Dementia and Wandering

Wandering:

 

Try these tips to prevent wandering out of the house by your loved one.

 

1. If there is a securely locked high fence around the whole perimeter of the property, let your loved one go outside, in good weather.  Go outside with them.
2. If there is no secure fence or there is other danger to allowing them to go outside at will, try these approaches:
   1. Remove from site triggers that would make the loved one or person with dementia think of going out, such as coats, umbrellas, shoes, purse, etc…
   2. Tell your loved one or person with dementia frequently where they are and why, in a calm tone of voice. Reassure them with words like, “XXX will return in an hour to be with you” or “Your family knows where you are”.
   3. Don’t confront or argue with the person, walk with them and redirect to another part of the house or to an activity. Use humor if possible.
   4. Purchase childproof doorknob covers, or deadbolts to put on the door above the loved one or person with dementia’s eye level, or slide bolts on the top or bottom of the door. These items will never be used when the loved one or person with dementia is alone in the home, only when someone is with them.
   5. If you don’t want to do any of the above, place warning bells above the outside doors, or activate the house alarm system, or get a monitor that goes on the loved one or person with dementia (such as a toddler monitor) or a pressure mat alarm, so at least you know when your loved one or person with dementia has left the house.
   6.  Try putting a full-length mirror on the inside face of the outside door. Sometimes people don’t recognize themselves and think someone is standing there and turn around and go back.
   7. Try putting a black throw rug in front of the outside door. To some people, it looks like a hole in the floor and that they won’t attempt to cross it.
   8. You might try to hide the outside door by putting a curtain in front of it, or maybe by making sure it is the same color as the surrounding walls, that way it may not be seen by the loved one or person with dementia.
   9. Put a big sign on the outside door saying “Stop” or “Do Not Enter” or “Danger- Do not Open”.
   10. Sew ID labels in the loved one or person with dementia’s clothes, or get a special Medic alert bracelet for the loved one or person with dementia, if they have a history of escaping the house. Also they need to have a current picture and a piece of unwashed clothes (for tracking dogs) handy to give to the police, in case the loved one or person with dementia does escape.
   11. If the loved one or person with dementia escapes while you are in the bathroom , grab your cell phone, and run out side, look around the whole block the house is on. Cover the whole block, if not found, call 911 and tell them that a person with dementia has escaped the house and is lost. Try to convince them that this person needs to be found immediately, they need their medicines badly.
   12. If the loved one or person with dementia doesn’t recognize his or her home as where they live, they may want to leave to go “Home”. They may be thinking of a home they lived in previously, such as in their childhood. Instead of telling them that this is their home, talk about the home they are thinking of. Reminiscing about it sometimes lessens their urge to leave.
   13. If they still want to go “home” tell them you will walk with them, and take a walk with them or tell them that you will drive them there, and take them out for a drive. It may help if you stop to get a treat, an ice cream cone, or snack. They probably will have forgotten about the other home by the time you get back, and may even recognize where they live now as home.

By Carole Larkin  MA, CMC, CAEd, DCP, QDCS, EICS is an expert in Alzheimer’s and related Dementias care. She has a Master’s of Applied Gerontology from the University of North Texas, is a Certified Alzheimer’s Educator, is a Dementia Care Practitioner, is a Qualified Dementia Care Specialist, and an Excellence in Care Specialist at the Alzheimer’s Foundation of America, as well as a Certified Trainer/Facilitator of the groundbreaking dementia care training tool, the Virtual Dementia Tour Experience She is a Certified Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. She consults with families telephonically nationwide on problems related to the Dementias. Her company, ThirdAge Services LLC, is located in Dallas, TX, and her website is www.thirdageservices.com.

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Driving and Dementia

Driving and Dementia

  What specific driving abilities decline in older drivers, even ones without dementia?

 

Well for one, older drivers have declines in their physical ability, meaning that they have declines in their muscle strength, their coordination, their reach, and in their range of motion for their arms, legs, upper body, and neck. Some may lose consciousness periodically when having TIA’s (also known as mini strokes).

Secondly, older adults lose what is called their psychomotor ability.  They lose the ability to respond quickly to something happening immediately in front of them like a dog running out in the street followed by a child chasing the dog.  They may not be able to respond differently to different types of things happening to them — such as their car skidding or hydroplaning on a wet patch of road, after driving on dry roads just a second before that.  In other words, their hand-eye and their foot-eye coordination can decline or slow down.

 

Additionally their visual ability declines just because they are older adults. They find it more difficult to differentiate things clearly under low light (night) and low-contrast (dusk) situations.  It’s also harder for them to see objects in motion (like a child darting out into the street) and when there is glare and right after glare is gone. Also many people’s peripheral vision becomes blurry or dark and they can develop glaucoma, cataracts and macular degeneration.

How does dementia add to declining driving abilities?

Dementia causes perceptual ability to decline. Perceptual ability is the ability of the brain to correctly interpret and act on what a person sees and hears, for example detecting the actual speed and motion of other cars on the road. A cognitively impaired person could stop at a red light, then pull out into traffic going on the green light without realizing that those cars were entering the intersection. A person with dementia may not recognize the sound of a train whistle while they are crossing a railroad track.  Sometimes the perceptual ability just slows down, meaning that the person does recognize what they see or hear but the recognition happens too slowly to react in enough time to avoid an accident.  Some cognitively impaired people have hallucinations and react to things that are just not there, thus causing danger to themselves and other drivers.

In people with dementia, the ability to pay attention to things going on while driving lessens in several important ways. The person’s attention span is shortened. They may forget to properly react just seconds after seeing something that needs to be acted upon. They may not be able to share their attention between several different things happening at the same time and get confused as to which to respond to, or may not respond to anything that is going on. Also they may not be able to easily shift their attention from one set of circumstances to another, or just shift attention fast enough.

Certainly in people with Alzheimer’s and some others dementias their memory declines. At any given moment they may not be able to retrieve the memory of what to do when a situation arises.  For example, remembering to allow the vehicle on your right to proceed first when both cars are stopped at an intersection simultaneously.  Or remembering what a stop sign means.

Other cognitive abilities decrease as well. Declines in executive functions such as logic, decision making, self awareness, impulse control, and initiation of action can and do lead to dangerous situations. Even if the person performs adequately most of the time, you never know when they will have that moment of failure of executive function. The fluctuation in abilities can and does change from moment to moment.

Are there any ways to counteract these losses, to keep the person with dementia driving safely   early in the disease?

Yes.  Some things can be tried such as:

Going to an Occupational Therapist who specializes in assessing driving skills in the elderly is a start.  After the therapist determines the deficits, they suggest ways to compensate for some of the deficits. Some methods involve vehicle control assists, and some involve training or retraining driving skills.

For cognitive deficits, sometimes Psychologists can train a person to help with mental processing of stimuli, which might lead to improved performance in driving skills for a short period of time.

Restricting the amount, times and locations of driving is another method. Some elderly drivers impose these restrictions on themselves, but for those who do not, the family needs to impose them — and monitor compliance on a routine basis (at least once every week or two).

Generally, experts agree that it is beneficial for people with dementia to be able to drive as long as they are not a danger to themselves or others.  When they hang up the car keys they are in danger of losing their access to friends and family, to medical providers, to shopping and other services crucial to keeping them independent. Isolation leads to depression and other physical and mental issues.

 What are some of the warning signs that driving behaviors can cause safety problems?

 

The American Academy of Neurology came out with recommendations and warning signs of unsafe driving on April 12^th 2010 but I find the list issued by the Hartford Insurance Company  in their brochure “We need to talk… Family conversations with older drivers”  is more complete. It is free, and can be ordered at www.thehartford.com/talkwitholderdrivers.

They list the signs from the minor signs to very serious issues.  Family members should observe (ride with) the person with dementia for a minimum once a week, and over a period of time. The person observing should keep notes so that changes in driving ability can be seen. The observer should look for a pattern of warning signs and for an increase in the frequency of occurrence of those signs. The signs are as follows:

 

A decrease in confidence while driving.

Difficulty turning to see when backing up.

Riding the brake.

Easily distracted while driving.

Other drivers often honking their horns.

Incorrect signaling.

Parking inappropriately.

Hitting curbs regularly.

Scraping or denting the car, mailbox or garage.

Increased agitation or irritation when driving.

Failure to notice important activity on the side of the road.

Failure to notice traffic signs.

Trouble navigating turns.

Driving at inappropriate speeds.

Not anticipating potential dangerous situations.

Using a “copilot”.

Bad judgment making left hand turns.

Near misses.

Delayed response to unexpected situations.

Moving into the wrong lane.

Difficulty maintaining lane position.

Confusion at exits.

Ticketed moving violations or warnings.

Getting lost in familiar places.

Car accident.

Failure to stop at stop sign or red light.

Confusing the gas and brake pedals.

Stopping in traffic for no apparent reason.

 

The rule of thumb is once you are nervous or uncomfortable riding with that person, the person needs to stop driving.

 

How do families broach the subject of stopping driving?

 

The most effective method is with several short conversations centering on health and safety. That way a pattern of open, calm, non-threatening dialogue has been started. There is no direct confrontation, no strain of asking them to change their driving behaviors. Opportunities to open discussion might be shortly after a car accident or near miss, or after seeing the doctor and new medicine has been prescribed for your family member.

 

Things that you can say to open dialogue might be:

“Have you talked to your doctor about the effects of your new medicine on your

driving?”

“That was a close call yesterday. I worry about your safety on the road.”

“Driving isn’t what it used to be.  There is so much more traffic nowadays, and people are driving more aggressively than ever. I read about road rage accidents and incidents in the paper all the time now”

“I worry about your getting lost.”

Of course, the comments should be appropriate to your loved one’s personal situation. Be prepared for negative reactions. After all, your loved one knows where these conversations are leading.  They understand that a big portion of their independence is at risk. They know that they will be more dependent on family members and others and that they will have fewer social opportunities. They might become depressed or even angry at the thought of giving up their driving privileges, even if they secretly agree with the assessment of their driving ability.

Who should be the one to start these conversations?

A Harvard/MIT survey concluded that married drivers prefer to hear about driving concerns first from their spouses. Those living alone prefer to have these conversations with their doctor, their adult children or a close friend, in that order.  Adults over the age of seventy-five allow their adult children to have more influence than younger seniors. Older drivers DO NOT want to have conversations with police officers on this subject. Would you?

How does a person prepare for these talks?

First, do your homework before you ask your loved one to restrict or stop driving.

Make sure that you have observed them behind the wheel a number of times over an extended period of time.

Have the knowledge. Learn the warning signs of driving problems and cite them in your discussion.

Speak to your family members’ doctor to see if they would be willing to help. Some doctors may take an active role in giving an opinion or writing a prescription to stop driving. Others may refer a concerned patient and their family to a driving rehabilitation therapist (OT) for assessment.

Have ready other options for transportation. Offer yourself or other family members to drive to doctor’s appointments, to the grocery store or for other errands, to social events, as your schedule allows. (If your loved one can still take public transportation find out what’s available to them. Many cities and towns have special buses for disabled adults. Prearranging for a regular pick up and drop off to the same location may work for awhile. Offer to pay for a taxi if your loved one can still handle that. Make sure the taxi driver knows not to let them off anywhere other than the designated location and watches them to ensure that they go in the door of the designated building. Private transportation is available as well. Look for companies offering rides for seniors. The same instructions would be given to the operator of the senior ride as are given to taxi drivers.

Be calm and supportive. Always let your loved one know that your concern is for their safety and well-being and that you love them. You might use some of the following direct appeals to your loved one.

“Even if you were not at fault in an accident, you could be seriously injured or die.”

“I know you would feel terrible if someone was hurt when you were driving.”

“I’m afraid to let the grandchildren ride with you”

“Let’s talk with your doctor about this.”

What if your family member refuses to stop driving?

Sometimes it takes more than just conversations. Maybe not renewing their driver’s license or canceling insurance will be enough. The State licensing authority can be notified in writing of your concern about the ability of your loved one with dementia’s ability to drive safely. Ask them to retest in all three areas: vision test, written test and driving test. Sometimes the prospect of being tested will make your loved one give up the keys voluntarily. Sometimes they can’t pass all the tests. Even if they do pass all the tests, you can ask that your loved one be tested again, say in 3 months or so. You may have to consider disabling the car, filing down the keys, or removing the car from their premises. These are drastic measures, and only to be taken when all other interventions have been tried and have failed. They probably will be very angry with you, but usually in time the anger fades. It’s really a small price to pay to keep your loved one safe and alive.

What dangers arise for families who do not address their loved ones with dementia’s declining driving skills?

The danger that always is cited first is that their loved one will get lost. People with dementia get lost driving every day. The longer into the disease they drive, the higher the chance that they will get lost, even driving to their self limited locations, such as the closest grocery store or drug store. Nonprofits such as the Alzheimer’s Association as well as a variety of corporations have systems for finding lost dementia patients. Technology can be used such as GPS or cellular tracking. They are good of course, but it is like closing the door after the house is already out of the barn. The real answer is for the family to be proactive and monitor their loved one with dementia’s driving skills and stop them from driving before they reach the point of getting lost.

 

Another danger to the person with dementia and the family is the much higher risk of liability from causing an accident — causing property damage, injury or even death. The family should check the limits of their loved one’s liability insurance, and increase the coverage as much as they can afford. Even then, there may not be enough coverage to protect the person from losing their income, home and retirement savings and other assets. If your loved one hits a bus full of people from the retirement home up the street, or a school bus full of children, will their insurance cover the costs from law suits that families of those injured or killed will file against them? I don’t think so.

One of these days, a judge somewhere will rule that the other family members (meaning adult children) are liable as accessories, if they knew that their loved one should not be driving, yet took no action to stop them. The likelihood of this ruling will rise with the number of people killed or injured by demented drivers. As more and more people enter older adulthood, and the epidemic of Alzheimer’s and other dementias continues, this result seems inevitable. When the ruling occurs, it will have an immediate impact on the income and assets of the family members who knew and did not take action. That would be devastating to all the family members affected.

 

By Carole Larkin  MA, CMC, CAEd, DCP, QDCS, EICS is an expert in Alzheimer’s and related Dementias care. She has a Master’s of Applied Gerontology from the University of North Texas, is a Certified Alzheimer’s Educator, is a Dementia Care Practitioner, is a Qualified Dementia Care Specialist, and an Excellence in Care Specialist at the Alzheimer’s Foundation of America, as well as a Certified Trainer/Facilitator of the groundbreaking dementia care training tool, the Virtual Dementia Tour Experience She is a Certified Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. She consults with families telephonically nationwide on problems related to the Dementias.  . Her company, ThirdAge Services LLC, is located in Dallas, TX, and her website is www.thirdageservices.com

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Should My Loved One Be Taking Alzheimer’s Medicine

Should My Loved One

Be Taking Alzheimer’s Medicine

By Carole Larkin

Over the years my clients have asked me, “Should my loved one be taking any of the Alzheimer’s medicines?” My answers have differed depending on how much I knew about the medicines, the relative costs of the medicines, and how much research has been done on the effectiveness of the medicines. Here is what I’m saying currently.

 

There are only 5 medicines that the FDA has approved for treatment of Alzheimer’s disease. The first one approved isn’t prescribed very much anymore (Cognex). None of the medicines cure the disease. None of the medicines stop the disease process from continuing on longterm, though they slow the progress of the disease for a period of time. The current time frame for slowing the disease has been estimated to be between 18 months and 36 months depending on the individual. The medicines may hold the memory loss steady and/or positively impact some of the common Alzheimer’s “behaviors”, meaning anxiety, paranoia, aggressiveness and other “negative behaviors”. The current estimate is that about 30% of people who are taking the medicines are helped by the medicines, but 70% are not helped by them

 

Alzheimer’s medicines approved by the FDA for early stage are:

• Razadyne  (galantamine, Reminyl)
• Exelon (rivastigmine)
• Aricept (donepezil)
• Cognex (tacrine) not prescribed much anymore.

 

Medicines that increase the effects of the above Alzheimer’s medicines are:

• Tagamet (cimetidine) – for Acid Reflux and ulcers
• Nizoral (Ketoconazole) – for Dandruff, Dermatitis, fungal and yeast infections
• Norvir (ritonavir) – for HIV/AIDS or too much serotonin
• Paxil (paroxetine) – for anxiety and/or depression
• Erythromycin – antibiotic

 

Medicines that decrease the effects of the above Alzheimer’s medicines are:

• Benadryl – Antihistamine
• Detrol  – Bladder control drugs

 

Alzheimer’s medicine approved by the FDA for middle-late stage is:

• Namenda  (memantine)

 

Medicines that interact negatively with the above medicine:

• Sodium Bicarbonate – baking soda, antacid
• Diamox (acetazolamide) – pulmonary edema, Sleep Apnea or Ataxia (lack of muscle coordination)

 

Researchers and a number of neurologists have recommended that patients with Alzheimer’s take one of the medicines for early stage and the medicine for middle stage together (during the same day), if they can tolerate the side effects of the medicines. The most common side effects of these medicines have to do with the gastrointestinal system, such as nausea, vomiting, stomach pain, and diarrhea. There are other side effects as well. Many caregivers when faced with one or more of these side effects appearing in their loved one after just a day or two abandon the attempt to use the medicine, but It may take up to several weeks to build up enough tolerance to the drug so that the side effects stop. That is why doctors titrate, or build up the level of the drug slowly (from 5 mg to 10 mg for example). While understandable that people don’t want to see their loved one suffer with the side effects for very long, it could be that the medicine is not given a decent chance to build up to high enough levels in the system to do its job. Maybe that’s why there isn’t a higher percent of effectiveness. That could be a new avenue of research!

 

Also, for a percentage of the population (in the USA) the cost of the medicines enters into the decision whether to try these medicines or not. Currently all of the medicines for early stage have gone generic, there for greatly reducing the cost of the prescriptions. The drug for middle stage and later is due to go generic in 2015. Perhaps not everyone buying these medicines knows this, and is still paying for the brand name. I hope not!

 

So, after all that information, the central question still remains. Should my loved one be taking the medicines?

 

Most certainly they are worth a try (meaning having the person on the drug for 2-3 months) if a couple of conditions exist.

 

• It’s early in the disease progression.

 

The problem is that many people don’t recognize the disease soon enough, or are in denial about the existence of the disease in their loved one, so that the opportunity for the early stage medicines to work is already gone. The medicines work on living cells, not on cells that are near or at death. The person may have so many dead cells in the brain that giving medicine to the live ones is essentially too little, too late. If that’s the case; what’s the point of spending the money on drugs, no matter what the price of the drugs are, cheap or not?

 

Another problem is actually the reverse of non-recognition or denial of the disease process. Many people think that their loved one is later in the disease than they actually are. Because they don’t know much about the disease, they think that early signs of the disease are actually middle or late signs of the disease (for example: asking questions over and over again, having trouble paying bills or taking medicine properly.) The caregivers mistakenly think that their person is “too far gone” and won’t even try the medicines. If the caregiver educates himself or herself as to what the actual stages of the disease look like, or conversely takes their loved one for neuro-psychological testing on a yearly basis to have a professional determine where in the disease they are, then the caregiver could make a more informed decision when determining whether to give their loved ones the medicines or not.

 

• If the caregiver or person with Alzheimer’s can afford it.

If buying the Alzheimer’s drugs, means that the person can’t afford his or her heart medication or thyroid medication or medication for their breathing, well by all means don’t buy the Alzheimer’s medicine! If buying the Alzheimer’s medicine means there isn’t enough money for food, rent, utilities and other basics of life, of course the Alzheimer’s medicines shouldn’t be bought. First things first! If there is any confusion on this point, just Google” Maslow’s hierarchy of need” and look at the bottom levels of the pyramid.

 

 

Then, if the person is already on one or more of the drugs, the question becomes, when should he be taken off of them?

 

• Because the estimate of how long they do well on the drugs is currently between 18 and 36 months, you could try it at the 3 year mark. The only way you know if the drugs have been doing any good is if when they are taken off the drugs, they take a sudden and sharp downturn in cognition (as expressed by things they are able to do for themselves, like dress, or feed or bathe themselves) and or memory. With the downturn you’ll know if they were being helped by taking the meds, but even if you put them back on the medicines again, they will never return to the level they were at when they were taken off the drugs. Quite a dilemma for the caregiver, I know. That’s when the caregiver should know what stage of the disease the person is at when they were taken off the drugs. If they are at the late stage, it just may not be useful to even attempt to put them back on the drugs. That again means either education on the caregiver’s part or neuro-psychological testing.

 

• And if the caregiver or person with Alzheimer’s can afford it.

 

Everything I said before bears repeating, plus the fact that there will be more medical costs awaiting the person with the disease than there were before. That’s the nature of this disease. Costs for physical ailments do rise as the disease goes on either because the cognitive problems have caused a deterioration in the person’s ability to be self aware of the things that need to be done for their other illnesses (like comply with a prescription taking regimen) or because the disease itself can cause failures in other organs and body systems, in the late stages.

 

• Finally taking someone off the Alzheimer’s drugs inevitably involves the caregiver’s inherent ability to take risks themselves (as the decision maker). Also the caregiver needs to be self aware of their own tendency towards creating guilt in their own minds, no matter whether keeping the person on the meds or taking them off the meds.

 

•  Since there is no clear right answer to the taking off/putting back on answer, it seems to me that the best a caregiver can do is learn as much as possible about the disease and about the med(s) their loved one is on, make their (informed) decision, own that decision, and then grant themselves Grace by saying, “I’m confident that I made the best decision for my loved one I could have, at the time.” Because you did…

By Carole Larkin  MA, CMC, CAEd, DCP, QDCS, EICS is an expert in Alzheimer’s and related Dementias care. She has a Master’s of Applied Gerontology from the University of North Texas, is a Certified Alzheimer’s Educator, is a Dementia Care Practitioner, is a Qualified Dementia Care Specialist, and an Excellence in Care Specialist at the Alzheimer’s Foundation of America, as well as a Certified Trainer/Facilitator of the groundbreaking dementia care training tool, the Virtual Dementia Tour Experience She is a Certified Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. She consults with families telephonically nationwide on problems related to the Dementias. Her company, ThirdAge Services LLC, is located in Dallas, TX, and her website is www.thirdageservices.com.

 

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Deficits in Executive Functioning in Alzheimer’s Disease

Deficits in Executive Functioning

in Alzheimer’s Disease

By Carole Larkin

Shall we ponder some of the issues regarding slowly losing executive functions in Alzheimer’s and related diseases today? First, let’s define what executive function is.  An article by Leilani Doty, PhD, the Director of the University of Florida Cognitive and Memory Disorder Clinics tells us that executive functions generally take place in our frontal lobes, right behind our forehead. These functions include our ability to plan things, to solve problems, to organize things in our heads, to develop the initiative to start something, to make an appropriate decision, to consider consequences of our choices, to form an idea, to prioritize things, to be able to control your own emotions and to be able to think abstractly. Additionally executive functions include the ability to use working memory (to hold the item in your head long enough to use it or apply it to something else), the ability to pay attention to something without getting distracted, the ability to focus in on important details, to work towards a goal (plan), to adjust to changes (shift gears midstream) and to know when to stop an action or task that has been completed. These things are what place us above other animals; in other words what make us human.

She breaks it down into 4 main steps:

1. “Start: Think about the problem and what needs to be done. Think of a way to solve the problem. Consider resources, past experience, new possibilities, values, deadlines, etc.
2. Maintain: Start acting on the first step and continue until that step is done.
3. Switch: Do each step and move on to the next step in order to complete the task or solve the problem.
4. Stop: Evaluate the outcome. Is the end result good, is it adequate, is it finished, or is more action needed? When done, then stop.”

And here are some finer brain actions within the main steps of executive function:

1. “Forming ideas to do an action.
2. Starting an action.
3. Maintaining an action until the step is finished (knowing when a step is done).
4. Switching behaviors to do the next step needed.
5. Regulating, controlling and adjusting body actions to deal with changes and new information along the way.
6. Planning a tactic down the road to deal with a new issue or new direction.
7. Holding details in working memory.
8. Controlling emotions.
9. Thinking abstractly.
10. Knowing when the whole task is finished, stopping that task, and moving onto a different task or activity.”

Follow this link to see the full article: http://alzonline.phhp.ufl.edu/en/reading/ExecutiveFxLatest.pdf.

Phew! That’s a lot of things that executive function controls. Now imagine the neurons in that part of the brain beginning to die. Think of it as if there is a light bulb representing that part of the brain  and it begins flickering; sometimes on strongly, sometimes on weakly, sometimes not on at all. Well that’s how it is for years and years in Alzheimer’s and other related dementias.

How do you (the caregiver) know when the person’s executive function is OK, kinda not OK, or definitely not OK, because it’s always fluctuating? The answer is: you don’t know. You couldn’t possibly know. Because, of course, you are not inside their heads watching the neurons fire, or not fire.  So here you’ve come face to face with the true evil which is Alzheimer’s or another dementia.

You are the caregiver. The one with the whole brain (theoretically). At any given moment, you are responsible for their safety and their continued existence on this planet. Yet, they deserve to be self-reliant and independent as any other adult would be. They know it and you know it.  What to do? What to say? Stressed out much, are you at this moment?

So now, I think we are talking about talking risks here, folks. We do it with them all day, every day. We don’t want to, but we’re forced to. They force us to because many times they are not even aware that the light of logic and reason is weak or has gone out. Oh and by the way, self awareness is another executive function.

I think each of us has their own answer to this quandary. Each of us has their own level of risk that we deem acceptable. And that’s OK, as long as we own our decision, meaning taking responsibility for the decision we make in regard to acceptable risk.

I would ask this of each of you. To think about taking a calculated risk by trying to control the environment or the circumstances in which this action (or non action) takes place, as much as possible. By tipping the scale on the side of safety as much as you can, you are taking a calculated risk as opposed to an uncalculated risk. It takes courage, I know, in the face of the anger and other nasty emotions that you will faced with, from the person with the disease. But at least try.

Carole Larkin  MA, CMC, CAEd, DCP, QDCS, EICS is an expert in Alzheimer’s and related Dementias care. She has a Master’s of Applied Gerontology from the University of North Texas, is a Certified Alzheimer’s Educator, is a Dementia Care Practitioner, is a Qualified Dementia Care Specialist, and an Excellence in Care Specialist at the Alzheimer’s Foundation of America, as well as a Certified Trainer/Facilitator of the groundbreaking dementia care training tool, the Virtual Dementia Tour Experience She is a Certified Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. She consults with families telephonically nationwide on problems related to the Dementias. Her company, ThirdAge Services LLC, is located in Dallas, TX, and her website is www.thirdageservices.com.

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Are Adult Children Responsible for Parents’ Long Term Care Costs?

Are Adult Children Responsible for

Parents’ Long Term Care Costs?

By Carole Larkin

Recently a businessman I know forwarded me a link to a Wall Street Journal article by Kelly Green written on June 22^nd 2012. Although I know his intent was to point out the fact that people need long term care insurance, I was nevertheless nonplussed by what I was reading in the article.

The article pointed out that 29 states have “filial support” laws that could be used to go after adult children wallets to pay for their parents unpaid longterm care bills. Those states are: Alaska, Arkansas, California, Connecticut, Delaware, Georgia, Indiana, Iowa, Kentucky, Louisiana, Maryland, Massachusetts, Mississippi, Montana, Nevada, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah, Vermont, Virginia and West Virginia. Note that only one state, Pennsylvania, routinely allows nursing homes to threaten families into either paying their parents nursing home bills or to complete Medicaid applications for their parents so that the state can pay the nursing home bills.

Under Pennsylvania’s filial support law, the parents have to be considered ”indigent” and the children have  to have the means to pay the bill. Neither threshold is specifically defined, which give courts a lot of leeway.” says Green. One case “Pittas vs HCR Manorcare has gone thru State Court and an appellate panel and both have found for the facility. An application for a reargument in front of the full state appeals court is pending. This is worrisome because Pennsylvania, like a number of the other states listed doesn’t require lack of cooperation or asset shielding on the children’s parts. The simply have to be deemed by a judge to have the means to be able to pay the parent’s bill. Green says that the key to this is not allowing a gap to form between private payments and Medicaid that later become the basis of a claim against children and other family members. She recommends hiring an elder law attorney who is familiar with the process of Medicaid application to be safe.

Online.wsj.com/article/SB10001424052702303506404577446410116857508.html?KEYWORDS=Kelly+green/

This gives a whole new meaning to reclaimed funds, doesn’t it? Scary, isn’t it?

Carole Larkin  MA, CMC, CAEd, DCP, QDCS, EICS is an expert in Alzheimer’s and related Dementias care. She has a Master’s of Applied Gerontology from the University of North Texas, is a Certified Alzheimer’s Educator, is a Dementia Care Practitioner, is a Qualified Dementia Care Specialist, and an Excellence in Care Specialist at the Alzheimer’s Foundation of America, as well as a Certified Trainer/Facilitator of the groundbreaking dementia care training tool, the Virtual Dementia Tour Experience She is a Certified Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. She consults with families telephonically nationwide on problems related to the Dementias. Her company, ThirdAge Services LLC, is located in Dallas, TX, and her website is www.thirdageservices.com.

Check out both sites by clicking on the logos

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Alzheimer’s disease: Do Not Resuscitate, Power of Attorney, Advance Directive

By Carole B. Larkin
With these legal documents in hand — Do Not Resuscitate (DNR), Medical Power of Attorney (POA) and Advance Directive (AD) you have one thing — Legal Control.

Without these properly executed documents you have no control over medical decisions and treatments. With them you have a fighting chance of having a say over medical treatment — and life/death decisions.

With Alzheimer’s or another cognitive illness, you need to understand that eventually your loved one won’t have the ability to make the reasoned decision needed for their best interest. And, it is likely the day will come sooner than you think. You need to get these legal matters taken care of today! Sound urgent? It is! Here’s why.

If you wait, and cousin Freddy, or the hospital administrator, or a doctor, can show that your loved one, Mary, wasn’t “competent” (in a legal sense) to understand the papers she signed — your control is out the window.

Say cousin Freddy’s spiritual beliefs mandate that he make every effort to save a life — no matter how ‘terminal’ Mary is. All he has to do is show that Mary wasn’t competent to sign the papers that say that Mary doesn’t want extraordinary procedures to extend her life.

Disputing Mary’s competency is a mechanism that accomplishes the goal of extending Mary’s life as long as possible and subverting Mary’s wishes and your goal of carrying out Mary’s wishes on her behalf. Often the hospital is inclined to support this legal mechanism. Why? Both for financial reasons and because extending life is what they do.

So you need to get all the legal papers signed early on in the disease, or as early as you can (and hope cousin Freddy doesn’t read this).

Every state has a version of all of these documents. They may be called different things in each state, but the intent is the same. These documents give you the right to act on your loved ones behalf and they (EMTs, doctors, hospitals, nursing homes, whomever) have to follow your wishes.

Lawyers can draw the papers up for a fee, but you can also get them free from the state (in most states). They are fill-in-the-blank type forms. Sometimes they have to be notarized. Call your Area Agency on Aging. There is an Area Agency on Aging for every county in the United States. Ask “What State Agency has the forms for Do Not Resuscitate (DNR), Medical Power of Attorney (POA) and Advance Directive (AD).” With that information you can then go to the state agency’s website and download them. Cumbersome, but FREE. Here is another way to find the information, dial 2-1-1 on your telephone and ask where you can obtain the documents.

Let’s take them in the order of use.

DNR is short for Out of Hospital Do Not Resuscitate. This is for the 911 guys (EMTs). Their job is to try to bring people back to life. They will do their job unless told not to. It may be great for someone who has been without breath or heartbeat for five minutes, but what about twenty-five minutes? Without a DNR to waive in the EMTs face, off they go to the hospital trying to revive all the way. What if a well meaning neighbor called 911 and you weren’t home? You loved one is revived and on the way to the emergency room. Your next opportunity to assert your control over the situation is at the hospital. To do that you must present the hospital with a valid Medical Power of Attorney (POA). Keep one in your car.

The hospitals have you sign one if you don’t have your own, but the one they give you may be contestable if your loved one is unconscious or too cognitively impaired. If you don’t have a POA signed prior to the admission/treatment and give a copy of it to the hospital as soon as possible you stand the risk of the hospital doing what is medically necessary even if it is against your loved one’s wishes. If that happens there is generally only one thing you can do and that is going to court to get guardianship. That takes time and money.

It is far better is to present a executed POA before the need arises.

Finally, the AD, or more properly the Advance Directive to Physicians sometimes called a Living Will. This is where you can and should get specific. Like, no feeding tubes, no artificial respiration and whatever else you care to list. I suggest that you include a statement, something like, “If not listed here, I want to be consulted before any action is taken or service given”. If you want no extraordinary measure of any kind, use the words “palliative care” or “Hospice”.

I understand how serious these decisions are. I’m not advocating for any specific choices, just that the choices need to be considered and decisions made. I know that it is a horrible burden to have to make these sorts of decisions, but the bottom line is– do you want a stranger doing it for you? I don’t.

Carole Larkin MAG, CMC, DCP, EICS is a geriatric care manager who specializes in helping families with Alzheimer’s and related dementias issues. She also trains caregivers in home care companies, assisted livings, memory care communities, and nursing homes in dementia specific techniques for best care of dementia sufferers. Her company, ThirdAge Services LLC, is located in Dallas, TX.

 

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Tips For Bathing Your Loved One With Dementia

Tips For Bathing Your Loved One

With Dementia

By Carole Larkin

In hopes of helping you make bathing go easier, here are some tips:

• Doctors recommend older adults shower or bathe a minimum of twice a week to reduce the chance of infection (especially UTI’s in women). If you can get them to bathe more, kudos to you. If not, be satisfied with twice a week, unless another medical condition demands more bathing per week.
• To combat the “NO’s” try to make it seem as if the request is just a routine part of daily life as in, “It’s Tuesday morning. We always take our bath on Tuesday morning. Let’s go get cleaned up, and then I’ll make you a nice breakfast.”
• Follow up on the positive reinforcement (as Bob calls it), so that your loved one does get rewarded for complying. Doing this over and over, as part of the regular routine, imbeds in your loved one the behavior you want to happen. Yes, it can be done with enough practice! ALWAYS PRAISE AND COMPLEMENT THEM AFTER THE BATHING IS DONE.
• Or try this: Take a walk around the house with your loved one. Stop at the bathroom door.  Have everything ready (Soap, shampoo towels, washcloth, etc…) in advance, all laid out ready to go. The room temperature is warm, maybe soft music is playing. You say something on the order of “your bath is ready for you. Here, let me help you with your shirt (Or shoes, or whatever).And start helping, turn the water on in the tub and temper it and say something like “madam (or sir) you spa awaits you.”
• If there is no other way to get them to bathe. Ask their doctor to write on a prescription pad something like this: “Mr. So-and-so needs to bathe two times a week for infection control”. Make several copies of the prescription (in case they tear it up). Show the prescription to them and say “Doctor’s orders”.
•  The bathing should take place at the time and in the manner the person always used to bathe, meaning if they were a morning before breakfast bather, then you should have them bathe in the morning before breakfast. If they were a shower person, then they should have a shower, not a bath, unless medical or physical reasons preclude that.
• Some persons with dementia actually grow afraid of the water, especially water coming out of a wall mounted shower head. It becomes threatening to them. If this is the case consider getting a flexible hand held shower head. That way you or your loved one can control where it sprays on them.
• Allow your loved one to do as much as they possibly can to wash themselves while in the bath. If they can do a credible job on their own with just reminders from you to wash here and there, let them do that. Even if they don’t do a credible job and you have to redo the washing, I suggest you have them wash themselves first. It gives them “ownership” of the task and gives them something to be successful at Even if all they can do is hold a washcloth while you do everything else, let them do that. At least they are participating in the task as much as they can. The same goes for hair washing.  The same advice goes for drying themselves. Allow them to do as much as they can, even if you have to go back over what they have done. ALWAYS PRAISE AND COMPLEMENT THEM AFTER THE BATHING IS DONE.
• Some people need to be distracted with something while you give them the bath or shower. Distractions that could be used are singing in the shower, giving them something colorful to hold and look at while in the shower (or several somethings to hold and look at) such as a squeeze ball or a shower scrub in the shape of an animal.  Whatever it is, it should be waterproof and not able to shatter in the shower.
• Some people are extremely modest, be aware that that may be the reason for saying “NO”. Respect their dignity by allowing them to cover up with something while in the shower. Perhaps a towel or a sheet or even a poncho. Just wash under whatever they use to cover up.
• Safety comes first. There need to be grab bars positioned for them to hold on to while getting in and while bathing. Their needs to be appliqués on the shower or tub floor to give them traction under their feet. I’m not fond of bath mats. I’ve seen them lose suction and slide under the person’s feet too often. If the person is unsteady, a shower chair is needed. I’m not a fan of using the bedside potty chair as a shower chair as well because using it in the shower tells that person that it is ok to go to the bathroom in the shower or bath. If the person is scared to get into the tub because they have to step over the tub wall, try using a “transfer board”. It is a fairly long straight plastic board that you place in the tub with one set of legs outside the tub and the other set of legs inside the tub. Your loved one sits on the outside part and you help slide their behind to the inside part (and lifting their legs over the tub wall, of course). Poof fear of falling is gone.

• Finally, after the bathing is completed and, your loved one is dressed PRAISE AND COMPLEMENT THEM and ask them to cross off that day on a year long calendar showing the year by months. Have them do this every time. Eventually you will have visual proof that they have taken their shower or bath every Tuesday and Friday (for example) for months and that it is a normal thing to do. It also squashes the “I took a bath/shower earlier today or yesterday” protest. Nothing works like visual proof.

Carole Larkin  MA, CMC, CAEd, DCP, QDCS, EICS is an expert in Alzheimer’s and related Dementias care. She has a Master’s of Applied Gerontology from the University of North Texas, is a Certified Alzheimer’s Educator, is a Dementia Care Practitioner, is a Qualified Dementia Care Specialist, and an Excellence in Care Specialist at the Alzheimer’s Foundation of America, as well as a Certified Trainer/Facilitator of the groundbreaking dementia care training tool, the Virtual Dementia Tour Experience She is a Certified Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. She consults with families telephonically nationwide on problems related to the Dementias. Her company, ThirdAge Services LLC, is located in Dallas, TX, and her website is www.thirdageservices.com.

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Denial is Dangerous

Denial is Dangerous

By Carole Larkin

You may be past denial — Perhaps your sisters or brothers, mothers or fathers, cousins or friends (especially ones that don’t often see your loved one with dementia) are in denial. People in denial about a loved one with dementia often say to themselves things like:

Denial:

• I’ve always looked to Dad for strength and guidance. I don’t know how I can handle things without him. The thought that I have to take care of him as well as myself is too terrifying for words.
• He’s the parent, I’m the child. It’s never been any other way and I don’t know how to change it.
• If I ignore it, it will just go away.
• He had a really good day today; maybe it’s not really as bad as I though. I’ll just wait until his behavior and memory get worse.
• He’s just having a bad day. He’ll be better tomorrow.
• If I admit that he has dementia then that means that I’ll probably get it too and I can’t face that.
• He made me promise that I would never put him in a nursing home. That’s where I’ll have to put him if he has Alzheimer’s, so I won’t admit that he has it.

Underneath the denial:

• Fear about the future. That’s really the underlying emotion behind the denial.
• It’s human to deny what we find unpleasant or frightening. But when it prevents us from seeing facts and facing their implication then it will not help our loved one or ourselves.

Consequences:

• Using denial as a coping strategy will always fail eventually.
• Denial will prevent the family from taking the steps possible to “get ahead” of all the issues to follow — like starting medications that could prolong the patient at the highest levels possible for the longest time possible.
• Denial can prevent completion of legal forms allowing your loved one or your family to be in control of medical choices, property matters and inheritance issues.
• Denial will cause major lasting conflict within your family.
• Denial can cause unwanted outcomes.  For example, your loved one could need nursing home care due to delayed care that could prevent the progression to the situation where only skilled nursing can care for them.
• Denial causes stress to the caregiver — even to the point of a serious heart attack, stroke or other fatal event, leading to nursing home placement for your loved one anyway.

You can help your family member or friend in denial by:

• Telling them that it is OK to be fearful but that it does not help your loved one or the rest of the family.
• Help them to understand that fear is overruling logic.
• Explaining that denial or doing nothing is actually doing something; and that doing nothing is going to cause more pain to all involved.
• Helping them see that this is not about them and whether they will get the disease or not. Tell them that there is no relationship between helping your loved one and increasing the chances of getting the disease. It’s not contagious!
• Helping them see that it is not about them and the inconvenience to their daily life. This is about helping someone that they love have the best care possible.
• Letting them see that this is not about whether they like or dislike your loved one and that even if they don’t like the family member or friend, that helping is the right thing to do.
• Be kind, gentle and calm in approaching your family member or friend in denial. Anger will only cause them to dig their heels in deeper.
• Let your family member or friend in denial know that you will be there to support them through the time they are confronting their fear — they are not alone.
• If you see that you are not making a dent in their denial, drop the subject. You can return to it another time.

Carole Larkin  MA, CMC, CAEd, DCP, QDCS, EICS is an expert in Alzheimer’s and related Dementias care. She has a Master’s of Applied Gerontology from the University of North Texas, is a Certified Alzheimer’s Educator, is a Dementia Care Practitioner, is a Qualified Dementia Care Specialist, and an Excellence in Care Specialist at the Alzheimer’s Foundation of America, as well as a Certified Trainer/Facilitator of the groundbreaking dementia care training tool, the Virtual Dementia Tour Experience She is a Certified Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. She consults with families telephonically nationwide on problems related to the Dementias. Her company, ThirdAge Services LLC, is located in Dallas, TX, and her website is www.thirdageservices.com.

 

 

 

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Calling All Memory Cafe’s -Tis The Season To Be Thankful

Calling All Memory Cafe’s -

Tis The Season To Be Thankful

Last year J. Arthur’s Memory Cafe did a couple of renditions to the 12 days of Christmas.  One was thanking the UK for sharing their wonderful Memory Cafe concept with us.  The other was a Caregiver Credo.  This year we have decided to do it again as we got such a great response. Below you will see last years videos we sent to the UK and and pushed out on social media to all those who give care.

The US Now Has Over 50 Social Support Gatherings For People with Dementia & Their Families! 

We know there are others out there too and with your help we would like to find them to put into our directories. Alzheimer’s Speaks (make sure to refresh this link as listings are always changing.  I still have several more to enter in to the system.) and Carole Larkin with  Third Age Services are both trying to track them.

If you have a Memory Cafe that is not listed in the system, you can enter it my CLICKING HERE

Together we can make is easy for people to find Memory Cafes.

This year, we want you to join us!

Anyone who does a video and lets me know I will post here on Alzheimer’s Speaks and push it out to our audience to help expand awareness of Alzheimer’s disease and other forms of Dementias. This year we believe our reach will be much larger since we were just recognized by Dr. Oz and Sharecare as the #1 online Influencer for Alzheimer’s.

Please join this great cause.  As you will see it was all in fun and we were not going for perfect by any stretch of the imagination.  We all had a blast.

On December 12th, J. Arthur’s Memory Cafe will do another rendition using the same lyrics we used the prior year.

Anyone and everyone is welcome to use the lyrics we made up or come up with your own.  The goal is awareness and to have fun doing it!

Here are our videos. Below are the lyrics…ENJOY!

Below are the lyrics to:
The 12 Days of Christmas Memory Café Song©
of Lori La Bey of Alzheimer’s Speak Dec 2011

We encourage you to make you own version or use ours to show your  support for Memory Cafes around the world.  Then send your YoutTube link to us and let’s see how many videos we can collect while raising awareness!

The 12 Days of Christmas Memory Café Song©

On the 1st day of Christmas the UK Gave to us
(And) A Brilliant Memory Cafe
On the 2nd day of Christmas the UK Gave to us
Encouragement
On the 3rd day of Christmas the UK Gave to us
Reason for Hope
On the 4th day of Christmas the UK Gave to us
Needs to Fill
On the 5th day of Christmas the UK Said to us
Work Together
On the 6th day of Christmas the UK Gave to us
Joy in Our Hearts
On the 7th day of Christmas the UK Gave to us
Lasting Friendships
On the 8th day of Christmas the UK Said to us
Find Those in Need
On the 9th day of Christmas the UK Saw in us
Increased Excitement
On the 10th day of Christmas the UK Gave to us
Safety Net for Many
On the 11th day of Christmas the UK Said to us
Thankful People Coming
On the 12th day of Christmas the UK Said to us
Build with Community

Below are the lyrics to:
The 12 Days of Christmas Care Partnering Song©
of Lori La Bey of Alzheimer’s Speak Dec 2011

We encourage you to make you own version or use ours and send it to us.  Let’s see how many videos we can collect while raising awareness at the same time!

The 12 Days of Christmas Care Partnering Song©

On the 1st day of Christmas my Angel Gave to me
(And) a mind set to embrace change
On the 2nd day of Christmas the Angel Gave to me
Grace to let go
On the 3rd day of Christmas the Angel Gave to me
Coping skills
On the 4th day of Christmas the Angel Said to me
Look for the joy
On the 5th day of Christmas the Angel Gave to me
Great Insights
On the 6th day of Christmas the Angel Gave to me
Gratitude and love
On the 7th day of Christmas the Angle Said to me
Savor each moment
On the 8th day of Christmas the Angle Gave to me
Hope and compassion
On the 9th day of Christmas the Angel Said to me
Live to be playful
On the 10th day of Christmas the Angel Said to me
Self care is (cares) important
On the 11th day of Christmas the Angel Said to me
Perfect doesn’t matter
On the 12th day of Christmas the Angel Saw in me
My sanity is back!

Please Pass This On!

Thank you For Your Support!

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Alzheimer’s Speaks Radio on Living Your Best With Early Stage Alzheimer’s

Living Your Best With Early Stage Alzheimer’s

Lori La Bey

Today we had a very exciting show today.  One which I believe will be life changing for many of our     listeners no matter what role you are playing in dementia; be you a person living with the disease, someone caring for a loved, a professional working in the industry or an interested party wishing to learn more about dementia. Everyone will feel the connection and the power they have to make a positive difference in our world and our dementia care culture.  I interviewed three dynamic women on this show: Lisa Snyder, Carole Larkin and Pat Sneller.  All are passionate in their own way about shifting our dementia care culture.

         Please take the time to listen to the show.

 

    Lisa Snyder is a Clinical Social Worker and the Director of the Quality of Life Programs for the Shiley-Marcos Alzheimer’s Disease Research Center at the University of California, San Diego where she has worked with people with Alzheimer’s and their families since 1987. In the early 1990’s when caregiver needs were receiving the most public and professional attention, she was a pioneer in developing support groups for persons diagnosed with early-stage dementia. She has since continued to facilitate these groups, research their efficacy, and publish findings on their beneficial outcomes. Her clinical efforts and research has also focused on better understanding the subjective experience of Alzheimer’s thus defying long-held prevailing stereotypes that persons with dementia have little insight into their condition. She has lectured and published widely on the subjective experience of Alzheimer’s and is internationally recognized for her work in raising awareness about the thoughts, feelings, and daily experiences of those experiencing the disease.

In 1994, Lisa began writing and publishing a seminal quarterly newsletter, Perspectives- An International Newsletter for Individuals with Alzheimer’s, at a time when literature on dementia was devoted almost entirely to caregivers. Perspectives continues to serve as a forum for people with dementia around the world to have a voice, advocate for their needs, and share their own narratives about living with memory loss. Lisa is also author of the books Speaking Our Minds – What it’s Like to Have Alzheimer’s (1999 and revised in 2009) and Living Your Best with Early-Stage Alzheimer’s (released in 2010). She is a consultant and lecturer to Alzheimer’s organizations both nationally and internationally.

Lisa is a woman I could personally talk to all day long and I truly believe you are going to enjoy this conversation.

Here are the two books Lisa has written which I highly recommend.

Click the link below for further information on the book

LIVING YOUR BEST WITH EARLY-STAGE ALZHEIMER’S

Click the link below for further information on the book

SPEAKING OUR MINDS- WHAT IT’S LIKE TO HAVE ALZHEIMER’S

SUBSCRIBE TO Perspectives Newsletter
The annual cost of four issues of Perspectives by surface mail is a suggested $20.00
donation or FREE by email.

Please complete and mail the information below to begin
a print subscription, or email lsnyder@ucsd.edu to request an electronic subscription.
Name____________________________________________
Address__________________________________________
________________________________________________
Phone/Email_____________________________________

 You can submit this information for your subscription by:

email to: lsnyder@ucsd.edu

Fax  it to: 858-246-1282 r

Mail it to:  Lisa Snyder, LCSW
UCSD Shiley-Marcos Alzheimer’s Research Center
9500 Gilman Drive – 0948
La Jolla, CA 92093

Carole Larkin, MAG = Masters of Applied Gerontology (University of North Texas), CMC ( Care Manager Certified),  CAEd ( Certified Alzheimer’s Educator), DCP ( Dementia Certified Practitioner), QDCS  (Qualified Dementia Care Specialist) and EICS ( Excellence in Care Specialist)

Carole is a geriatric care manager who specializes in helping families with Alzheimer’s and related Dementias issues. She teaches them about the diseases and helps them find options to deal with problems arising from dealing with the dementias.   Carole is  also is a certified facilitator/trainer in the Virtual Dementia Tour/Experience which screens caregivers in home care companies, assisted livings, memory care communities, and nursing homes for compassion for those with dementia, as well as trains them in communication techniques with those with a dementia. Her company, ThirdAge Services LLC, serves the Dallas/Ft. Worth Metroplex.

214-649-1392          thirdageservices@gmail.com         

http://thirdageservices.com

Pat Sneller  is a care partner for her husband, Lee, who was diagnosed with MCI in 2005 and Alzheimer’s Disease on Feb. 6, 2009.  They currently live in Flower Mound, TX where we moved to be closer to their daughter and her family.  They have two sons who still live in California with their families.

Lee’s mother, his maternal grandmother, and my father all had Alzheimer’s Disease.  Pat’s  mother had age-related dementia at the end of her life.  While none of them lived with us, they moved closer to us as their cognitive abilities declined and we were their care partners for the last years of their lives, taking care of financial, medical, legal and everyday issues for them.  Lee and Pat have been active volunteers for the Alzheimer’s Association both on a national as well as a local level since shortly after his diagnosis.

Lee and Pat were honored to ride in the Rose Parade on

January 1, 2011 on the Alzheimer’s Association/Pfizer float.  

Lee and Pat are right in the middle;

Lee has white hair and Pat is sitting to the right (his left),

with her purple glove waving to the crowd.

They continue to speak and provide educational videos whenever asked, although this will not be possible for Lee for much longer as his word-finding abilities continue to decline.  Their  message is always titled:  There Is Life After Alzheimer’s.   Pat have a BS in Business Administration from California State University, Fresno and have found her education useful in helping to develop programs and to facilitate existing programs and services for those living with Alzheimer’s or other dementia.

Pat’s most recent vision became a reality on June 7, 2012 with the help of 5 talented and dedicated Alzheimer’s professionals when the first Dallas-area Neighborhood Memory Cafe met in Richardson, TX.  Her vision includes replicating their Cafes in every Neighborhood in the Greater Dallas area.

You can reach Pat through Carole Larkin

Join Us in Shifting Our Dementia Care Culture by:

Sharing this article with your friends and colleagues on Facebook and linked.  Email this link to others of interest.  Add this link to your newsletter!  Like us Alzheimer’s Speaks on Facebook, Youtube, and the Radio Show.  Connect to Lori La Bey on Linkedin.

If you know of a Memory Cafe please contact me via the blog here as I’m in the process of putting an international directory together for them….Thanks for your help in advance!

We are all into this together and so appreciate your help in our grass roots effort to raise awareness and educate the public.

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