One of the things you notice in nursing homes that have Alzheimer's floors and non-Alzheimer's floors is that the mere hint of a dementia diagnosis induces immediate compliance with orders. Management by fear isn't optimal. There are better ways.
I spent the past two weeks as a resident in a nursing home. I'm a little young to be in senior care, but a few months ago I got a little knick on my foot. I had to wade through some sewage-infested flood waters after a rainstorm. The wound got seriously infected, I was in and out of the hospital for two months, and I was sent to the nursing home to recover. I was by far the youngest resident of the home, and I'm sixty.
This was no ordinary nursing home. Residents included a retired three-star general, a former member of Parliament, and a brain surgeon. All of us were on the same floor in a beautiful building and all of us received restaurant-quality food, anything we wanted from a menu with 50 items. Patients with Alzheimer's were put on a different floor with a very different daily regimen. However, even retired members of parliament and generals do what the nurse wants when there is even a hint they might be written up as suffering with Alzheimer's.
The New Threat Of An Alzheimer's Diagnosis
Elderly people in general tend to have considerable, rational fear of the "A word". After all, a diagnosis of Alzheimer's means a loss of personal independence. Diagnosis leads to loss of the legal right to run one's own life, and the disease itself, although it can be slowed down in some cases, cannot be cured and always leads to an unpleasant, slow death.
Making the situation worse, from the perspective of fearing old age, is a new diagnostic category of "mild cognitive impairment," or pre-Alzheimer's. The criteria for being diagnosed with pre-Alzheimer's are:
- No obvious signs of full-fledged dementia, with
- Continuing ability to carry out everyday activities, but with
- Objective evidence from a neurological exam or psychological test of changes in the ability to pay attention, or language skills, or eye-hand coordination, or "executive function," making good decisions, along with
- Expression of concern from a family member or a caregiver or the patient that something is wrong with mental function.
How The Threat Of A Pre-Alzheimer's Diagnosis Plays Out In A Nursing Home
It's that last criterion that gives caregivers a way to influence outcomes for patients in potentially insidious ways. For instance, I needed to see a surgeon (to repair damage to my foot caused by the infection) who was slightly outside the usual range of the nursing home driver. The facility costs $10,000 a month and charges up to $500 for a trip to the doctor off-campus, so I protested. I thought for all those thousands of dollars, maybe they could drive a literal extra mile for me.
The services coordinator told me "Oh, you don't remember telling us you didn't really want to see your doctor?" as in, "Do you want to get written up for a pre-Alzheimer's evaluation?"
My response, however, was that I was in no way suffering dementia and "Although I could give you a piece of my mind and have plenty left over, my primary concern is to get to my doctor and I will call the state Department of Aging and Disability Services if my condition continues to get worse and you don't send me there." I wound up calling the state's nursing home watch dogs, giving a two-hour interview to explain myself, and getting my ride to the doctor. Nobody referred me for a pre-Alzheimer's evaluation. However, there really is a better way to deal with cranky old people like me.
Better Ways To Accommodate Seniors In Nursing Care
There are better ways to handle seniors in nursing care, assisted living, your own home, or their home than threatening them with a label of "crazy old person". There really are ways nursing home staff members can get the results they want without threats and intimidation (although sometimes assertive action finally is required by residents).
Here are some suggestions for caregivers and for families making sure their seniors are well taken care of.
- Calm caretakers tend to have calm patients. Speak to management about any nurse or attendant who flies off the handle, even once. If the senior in your life is still at home and you are the caregiver (bless you), then cultivate a calm attitude yourself.
- Make sure the home of the facility is quiet. Sudden loud noises are a problem for just about anyone who is under stress, not just people who have Alzheimer's. A quiet night-time environment is a must.
- Provide opportunities for social interaction. Even when seniors are "slowing down" and aren't quite as verbally fluent as they used to be, they still need to visit with other people. The ability to carry on a conversation with friends and even with strangers goes a long way toward staving off, at least slowing down, mental changes associated with aging.
- Talk about the past. A good way of understanding what happens to our ability to learn new things as we age is that we already have had so many experiences that there isn't as much mental "room" for new ones. It takes longer to integrate a new friendship, a new skill, or the ability to get around in a new environment when you are older than when you are younger.
- Avoid excessive stimulation in the new environment. Garish colors that capture attention aren't a good thing when you're having trouble remembering which room is yours. Overly solicitous social event workers (to put it more bluntly, people who just won't shut up and let you talk) can defeat the purpose of social interaction. This is far more likely to be a problem with an overly zealous nursing home social coordinator than it is with a friend or family member.
- Encourage contact with pets. In the nursing home, we were visited on Fridays by Rosie, the therapy poodle. Personally, I always had bigger dogs, like Great Pyrenees and Labradors. Poodles and I don't naturally connect. However, with her (real) pearls and designer sunglasses and haute couture, and her tendency to lick things, Rosie certainly was a break in the routine. She was just enough of a break to make a positive difference in mental functioning for the day.
Another overlooked aspect of successful elder care is planning for success.
If you have sent grandma to rehab after she had a knee replacement, for instance, keep in mind she will be moving around a lot more as she gets over the surgery. Be ready to deal with wandering and the increased risk of trips and falls when elders are more able to move around the house. Similarly, if you have been working hard to help an elder regain speech after a stroke, make sure there is someone to talk with. Be ready for changes that come with the improvements you work so hard for.
Sources & Links
- Pam Belluck, "New Guidelines Allow Earlier Diagnosis of Alzheimer's," New York Times, 19 April 2011.
- Photo courtesy of Pictures by Ann via Flickr: www.flickr.com/photos/picturesbyann/12456887264
- Photo courtesy of Pictures by Ann via Flickr: www.flickr.com/photos/picturesbyann/11219713804