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Medical Forum / Diseases and Disorders / Alzheimer's / November 2004

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First day of day care today

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Stephen B - 24 Nov 2004 01:10 GMT
I enrolled my mother in an Adult Day Care program near home and today was her
first day. My mother is physically very capable at 77, but the Alzheimer's has
progressed to the point where she is unable to care for herself and is quite a
burden on my 84 year old father, who is the primary caregiver. We decided on 2
days a week, Tuesdays ad Thursdays, and they pick her up an dbring her home. She
is in utter denial of having a problem, and becomes agitated, angry and
depressed all at once if there is a hint that she has a problem. In her world,
the neighbor is in and out of her house and yard and messes everything up. The
poor neighbor, who she doesn't speak to, is the focus of all blame. Her father,
who has been deceased for over 50 years, is alive and well in her world, only
missing. There are an amazing number of people living in the house. Outside and
inside are interchangeable. An avid gardener for her entire life, she believes
plastic and silk flowers are real, takes potted plants out of their pots and
"replants" them in strange containers like baskets, and basically kills all
plants with too much water or too much food. Currently, she is lamenting the
loss of all of her plants to the ravages of the nasty neighbor, while the
problem with the outdoor ones is that winter is coming. She is only visiting the
house she has lived in for 53 years and her father, who has never lived in the
US, has a house within walking distance, but he never visits and she is a
prisoner, so she can't go where she wants when she wants. Never mind that I had
to track her down one cold day last month when she bolted in her pajamas and
bathrobe on a Saturday morning. She wears a tracking device, complements of the
County Sheriff's department, so we feel safer about being able to locate her if
she wanders, which is rare so far, fortunately. On the day I located her, the
Sheriff's officer was on the way and the local police were already searching, I
simply lucked out in finding her first. I am fortunate, or unfortunate as the
case may be, to be living about 10 minutes away by car, so I see my parents
daily to check on them each afternoon on the way home from work.
Anyway, she was told that she was going to the Adult Day Care Center as a
volunteer, and the Social worker was fine with that and the staff went along
with this ruse. Apparently, she was asked to help a bit, but she still felt very
bored and was angry that she had been made to go to this place. I spoke with the
Social Worker who advised that she had a difficult morning, telling staff and
others alike that she didn't belong there. In the afternoon she seemed to make
friends with some people around her, but upon her arrival home she was clearly
unhappy about the experience and stressed that she was very bored and that all
they did was sit around. I know better than to believe her completely, but I do
believe that she was bored if she was not actively involved in something almost
constantly. She is not one to sit around, generally puttering around all day.
(That would be cleaning up by emptying closets and drawers and moving things all
over the house continually, driving my father nuts, of course. And in the yard
endlessly moving things around, sweeping the driveway, lawn and garden with
whatever is handy...) What are your experiences with dealing with the transition
to Day Care? I really need this to work for both her and my father's sake.
-steve
Evelyn Ruut - 24 Nov 2004 01:34 GMT
>I enrolled my mother in an Adult Day Care program near home and today was
>her
[quoted text clipped - 79 lines]
> to Day Care? I really need this to work for both her and my father's sake.
> -steve

in our case we told my mother in law that she had to go as therapy for a
while "till she got better."  there simply was no choice.  i absolutely
could not deal with having her into things here all day.   i needed the
break and she needed the stimulation.   we made excuse after excuse, but
when that bus came, she had to go on it.    it wasn't mean, i believe that
the reason she did so well was because of the stimulation of daycare.   they
did lots of wonderful things.
Signature

Regards,
Evelyn

(to reply to me personally, remove 'sox")

Tumbleweed - 24 Nov 2004 01:43 GMT
>I enrolled my mother in an Adult Day Care program near home and today was
>her
[quoted text clipped - 79 lines]
> to Day Care? I really need this to work for both her and my father's sake.
> -steve

Stephen, this sounds exactly like my father, many of the same
characteristics. He never settled into day care and after a couple or three
years at it, causing a huge stress on my mother every single time he went
(starting 1, and then 2 days/week) , he had to go into full time care
because she simply couldnt cope any more. ]

Sorry to say this, but you are going to have to start looking for a home
now, if she is in a position where she can wander out of the house, then
ultimately the tracking device is just going to be a way of finding her
body. What if she wanders off at 2am on a snowy day, or blunders about on
the roads in the dark? A 24 year old person cant look after an Az patient
24x365, let alone an 84 year old one. A few years ago an Az sufferer
wandered off in the middle of DFW airport. The were never seen again.If
someone can vanish with all those people around and with secure doors and
exits and so forth, how much easier when its just one 84 year old person
looking after them.

One harsh fact of AZ is that you cant always have things work the way you
want.  You cant persuade an late stages Az patient of anything they dont
want to hear. You may need it to work for you and your fathers sake, but
from what you describe, its unlikely to. I would begin looking at homes now,
it can take months to years to find a good one and then get your LO
admitted. You dont want to be in a position of having to take the first
thing that comes up when a crisis occurs with your father, which inevitably
it will, either because he cant cope, or as a result of illness, however
minor.And the stress on your father will undoubtedly make him more
susceptible to illness.

Signature

Tumbleweed

email replies not necessary but to contact use;
tumbleweednews at hotmail dot com

Stephen B - 24 Nov 2004 09:38 GMT
>Sorry to say this, but you are going to have to start looking for a home
>now, if she is in a position where she can wander out of the house, then
[quoted text clipped - 6 lines]
>exits and so forth, how much easier when its just one 84 year old person
>looking after them.

I rambled enough in my post that I didn't mention that I will be looking at a
home within the next month or so. The Day Care facility is actually an offshoot
from a Nursing Care facility and they have an Alzheimer's care unit. Day Care
clients have preferential treatment on the waiting list. I am also looking at
Potomac Group Homes. The cost of both is the issue, of course. My father is
relaizing that he can't do it much longer, but he doesn't want to part with any
of his money. I'm working on it.
As for the wandering, the house is locked at night and she can't get out. Locks
are up high. The problem is strictly daytime and only when my father forgets and
"accuses" her of doing something, taking something, imagining things, etc. We
are fortunate that she isn't a sundowner. She sleeps well through the night,
usually going to bed early and getting up "late" morning.
Thanks for your very valid concerns. It is way too hard on my father. It kills
me for 1 hour daily!
-steve
Feather Forestwalker - 24 Nov 2004 02:06 GMT
> I enrolled my mother in an Adult Day Care program near home and today was her
> first day. My mother is physically very capable at 77, but the Alzheimer's has
[quoted text clipped - 41 lines]
> to Day Care? I really need this to work for both her and my father's sake.
> -steve

Hi, Steve,

I told my client that I was taking her to the Adult Day Care Program as
a volunteer, and that worked. Once in a while she tries to leave, but if
I stay there with her, she's fine. Since I was hired to help with
wandering and the like (and since she lives alone with Early-Onset AD at
age 57), as well as with her morning and evening medications, she's had
less tendencies to wander and less tendencies to get agitated and angry.

She won't ride the bus that will come and get her, she won't let me
leave but for a moment. After lunch is when she wants to leave. So we
generally do. Because she is still very active, she wants to "do
things," and so, we have:

I've taken her out to the stables to feed carrots to the horses (she
loves horses), and have taken her out to play tennis, as well. She loves
the fresh air and sunshine, which we've been fortunate to have a lot of
lately.

Because this is your mom, may I suggest getting a part time caregiver to
come in and go with her to the program? Sometimes that helps to minimize
the agitation.

Other caregivers (both children and hired help) drop their clients (or
parents) off at the day program because they (the patients) are more
used to being there.

However, there's one new client, whose husband has been bringing her,
who simply will *not* stick around and tries to leave frequently. She's
almost deaf, too, so it makes it hard to tell her that her husband will
be back at 2 PM to pick her up. She wanders around and around the room,
asking for him. . .but is easily distracted. That's what we have to do
in the program, is distract the clients whenever they seem as if they
are becoming agitated.

I wish you the best with your mom. Time will tell with regards to the
continuance of the day program. I hope you can get her to continue.

Feather
Dennis P. Harris - 24 Nov 2004 03:27 GMT
> She won't ride the bus that will come and get her, she won't let me
> leave but for a moment.

THEN SNEAK OUT.  Seriously.  She needs to get used to the idea
that you're not going to be there while she's there, and that she
needs to get involved with the group activities.
Feather Forestwalker - 24 Nov 2004 17:09 GMT
>>She won't ride the bus that will come and get her, she won't let me
>>leave but for a moment.
>
> THEN SNEAK OUT.  Seriously.  She needs to get used to the idea
> that you're not going to be there while she's there, and that she
> needs to get involved with the group activities.

LOL....tried that; she *FOUND* me.

;)

Feather
Stephen B - 24 Nov 2004 09:41 GMT
>I wish you the best with your mom. Time will tell with regards to the
>continuance of the day program. I hope you can get her to continue.
>
>Feather
Thanks for your feedback. I think we'll continue with the "helping" ruse. I
think she will be okay as long as they can get her more involved and active. She
can't leave the facility, by the way, as all doors are alarmed and or locked.
-steve
Dennis P. Harris - 24 Nov 2004 03:24 GMT
> Never mind that I had
> to track her down one cold day last month when she bolted in her pajamas and
[quoted text clipped - 3 lines]
> Sheriff's officer was on the way and the local police were already searching, I
> simply lucked out in finding her first.

Sounds like it's time for your father to seriously think about
placement, as much as neither of them may like it.  If you don't
do that soon, he will either collapse from fatigue or she will
escape and you *won't* be lucky enough to find her.
Stephen B - 24 Nov 2004 09:42 GMT
>> Never mind that I had
>> to track her down one cold day last month when she bolted in her pajamas and
[quoted text clipped - 8 lines]
>do that soon, he will either collapse from fatigue or she will
>escape and you *won't* be lucky enough to find her.

I agree completely. Thanks for the feedback, Dennis.
-steve
Rose - 27 Nov 2004 15:58 GMT
Hi Stephen:

I don't want to say I think medication is the answer to everything, but I would
like to share with you that my mother would not tolerate day care until her
doctor put her on a low dose of Zyprexa.  (Low doses of anti-psychotics like
Zyprexa can be helpful in keeping elderly dementia patients calm without making
them more confused, which anti-anxiety drugs can do.) Since being on that she's
been happier, more reasonable, easier to manage and less totally dependent on
my being with her every second.  I was afraid it would make her a zombie but
she's been able to take part in areas of life that she couldn't before, like
going to a restaurant that's a little noisy.

May I also suggest trying a couple of different day care settings?  The first
one my mom tried had a lot of people and was pretty hectic, which got her
agitated. I found a smaller, calmer one for her.  It makes use of dogs and has
a nice outdoor area where the clients can walk around.

Is she on Namenda?  That medication can help with symptoms of moderate to
severe dementia.  Thanks to this drug combined with Aricept and Zyprexa my mom
is doing much better than she would have been absent these medications.

Good luck!

___
"This is an impressive crowd, the haves and the have-mores. Some call you the
elites.  I call you my base."  -- President George W. Bush
Stephen B - 28 Nov 2004 00:53 GMT
>Hi Stephen:
>
[quoted text clipped - 16 lines]
>severe dementia.  Thanks to this drug combined with Aricept and Zyprexa my mom
>is doing much better than she would have been absent these medications.

Thanks for the comments and suggestions. I am planning to call the doctor next
week to discuss medication as she has begun to get more anxious. She is
currently on Reminyl and Paxil. I think a change is in order. I'll mention
Zyprexa and also ask about Aricept and Namenda.
The day care is not too hectic - there are about 30 people total there. They
also have some outside space to go to, but the weather now is too cold for that,
unfortunately. The current plan is to call her Tuesday morning to tell her that
Emily (the social worker) called me to ask for her help that day. They will
specifically address her needs with some craft project to "lead" other with. The
social worker also suggested that they could make it more into a job, too, as
that worked for a previous client with similar behavior patterns. They would
give her a "paycheck" which I would "deposit" for her. I'd rather not go that
route, but at least they are trying and willing to work things out with us.
-steve
 
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