Tuesday, January 13, 2015

How Do You Choose?

Recently, I was asked "How do you choose to place your loved one in a Memory Unit?"  Let me be the first to say that I've not had to make that decision yet and so, I listened.

I listened as the person spoke of the love and commitment for the parent with Alzheimer's, the desire to keep the parent as independent for as long as possible and the fear that the Memory Unit would mean a loss of the parent's quality of life.  All of this factors into why familial care providers often struggle to made the decision to move the patient to a Memory Unit or even to a nursing home in the first place.

If we remove the emotions of the care provider, we can ask a couple of questions that may help the care provider to make a difficult decision.

  • Is the person aware of their surroundings?
  • Where is the person in their life's memory movie?
  • Is the person still functioning independently?
  • Is the person safe when unsupervised?
If we ask "Is the person aware of their surroundings?", we're asking if they can still get around without getting lost.  Are they wandering or looking to go home even when already home?  We are asking if they know not just the city or the country, we're asking if they know their neighborhood or even their block.  How small is the scale of their place?  If they step outside and get lost, if they don't know the difference between a hotel room and a hospital room, if they don't know their current room any longer, they may need more supervision than they are currently receiving.

Think of a person's life as a movie.  Alzheimer's puts that movie into rewind.  This is why it is reasonable to ask where the person is in their personal movie.  There are frequently clues that they will give you.  It may be a statement that seems odd or out of character.  If you were to consider that statement in the context of an earlier age, what age would that match up to?  If that person is in an earlier time, such as their 20's or teens or even earlier, their connection to the here and now is damaged and they may need more supervision than they are currently receiving.

It is important to be brutally honest in assessing if the person is still functioning independently.  Are they still able to pay their bills on time?  Can they tell the difference between scams and real requests?  Can they tell the difference between spam (e-)mail or legitimate business?  Can they still tend to their hygiene needs or cooking?  If they are not, they may need more assistance than they are currently receiving.

Most importantly, is the person still safe when unsupervised?  If the stove has been left unattended, if perishable food has been improperly stored, if household cleaners are getting misidentified, the person is not safe.  If you are considering baby-proofing an adult's home where no toddler resides, the person needs more assistance than they are currently receiving.  Safety trumps a person's desire to stay in their home until their death.

Neurological diseases cause the symptoms we collectively call dementia.  The most common cause is Alzheimer's.  Dementia is not some simple aging of the mind that leaves a person as a sweet but doddering elder.  It is a disease which is causing deterioration of the person's mind and a failing of the person's body.  It is a terminal disease.  Providing a person with a terminal disease with the resources and supports that are needed is showing love and commitment even if that means a move to a Memory Unit.

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