Cases
JoeDealing with Alzheimer's
Joe lived with his wife. His adult children lived out of town. As a result of professional testing, Joe was accurately diagnosed with Alzheimer's.
We met with Joe's wife, contacted family members and discussed what Alzheimer's disease really is, what to expect as the disease progressed, some management techniques that would ease care giving and caregiver stress.
We took Joe out five days a week as his energy level allowed. He enjoyed trips to the Senior Center where he played pool with other guys until he lost too much cognition to play. Joe had done woodworking as a hobby, so we would take him to woodworking stores and Home Depot to view what tools were new and to smell the fresh wood. We took him for walks in the mall. We organized activities around his personal likes and abilities such as painting a chest of drawers. Later, when he was showing depression and grief over loss of self, he said he "had no purpose." Then we had him assemble balsa wood planes and paint them as gifts for needy children at Christmas.
We attended all doctor appointments with Joe and his wife. We reported to the doctor those symptoms that indicated changes in Joe. As eldercare specialists, we were able to discuss with his doctor Joe's condition and response to medications, relieving much of the stress that was otherwise carried by Joe's wife.
The dementia progressed as it would, but Joe's quality of life and ability to function in his world remained high.
He is now in a special memory unit of assisted living on hospice. His wife visits daily. She calls us if she needs us.
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Dementia and how to actively cope Care specialists often describe the progression of dementia as 7 stages from mild cognitive decline to delusional behavior, loss of verbal abilities, incontinence, inability to walk or sit. Not every sufferer will experience every, nor will stages always happen in the same order. A few words about progressive dementia:
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Virginia
Caring for home and health
Virginia lives in her home alone. When we were introduced to her, she was anorexic, had a nasty rash, filthy home, leaky roof, mold on the interior, no water in her bathroom. Caregivers from a local home-care service, whose experience and skills weren't well suited to the case, struggled with Virginia. Over time, predictably, their care deteriorated.
It took us a year. Virginia is now successfully diagnosed and medically treated for her mental illness. She has gained weight. The mold was identified as Black Mold, which is a health hazard. It was safely removed, and its cause, a leaky roof, was repaired. Her home is clean. Medications are correctly set up and delivered by Continuum's med tech weekly.
Virginia is now continent and her rash has been gone for months. She now will go outside...but only with someone she trusts. A Continuum assistant visits daily for 2 to 3 hours and gives her a shower (plumbing repaired), does light house cleaning (with the goal to have Virginia assist to clean), takes her to get milk shakes (which she loves and provides needed calories), serves lunch, and fixes and puts supper in the clean fridge.
Gloria
Straightening out wrong care
Gloria appeared to have dementia. She saw things that weren't there, she had symptoms of paranoia, she couldn't get herself dressed, she didn't know if she had had eaten or if the "girl" had come to feed her. We noticed every time her husband entered the living room, she would grab the TV remote control, aim it at him, and push the power off button.
There was something about her case that concerned us as we got to know her and care for her: she was on many medicines that were prescribed by two separate doctors-a family physician and a psychiatrist.
We took her to her family doc who had prescribed some of her meds. He had never seen a list of all the meds she was on. Then we took her to the psychiatrist who had ordered behavior modifying medications. We found that Gloria was the victim of an all-too-common medication impasse: the family doc couldn't change the other doctor's prescriptions. And the psychiatrist wouldn't lower dose or discontinue any medications. We then took her to a neurologist who said that Gloria is just a very demented lady and there's nothing more that could be done.
We simply weren't satisfied with the diagnosis and treatment. We took Gloria to another doctor whose practice included working with geriatric cases and with whom we had worked in the past. He weaned Gloria from all of her behavior modifying meds. Medications were administered by Continuum's med tech.
With the teamwork and coordinated efforts of a knowledgeable doctor, a good assisted living staff, Continuum care management to keep it all together, and wonderful adult children encouraging their Mom. Her conditioned was a pseudo-dementia.
Gloria moved from the assisted living home, leaving her wheel chair behind. She eventually moved nearer her son and lived happily for years. We kept in contact by sending each other notes and cards for several years after, until she passed away.
Irene
Alone and coping but certainly not nuts
Irene lived alone. Her family lived out of town and she had pretty much out lived her friends.
Her daughter-in-law was certain that Irene was demented. She was concerned and always eager to hear our observations about Irene's mental abilities.
One evening around dinnertime one of our Care Managers arrived at Irene's house. She knocked on the door and, as usual, let herself in. Irene was in the dining room where she sat at the head of the table with dinner on her plate in front of her. The table nicely set. Across the table from her, setting on a chair, on top of two phone books, was a three foot Teddy bear wearing a black top hat. Dinner plate, water glass, knife, fork, spoon set neatly in front of him.
After Irene stopped laughing at the expression on our Care Manger's face, she explained that her son had given her the Teddy Bear long ago on a New Years Day visit. It's lonely to eat alone, so she didn't. She set up the Bear and ate with memories. So who's nuts?
Probably the most important thing in care management is... discover what is real, relevant, and true.