Dementia Days

So, that dreaded ghost of dementia pops up in my family’s midst, and I throw myself headlong into all the logistics that come with it. I take care of living arrangements, doctors visits, safety concerns, food needs, financial matters, and so on and so on, and suddenly I have a moment with nothing to do. I’ve just spent days, weeks, months, even years, adjusting to the new reality, thinking about everybody but myself. And now, there’s me. And chances are, I have this moment right after I realize I forgot something.

And there it is, not a ghost in the room, but more like an elephant: Am I showing the beginning signs of dementia? Have people been politely tolerating my lapses?

Over the past days, weeks, months, years, I have scanned my memories of the past, and there were so many “oh” “ah” and “aha” moments, realizing how long dementia had already been a steady companion to my mother. The continuous searching for keys and glasses, the missed appointments, the oddly addressed envelopes, the strangely stored possessions, the decreasing ability to communicate in a true dialogue – many of these things having been going on since I was a rather intolerant teenager who was more concerned about having her own voice heard.

So now, in this moment after I’ve misplaced my keys or forgot about my sons play-date or just monologue-ed at my husband for 10 minutes straight (he truly is an exceptional person!), I begin to wonder… If Sigrun’s dementia started long ago, maybe mine is starting now? It does run in families, and I’ve found myself to be quite forgetful lately…

It is much easier letting go of stigmas and being understanding and compassionate with your loved ones dementia. When I consider that I myself may be developing dementia, I find myself right back where I was with the fear, dread, and lack of understanding about the disease.

The next step is to contemplate the consequences: So what if I have dementia? If it’s ok for my mother, why should it not be ok for me? My sister Fiona reminds me frequently that it is, after all, a race between the mind and the body. One of them is going to give before the other. Which would I prefer: To be in pain as my body bids farewell, or to feel somewhat confused, but mostly pain free as my mind takes a permanent vacation? In the end, much of the sorrow of dementia resides with the family and friends, and not with the patient. And, if I were to develop dementia, maybe I could prepare my family by letting them know that I’m ok with this new path in life…

Then again, maybe I’m just sleep deprived and hyper-sensitized to the issue, and need to put things in perspective:

When I had kids, I had to become a grownup. Now, that my father has passed away and my mother is barely there, I am becoming the “older” generation. Nobody ahead of me anymore. I am on deck – and I don’t even know much about sports!

Ultimately, I need to realize that there are many reasons to be forgetful and I seem to find myself in the eye of the perfect storm:

I am the mother of two small children (Sleep? What’s that?). I am caring for somebody with Alzheimer’s (not a bad reason to be a bit paranoid). I am about to turn 40 (Time to take stock!), and I am trying to be a decent wife while working from home. So, there’s a lot on my plate. And my guess is that there’s a lot on most of your plates.

Let’s be forgetful together and know that it could be for any number of reasons!

There are quite a few scenarios in life, when one becomes the target of a barrage of unsolicited advice. Motherhood, certainly, jumps to mind as the most prominent example. As we become parents, surviving the trials and errors of child rearing, we feel battle-hardened, involuntarily enlightened, full of lessons-learned and to be shared with newcomers to the universe of parenthood. And bursting with all this new information, one is often hard-pressed not to inundate the unsuspecting new mother or father with – well, that barrage of unsolicited advice.

Caring for a loved one with dementia also puts us into a unique group of battle-hardened people. People who want to share the “had I known this in advance” experiences in hopes that they may save somebody else a bit of trouble; or maybe, in order to tell somebody about the struggles we’ve undertaken to show our loved one just how much we truly love them – knowing full well, that the very person this love is meant for no longer understands.

So, with that, here’s my unstructured, unorganized, stream-of-consciousness laundry list of unsolicited advice about lessons learned from the journey through dementia:

1. Get a Durable General and Health Care Power-of-Attorney!

The most helpful piece of advice (and help – thanks, sweet family!) I have gotten in the course of this odyssey was to get a Durable General and Health Care Power-of-Attorney (POA) for my mother – while she was still able to sign one. Make sure the general POA includes wording for financial matters, as well.

The National Cancer Institute defines the durable power-of-attorney as follows:

A type of power of attorney. A power of attorney is a legal document that gives one person (such as a relative, lawyer, or friend) the authority to make legal, medical, or financial decisions for another person. It may go into effect right away, or when that person is no longer able to make decisions for himself or herself. A durable power of attorney remains in effect until the person who grants it dies or cancels it. It does not need to be renewed over time. Also called DPA.

(National Cancer Institute, U.S. National Institutes of Health, www.cancer.gov)

The Family Caregiving Alliance National Center on Caregiving has a great FAQ on durable POAs at: http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=434

Their website www.caregiver.org is filled to the brim with excellent information and advice.

I have had to use that power-of-attorney in so many situations that were logistically challenging as they were, but would have been bureaucratic nightmares without the power-of-attorney.

As wide-spread as dementia is, there still seems to be an indescribable ignorance to the handicaps demented people face.

Before I had the power-of-attorney, I almost got dizzy in some interminably circular conversations with credit card reps, bankers, even newspaper sales people:

“I speak for my mother, because my mother has dementia and can no longer make rational decisions about these matters. No, I don’t have a power-of-attorney. No, she can’t come to the phone to discuss this with you, because she has dementia. No, she no longer is able to read the newspaper (use a credit card, work her bank account), and no, she doesn’t want another subscription (credit card, banking services). No, she can’t come to the phone to explain that to you because she has dementia…”

Get that durable power-of-attorney as soon as you can! And get a living will with it, while you are at it!

2. If your loved one is still able to understand, talk with them about dementia. If possible, tell them they have dementia. There still are so many stigmas attached to dementia, that shame, embarrassment, and anger are ready companions to any discourse, even just thoughts about the disease. But pretending everything is just fine can add challenges that may not need to be there.

A long time before my mother was diagnosed, she used to make jokes about Alzheimer’s. Back then I thought that her humor was simply a bit inappropriate. In retrospect, I believe she was already struggling to keep up appearances, divert any suspicions, possibly even convince herself that dementia was nothing for her to worry about.

For many years, as a family, we came up with excuses, justifications, seemingly reasonable explanations for my mother’s scatterbrained behaviors. And many of them may have been true. After all, having three children within three and a half years, will drive anybody close to dementia.

Yet, when I think how much easier things became when we all acknowledged Mr. Alzheimer in our midst, I wish we had talked about it sooner. Instead of working hard to pretend that everything was ok, my mother felt free to rant at the disease for making her life more challenging. When something wasn’t going right, we could all jokingly blame that darn Mr. Alzheimer (to whom I, of course, apologize, since he’s not to blame).

As my mother’s care level increased and she needed to get help performing some of those tasks for which we need privacy or independence to maintain our dignity – such as bathing and eating – , we could always talk about the disease, and she didn’t need to worry that it was her who was somehow not smart enough, not capable enough, not independent enough. I realize that for some families to talk about dementia might not be an option, but don’t be too quick to think that is you. I never would have guessed that my mother would be able to accept the disease. Yet she did. And she has weathered the many many challenges much better for that acceptance.

3. Get in touch with your local Alzheimer’s Association chapter (www.alz.org)!

Not only do they have some of the kindest people who will listen to your sorrows, they also have a great newsletter with community events and updates on new research, as well as a plethora of information. The main website (www.alz.org) will let you search for contact information for your local chapter.

4. Be the squeaky wheel!

My mother lives at an assisted living facility. So I can’t talk about care giving at home. However, after three moves between assisted living facilities, and researching about a dozen or so on each move, I feel like I have a pretty good sense about what’s out there in terms of assisted living and reminiscence care units. First of all, no matter how much you pay (well, except for the $10,000 or more a month facilities) most assisted living facilities are understaffed, and the staff is underpaid. That, of course, means that turnover is high, and you may get to know many different dedicated, but overburdened caregivers during your loved ones stay at such a facility. On the upside, it also means that if you don’t like a caregiver, chances are, they won’t be around in a few months.

Because caregivers are stretched to the limit, things fall through the cracks. I have found myself becoming educated about medications and treatments, because I am my mother’s only advocate. She can’t say if something isn’t working or she doesn’t want something.

After a hip fracture, my mother had to live at a skilled nursing facility for a few months. She had a great nutritionist, a charming activities director, but a horrible director of nursing unable or unwilling to deal with the challenges of dementia, who, hence, was trying to “chemically restrain” my mother. And since skilled nursing facilities can easily write prescriptions, they bombarded my mother with heavy duty medications that were clearly inappropriate for dementia. I was not asked before my mother was medicated and soon had the added challenge of seroquel anger. (More on that in another blog post)

Note to all you wonderful caregivers out there: I hope you will comment on this blog and let us know about the many difficulties of your jobs and let us know how we as family members can make your life easier.

5. Take your loved one out for excursions while you still can.

My mother loved going out for meals, sunbathing, dressing up to go to the opera, or anything that made her feel like she wasn’t trapped at the assisted living facility. She no longer is able to easily leave, and, although we did a lot, I wish we could have done more.

I will add to the list as more things pop to mind. In the meantime, I hope anybody who reads this blog, will feel inspired to add their own tips and tricks.

It takes a village to raise a child. It takes that same community to care for the elderly.

Sigrun Posing for Photographer

A few days ago, on my way to visit my mother, one of her care managers approached me with a request: My mother’s closet is packed full of clothing, and it is difficult for the care managers to keep everything laundered and organized. Since Sigrun no longer wears most of those clothes, the (very nice and considerate) care manager suggested that I remove some of that clothing from my mother’s apartment.

It seemed like a very reasonable request; a request I agreed to without hesitation.

Then, I found myself standing in front of her closet – paralyzed, unable to remove much of anything. There were some blindingly bright pieces of 70s garb, some sheer blouses in all the colors of the rainbow, tight, form-fitting tops and sleek pants; most items clearly impractical for life in the reminiscence unit.

All of this may sound like the wardrobe of Peggy Bundy, but it is the tool chest of the couture magician I know as my mother. For as long as I can remember, Sigrun has been an impeccable dresser – no, more than an impeccable dresser, a woman with style; not a fashionista following every trend, but rather a connoisseur of elegance that lasts. Her favorite designer – Coco Chanel. Remember the pencil skirts with the tight short jackets? The high heels and the cute little hats? That was my mother, and, if she was still capable of picking out her clothes, it would still be her.

So, who am I to steal colors from the palette of Michelangelo? Sneak instruments out of Mozart’s compositions? So what if my Michelangelo started wearing 13 pairs of underwear at the same time? I’m sure they were carefully chosen and matched in color! So what if shoes didn’t always come from the same pair? I’m sure they, too, complemented each other in my mother’s creative mind!

In fact, Sigrun still holds strong opinions on anything that might compromise a perfect ensemble. When I visit my mother, I am always acutely aware of what I am wearing. As I stand in front of the entry to her assisted living place, I look myself over, regretfully discovering the snot stains on my jacket from my children’s runny noses. I rediscover the little hole that I’ve been meaning to fix in my sweater. And, oh yes, there’s the pimple that’s been forming on my forehead.

And, sure enough, as I then sit across from my mother, the lady who now is confined to a wheelchair and no longer is able to intelligibly utter a sentence, the lady whom I love so dearly, her outstretched finger comes across the table and finds its target infallibly, pointing out the hole in my sweater, or the snot on my jacket, or, unabashedly, the pimple on my forehead. Her facial expression seems to indicate a caring, but concerned recognition that I simply can’t measure up to her understanding of style.

Another Pose

And indeed, I can’t. As a member of the sandwich generation, juggling 2 kids, a mother in reminiscence care, and work, all the while trying to also be a reliable, loving partner to my wonderful husband, I feel I have plenty of excuses for the snot, the hole, maybe even the pimple! Then again, how did my mother do it? She had three kids, worked part-time, traveled, yet always looked impeccably groomed.

Drifting into the oblivion of dementia, my mother continues to set an example for me, not to let myself go, to take pride in my appearance, no matter what the setting, no matter what my mental state may be (and with sleep deprivation and toddler distraction, it often times resembles the early stages of dementia).

Mental note: fix that hole! (since I can’t do anything about the pimple or the snot)