laundry, but it is clearly not enough. He is still not eating properly, he is sleeping too much, he mixes up his pills, he is not stable on his feet, he keeps trying to go down flights of stairs by himself when we are not there. He also has severe anxiety problems, and phones us up to 14 times a day.

It is impossible to tell if he is in danger or not, as he sees everything as a crisis. And yet, every assessment he has goes so smoothly (he is good at pulling himself together for these visits).They always say that he is surely capable of taking care of himself. But he isn't. Short of quitting my job and moving in with him (not really an option for me), what more can I do?

A: First of all, don't beat yourself up by feeling guilty that you aren't doing enough. You've tried to do the right things. Caregiver stress and burnout are huge concerns in these situations, so talk to your family doctor if needed and make sure that each person in the family who is "sharing the care" also gets a break.

Fortunately, good planning can make a difference, especially if you're lucky enough to have siblings who can help. Here are a few suggestions:

  • Have a heart-to-heart talk with your father's family doctor. Simply request an urgent appointment and lay your cards on the table.
  • Have detailed notes that you can hand over outlining the steps you've taken and the concerns you have. While your dad does have a right to live at risk, it sounds like his way of living is very stressful on those who care for him. The doctor may be willing to talk to your father and lay things out in an authoritative way. After all, elders are often more likely to listen to their doctor than to their children.
  • Find out who has power of attorney for personal care. If you do, then it may be possible for the doctor to help you in placing your dad in an assistive living facility or a nursing home depending on his medical needs. However, keep in mind you cannot force your father into a facility even if you do have power of attorney.
  • Alternately, a geriatric care manager can help you. As an unbiased eldercare expert, he or she can provide helpful solutions, including speaking with your dad, assessing his needs, and arranging for more in-home help, which will alleviate your stress. Care managers are not usually covered by government health care plans and are paid privately by the hour. However, some people have insurance or enough personal assets to cover these costs.
  • Introduce your father to an activities or a day program at a local nursing home or community centre. You don't mention any companionship for your dad. His phone calls may stem from the fact that he is lonely. Consider taking him to a community day program at a nursing home to get him out of the house and to meet others his age. Taking him to a program will give him a non-threatening, first-hand look at life outside of his home as he meets and talks with the residents.
  • Plan ahead by thinking where your father may live just in case his health changes. Visit nursing or assistive living facilities. Ask him to come with you to get an idea of what he might like. If he refuses, work with your family members to make a choice. Don't forget, a geriatric care manager can help you select the right facility. He or she can also help you make a list of what's important such as location, room size, activities offered, ratio of nursing staff to residents, and so on. Most nursing home have waiting lists, so planning ahead is important.

For the short term, you will require some professional assistance to help you manage. At the very least, you'll need a professional home care worker to help you monitor your father's medication and eating habits on a daily basis. Once that aspect of your father's care is under control, you can hire additional help to take the stress off you.

 



Q: We are currently caring for my father-in-law, who has had a stroke last July and has since had periodic mini strokes. Sometimes he is lucid, and sometimes he isn't. He doesn't seem to understand some questions we ask him. How do I care for him without him thinking that I am his sole caregiver, who must be here for him at all times? I am still working outside the home, but try to come home shortly after work, as I worry about him being alone. He expects me to wait on him when I am here, which I'm finding a bit difficult. Please advise me. I don't want to be unkind to him.

A: You're not being unkind, just realistic. But before things get more serious, you need to get some help. I am concerned that your father-in-law is not lucid. Has his family doctor assessed him recently?

Also, you don't mention if your husband is involved in the care. Can he help in any way? Are there any other siblings who could help? It's essential that you are not trapped into being your father-in-law's sole caregiver. Otherwise, you'll get worn out, putting your work, marriage, and health at risk.

As you're working full time, it's time to get some outside help. A home support worker could provide much-needed assistance with dad's personal care, be a companion to him, and help with household duties such as laundry, cleaning, and so on. Consider Meals on Wheels for lunchtime in the short term. This service will not only provide healthy food for him but also someone who is checking in on him whenever food is delivered.

Contact dad's family doctor and ask for advice as well as a referral to provincial home care services. And, start looking at suitable long-term-care options - with the help of professionals, if necessary - in case things become too much for you at home.

 


Q: Our family is, unfortunately, seeking information about a senior member who may have to be placed in a retirement home against their will. What would be the steps we have to follow?

A: Remember, a person who has power of attorney has no legal authority to place a family member in the home against their will. The best thing to do is to consult the person's family physician for advice. Make sure you've clearly documented the reasons why you think a move is necessary.

You mention your family is involved; I hope everyone agrees on this move because it may make it easier to convince your family member to move. While you are seeking the doctor's advice, consider looking for places for your family member to move to by taking the time to research and visit homes.

In the meantime, a home care assessment may be required just to be sure. Ask a consulting health professional such as an occupational therapist or care manager to assist you. It may turn out that, with the right care, your family member will not need to move and can live safely, with supervision, at home.

 



Q: My mother has severe dementia, and her doctor is pretty certain its Alzheimer Disease. I realize that this is never a 100 percent sure diagnosis, however. Also, she has never had a brain scan, and some of her symptoms seem strange for Alzheimer's, even to the doctor.

It is advanced to the point now where it doesn't really matter anymore what is wrong with her, we are just trying to keep her as comfortable as possible. We certainly don't want to subject her to all sorts of diagnostic tests at this stage...they would just scare her, and would not help her in the least. However, I think it is important for us, as her offspring, to know what condition she suffers from -- especially if it is something that could be genetic, or treatable.

This may sound like a very morbid question, but when she does pass away (hopefully years from now), is it common practice to request to have an autopsy done, or will the rest of my family think I am a ghoul for even thinking such a thing? Who would make the final decision?

A: Symptoms of other conditions, such as depression and heart disease, can mask symptoms of Alzheimer disease, so I understand your concern. However, although a diagnosis is never 100 percent certain, a doctor should be able to diagnose the condition about 80 to 90 percent of the time.

A diagnosis involves assessing a person's faculties, including memory, reasoning ability, language and judgement. Your doctor may assess these, or he or she may call in outside experts to aid him in his diagnosis. Nevertheless, if you'd like a second opinion, ask your doctor for a referral to a geriatrician, who is a doctor that specializes in caring for older adults.

If you're concerned about scaring your mom with additional tests, you'll need to weigh your concerns against what is right for your mom. If you truly suspect she does not have Alzheimer disease or perhaps has another underlying condition, undergoing a few extra tests is well worth the effort, as they will result in a more certain diagnosis, which will see her get the care she needs.

As for your concern about you and your immediate family, you can be genetically tested for the condition. There are two types of testing available: one test checks whether or not you have a "high" or "low" chance of developing the disease, and the other test checks for genetic risk factors that may cause you to develop Alzheimer disease. Depending on the type of Alzheimer disease your mother has, a doctor may or may not test you. For more information about genetic testing, speak to your family doctor.

 


Q: My 93-year-old mother has had a pacemaker for eight years. Other than that, and the fact she has no short-term memory at this point, she is very healthy. A few years ago, she lost almost all her front teeth. My sister and I disagree on whether to get implants for her, or whatever needs to be done to provide her with teeth.

My mother is adamant she won't go to the dentist, but I've read that gum disease is related to heart problems and I'm worried about her health. Also, she is eating poorly...she says, "When you're 90, you won't want to eat much either." But I think she's not eating much because of the teeth situation. What do you think we should do? Thank you.

A: First, good oral hygiene at any age is essential. The mouth is a haven for bacteria, which has been linked, though not conclusively, to various conditions and ailments. At the very least, you'll want to help her care for her teeth by reminding her to brush regularly or by brushing them yourself (or with the help of a home care worker).

Second, your mother has probably changed her diet to one with softer foods, and at this point, she may not adapt to a dental plate. To help her improve her eating habits, you'll want to monitor her nutrition intake and supplement her diet with soft or pureed foods.

Finally, ask your mom why she won't visit a dentist. She may associate the dentist with pain, and thus may be reluctant to go. Learning her concerns will help you address them and help her get the oral care that she needs.

 



Q: My parents live in another city than my siblings and I. They have recently announced that they would like to move to the city in which we reside. They are still very active in their own city and have a good social life. I suppose they are thinking about the future and who will eventually care for them. From that point of view, the move makes sense. Yet I am concerned that when they move here they will feel quite lonely, since they don't know anyone else except me and my siblings. Do you think that they are making the right decision?

A: Your parents may be planning for their future care needs, or they may simply want to move closer to family. It's important that you understand what their motivation is. Are they missing you and the grandkids? Do they expect to spend a lot of time with you that you may not have?

Discuss the move with them openly and honestly. If it's for their future care needs, it certainly makes sense if you and your siblings are prepared to help; however, you'll want to plan this out ahead of time. (Who among you will take responsibility for care? Will they live with you or another sibling if their health fails or if one passes away?)

If you parents are intent on moving, you can help them by thinking ahead. Are they planning to live close by? If so, is your community senior-friendly? What are their housing options? (A lot of adult lifestyle communities have fabulous activity schedules for healthy seniors and often have provisions for long-term assistance and support built in). There are no right and wrong answers to these questions. Nonetheless, it's important that everyone embarks on this journey with their eyes open so that no one is surprised or disappointed.

 


Q: My mother has advanced Alzheimer Disease and lives in a nursing home. I noticed one day that she wasn't eating very well and her teeth looked terrible...like they hadn't been cleaned in weeks. It turns out, after we demanded a dental assessment, that she had many cavities and was probably in a lot of pain.

When I confronted one of the workers there she said that they used to try to brush her teeth, but she gets scared whenever someone touches her mouth (she was always terrified of dentists), so they don't really bother trying anymore. This seems outrageous to me, but I don't know what the solution is. If it scares her that much perhaps it isn't worth it?

Are there any products or tricks you could recommend that could help keep her teeth cleaner? Have you run into this sort of problem before? And why hadn't the nursing staff thought that maybe her lack of appetite had something to do with a toothache? It makes me very upset to think of her in pain, and no one noticing...

A: Dental care in the nursing home is an age-old problem, because it is, as you suggest, often difficult for staff to encourage residents to brush their teeth or let them be brushed.
I always brush my mother's teeth with her when I visit her at her home. While my visits aren't as regular as I'd like it to be, it's a start.

Consider hiring a private caregiver from a local agency to visit your mom and help her with her personal care. Oftentimes, people with advanced Alzheimer disease respond well to one specific caregiver; your mom may have trouble adapting to the constantly changing staff of the nursing home.

As for tips, consider using oral hygiene sponges with peroxide, which are fairly easy to use. Also gargling with salt water is a manageable alternative.

 


Q: Since dementia has seemed to take over, there is a question regularly asked by my mother that tortures her and those from whom she seeks an answer. I've heard that many others caring for an elderly person are asked the same question, which is a variation on: "When am I going to go home? I want to go home. Just take me home. When can I go home?"

My mother is still living at home but now as a widow with a full-time caregiver. She has lived there for 33 years. Please help me find an answer for her that will give her comfort. Just saying, "You are home, Mom. This has been your home for a long time." does not settle her because she can no longer recognize her surroundings. What can I do? Please help.

A: Due to her mental condition, your mother is probably now recalling "home" as her childhood home. This occurs quite frequently with people who have Alzheimer disease, particularly as the person's long-term memories are left mostly intact while their short-term memories deteriorate.

While hearing her repeat this question can be frustrating and emotionally draining, remember to treat your mother with respect. Alzheimer disease may take away a person's thinking, but feelings remain. If you don't want to answer the question, try changing the subject ("What did you do today?") or suggesting an activity ("Let's go for a walk").

Most importantly, reassure your mom that even though she is in unfamiliar surroundings (at least to her), she is still safe. You can demonstrate this by touching her or hugging her. Human contact, especially from a family member, is very important to older people.

Above all, remaining positive and patient. Remember your mom's condition, and help her enjoy her remaining years as much as you can.

 

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