Thursday, September 27, 2012

Peninsula Daily News Column 9-27-12 "How to make Alzheimer's less scary"

            Last week I went on a bit about five basic principles that will generally make life a lot easier for those of us who are taking care of people with Alzheimer’s, or something else that looks a lot like it; from what you’ve told me, it helped – At least, a little – And most of us who live in that world will take all the help we can get, so today we’ll try a little more.
            Remember, working closely with your health care provider – Talking and listening and asking questions – Is guaranteed to help! And learning all you can about the disease you’re up against is…well, remember this: Know thine enemy! You have tremendous resources and expertise available to you, and most of them are free, so if you don’t know where to look, call any of the numbers at the end of the column and good folks will help you find what you’re looking for.
            OK, so, you’re a caregiver for a person with Alzheimer’s – 24/7 or a few hours here and there – And you want things to go well. Here are a few ideas (concepts, principles, do’s-and-don’ts) that will help, but let’s start here: Think about yourself (go ahead, we’ll wait). Most of how we experience other people (and, thus, our world) doesn’t come from the exact content of what somebody says – It comes from the tone, the volume, the body language, the expressions, the posture, the…expectations, that we “read,” whether we know we’re reading them or not.
            We do; so do people with Alzheimer’s – Whether they know it or not. OK? Please remember that; so, what are some good things to do:
            Smile and laugh – A lot! Be cheerful! Watch the volume and don’t go crazy, but be “happy.” Talk in soft, gentle tones and generally be warm and friendly. Praise what deserves praising and use kind words. Show appreciation, say “thank you” and GO SLOW: Approach your person from the front (You don’t like to be startled, right?) and establish eye contact. Right: That’s how I prefer to be treated, too.
            Use short, simple words and sentences. Agree, even if you don’t agree, remembering that there are limits to what you can agree to and apologize, even if you didn’t do anything wrong. Remember what you’re trying to do here: You’re trying to provide CARE, so we want everything to be soft, mellow – Easy. Show respect, be consistent and do everything you can to help your person remain as comfortable as possible. Right.
            Here’s one that can be tough, sometimes: Step into their reality. Arguing or correcting won’t help – If they could get it “right,” they would, so don’t worry about accuracy or real “reality” – It doesn’t matter, because they are where they are, so be there with them, because anywhere alone doesn’t feel good to anyone. ANYone.
            This can be tougher than it sounds, particularly when your person thinks you’re somebody else. Here you are, knocking yourself out to help them be OK and they don’t even know who you are! Or that you’ve ever existed! Maybe you’re a complete stranger to them – It isn’t fair!
            No, it isn’t and No: You don’t deserve that, but here you are and there they are, so correcting them – “Reminding” someone who can’t remember – Is pointless. Just try to be where they are, if “there” seems to be a pleasant place, and be grateful that they have a few moments of relief from what has become a very scary life. Maybe “there” isn’t so pleasant? OK, then try to distract them away from it to a happier place.
            Getting resistance? Push-back? Don’t push back – Just back off and try again in a bit, because their reality changes faster than yours. And try to remember that your person’s soul – Their “core,” if you will, loves you and appreciates who you are and what you’re doing. A little faith can go a long way.
            If you’re getting angry or frustrated, then you back off and breathe, and try again in a bit. Don’t argue or punish or confront or over-explain – Reasoning probably won’t help; if it would, then you wouldn’t be doing what you’re doing, right? Right, so don’t be harsh or directive or give orders, because all you’re doing is pouring gasoline on the forest fire.
            Sometimes, you’ll lose it. You’ll get so tired or frustrated or hurt or scared that you “lose it” before you even know it! It happens. It happens to almost all of us, so accept that you’re a human being and doing the best you can out of love, so forgive yourself, back off and try again. Physical abuse is NEVER OK, but emotions come and go – Let yours ago. Alzheimer’s, in its own, horrible way, is generally very forgiving.
            Don’t use baby-talk or talk in childlike tones, and never mock, mimic or laugh at your person, because they will feel it. Time out: Most of us who have lived (or are living) in this world know the difference between “laughing at” and “laughing with,” because laughter is a wonderful, sharing thing. How do you know the difference? If the humor makes your person “less,” then you’re laughing AT. Alzheimer’s caregivers laugh a lot! It’s mandatory.
            Stay away from words like, “No,” “Don’t” or “Can’t,” and rely on distracting or redirecting their attention. Stay as positive and pleasant as you can; remember, this is about “success,” not winning.
            And, No: It isn’t fair. I’m sorry this is happening to you and I’m sorry this is happening to them. And thank you for doing what you’re doing.
            Two days from today will be the “Walk to End Alzheimer’s” at the Boys & Girls Club in Sequim, starting at 9:00 a.m. and going until a little after noon. If you can walk, please do, but many of us can’t, for any number of reasons, so just show up and register and be a part of it, because you already are – Laugh, cry, hold hands, learn stuff, meet people who are doing what you’re doing or just get out of the firefight for a little while.
            Or just come and be quiet. You are, after all, a whole person.
            And, sometimes, it’s easy to forget that.
.

Thursday, September 20, 2012

Peninsula Daily News Column 9-20-12 "'Behavior problems' hide a message"

            I’m not sure why I’m hearing the same questions, more or less, from a lot of different folks – Maybe it’s because most of us are beginning to feel “Fall” in the air: A bit of a chill, an “edge,” that drives our lives back inside, or maybe it’s just because there are a lot more of “us” – A lot more of us dealing with a monster called Alzheimer’s. It probably doesn’t really matter.
            And it probably doesn’t really matter whether or not “it” really is Alzheimer’s or some other kind of dementia, a lot of our questions are still the same. The actual diagnosis can matter – A lot! – Especially if you’re on the front end of what seems to be “cognitive decline” (memory loss, confusion, etc) because the diagnosis can make a huge difference in what types of treatments and medications could truly make a difference, so don’t be too quick to say, “Oh, it doesn’t really matter…” It does, so go see your health care provider, right now!
            But if you’ve already done that – Are doing that! – And can’t bet the farm on “it” being Alzheimer’s or some other type of dementia, then it probably doesn’t really matter, because YOU, Caregiver, are still trying to do what you’re trying to do. Caregiver? – Somebody who is taking care of somebody who needs to be taken care of, whether you (or they) like it or not. And what you’re trying to do – 36 hours per day – Is take care of someone with Alzheimer’s.
            So, the questions I’m getting have to do with “behavior problems:” resistance or fighting care, restlessness, wandering and rummaging, poor intake, yelling, crying, etc – You get it. Any of that sound familiar? I know, and…
            …Yes, I really do know.
            Clearly, there’s no way that we could take on every “behavior problem” there is in this little column; besides, there are people and organizations who are much more skilled at these things than I am; for instance, if you’re a caregiver who’s embarking upon this journey, start with going to http://www.alz.org/alzwa/ when you have the time to really see what’s in front of you. You’ll find access to amazing resources and amazing people who can and will help you, for free.
            Then, please consider joining a support group. I know: You’re thinking that there’s NO WAY you could find that kind of time, or how would you manage to be away, or or or…And you’re probably right, but if you want to find the smartest caregivers in the world who are “walking the walk” every day, this is where you’ll find them. And how do you find these mystical support groups? Just call any of the numbers at the end of this column, and good folks will direct you.
            So, if we can’t take on all of these “behavior problems,” what can we do? Well, we can talk briefly about five important principles to caring for a person with Alzheimer’s that will, if you really follow them, make life easier for both of you – I promise. These will sound, to a lot of you, simple and obvious, but when you’re “in it,” they aren’t, so step back for just a minute, and consider:
*First and foremost, be sure you’re “person” is as safe as you can make them, without restraining them – It’s in both of your “best interests;”
*Do everything you can to maximize your person’s comfort. Yes, it is simple, but think about it: How do you get when you’re UNcomfortable? I know – Me, too – So…
*Assume that “behavior problems” are a way of communicating with you, because they are. What is your person trying to tell you, in the only ways they have left? You’re being told that something is wrong and needs fixing; so, solve the problem and the “problem” and will go away;
*In the same vein, the message is often about “unmet needs” so, again, the “behavior” is a way of communicating with you – Too hungry? Too cold? Too warm? To…? If you can anticipate and address those needs before they come up (just like you would your own), everybody will be happier; remember, your person isn’t out to torment you, although sometimes on a bad day it can certainly feel that way – They’re sending you a message, so if you can “get” that message or prevent the need to send it in the first place, life mellows. There is absolutely no substitute for knowing your person very well – Understanding their rhythms and preferences and histories and habits – So, use that information. Your person hasn’t changed – He or she has just…changed;
*Use a “soft approach:” Soft voice, soft actions, soft expressions, soft touch. Smile. Go slow. Keep it simple. Be gentle and respectful, and NEVER correct or confront. Didn’t work? OK, back off – Maybe step out of the room – And try again, after you’re sure that you are calm and collected and capable of being “soft” – Because, sometimes, we aren’t.
            And will we all live happily-ever-after if we do all of these things religiously? I doubt it, but the level of uproar and fear and frustration and exhaustion (Remember “exhaustion?”) will decrease significantly. The more you know about the disease and about your person, the better it will go. The better it goes, the better you’ll both do. The better you both do, the longer you can do it – Which isn’t, always, forever.
            But most of us would settle for having a soft “today.”
            On Saturday, September 29th, a group of good, local folks have put together the first-ever LOCAL “Walk to End Alzheimer’s,” 9:00 a.m., at the Boys & Girls Club in Sequim. Yes, it is a “fundraiser,” but there are going to be a lot of resources there. And folks who are doing – Or have done – What you’re doing.
            We’d love it if you’d “walk,” but you certainly don’t have to; just show up, register and be a part of what’s happening. Just come say “Hi” (I promise to say “Hi” back) and look around, hang around, see what you see – And feel.
            More info? OK, go to http://act.alz.org/nop or call 360.461.3402.
            Sometimes, the worst thing is that feeling of being alone, so just come say “Hi” and we’ll say “Hi” back, and you won’t be alone; at least, for a little while.

Monday, September 10, 2012

Peninsula Daily News Column 9-6-2012 "Grandparents get a little appreciation"

            I know what you’re thinking.
            You’re thinking what lots of people think on the sixth day of September every year. You’re thinking, “My kingdom, if I only knew the most popular baby names in Washington State last year!” (Well, OK, you may not have offered up your entire kingdom, but you’re pretty doggone anxious about it!) Don’t panic – I’m here.
            For girls, in Washington, in 2011, in this order: Sophia, Olivia, Emma and Isabella; for boys, Mason, Liam, Alexander and Jacob. Feel better? Good.
            And how, pray tell, do I know this? Well, I know this because the Social Security Administration announces it every year, based on applications for Social Security cards in the previous year. Now, in fairness, let’s just accept that (1) apparently, parents have enough faith in the future of Social Security to even bother to get their babies Social Security numbers, and (2) that, Yes: There probably is something else that the Social Security Administration could be doing besides compiling lists of babies’ names, but that everyone needs a hobby, so we probably ought to just celebrate the fact that, given the times in which we find ourselves, people are even inclined to continue to make babies at all!
            Apparently, despite the daily predictions of the END OF THE WORLD, life goes on; in fact, do you know what day Sunday is? Yeah, OK…Do you know what else it is? Right! It’s “Grandparents Day!” Really! “Grandparents Day!” Well, OK, but if we set aside, for a moment, our all-too-sophisticated cynicism and just take it for what it seems to be, how cool is that? Grandparents Day! And if you think I’m making this up, go to http://grandparentsday.org/ and see for yourself; by the way, you’ll find some great suggestions for “doing something grand” on Grandparents Day, so go look.
            And sure, I could go on indefinitely about grandparents and grandparenting and the joys of intergenerational interaction and the “cycle of life” and have it all be absolutely true – So could you, so please do! But I’m going to take a little detour here, because we all know that, sometimes, all those little Sophias and Masons and Olivias and Liams aren’t always born into the happiest of circumstances; sometimes, they’re born into hell.
            You’ve heard the horror stories, just like I have, so I’m not going to make you hear them again. And you know, just like I do, that it isn’t just happening “somewhere else” – It’s happening right here, right now, today. It’s sad.
            So, often, who are the only ones left standing who can-and-will stand up and step in to rescue the little ones – Take them, love them, protect them – When no one else can? Yup, the grandparents. The grandparents who didn’t plan on it, budget for it or expect it – The grandparents who weren’t…ready. The grandparents who quit thinking about stuff like that a LONG time ago, who now have to relearn it all – Except a lot of it has changed; at least, on the outside.
            And what about their own kids, who were/are the “parents?” Do they need parenting? Probably. And these little ones – Are you the “parents?” Well…yeah, but…
            Yeah. But…
            I know; so, on the ninth day of September, 2012, happy Grandparents Day! If anybody deserves a day, you guys do! Could you use a little help? Maybe? OK, if you’re around Port Angeles/Sequim, call Carolyn at 417-8554 (1-866-450-3152). A little closer to Port Townsend? OK, call Heaven at 379-4421 (1-800-801-0050). More toward the West End? OK, call Susie at 374-9496 (1-888-571-6559), or just e-mail me and I’ll connect you. Just talk it over – You don’t HAVE to do anything! – But you might be surprised.
            By the way, if you feel like doing a little celebrating on Grandparents Day, how about going to a “Grandparent Celebration Day,” 9/9/12, Sequim Senior Center (921 E. Hammond, if you didn’t know that), 1:00 p.m. to 4:00 – Free: Good info, some organizations around that could help support you, refreshments/munchies – Why not? Kids are allowed.
            One more thing, to you “grandparents raising grandchildren,” and all the other kin who are raising somebody else’s kids because there isn’t somebody else: Thank you. I know, and I know why you do it, but that doesn’t mean that someone can’t just say “thank you,” and mean it.
            Thank you.
            And for the rest of us? Celebrate what we have – And what we don’t – And the universal justice that resides squarely in the “payback.”
So, what’re we gonna do on “Grandparents Day?” Right – Ready? Set? Go SPOIL somebody!!!