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

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To Daphne

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Paul R. Bennett - 18 Feb 2004 04:44 GMT
Daphne
Please, listen.
Been there, done that.
It hurt, a lot, but because I loved my family, my father, and my mother,
I could not turn away if I could do anything.
Of course, I did not live with them day to day, but I was taking time
off from work, family leave act and family sick leave.  I could see it.
I could see what was going on.  Knew it was not healthy.
I made phone calls, I had to deal with my father's anger first hand.
OTOH, I had my own home I could retreat to when it got too bad, but it
was very rough.
I made the calls to the 911 folks and the State Elder Abuse folks more
than once because I loved my parents very much.
I had to deal with family anger and resentment.  But I had a clear
choice and I made it.  I made more than one phone call to Family
Services and to 9-1-1 and to doctors because I could see what was
happening.
I chose to do what I could to get the folks involved who officially had
the power to take measures to deal with the situation for the sake of
both my parents.
I did it because I loved my mother and father more than I cared what
they thought of me.  I was seeing Dad becoming increasingly violent and
irrational, mom becoming increasingly mindless.  Something had to be
done.  I chose to do the best I could, out of love, for them and their
wellbeing.  And I had to pay a price for that.
Ask yourself, in your heart, how much do you love your mom and pop?
It hurts, I know that all too well.  It can be terribly hard.
I think it was Darryl who mentioned tough love.
You see things going wrong, you see them first hand.  Then, forgive me,
but you need to get involved.
Been there, done that, got the scars, but under the same circumstances I
would do it again, even faster.
Paul
Kay - 18 Feb 2004 19:32 GMT
Paul,
What was the outcome of your efforts??

Kay
Evelyn Ruut - 18 Feb 2004 22:35 GMT
> Daphne
> Please, listen.
[quoted text clipped - 29 lines]
> would do it again, even faster.
> Paul

Dear Paul,

I hope Daphne read your heartfelt message.   Nothing and no one could have
said it more clearly.

She needs to find the courage and the guts to stand up and do what needs to
be done, even if her loved ones are telling her "no"......

That is a hard thing to do, but ultimately I hope she sees the wisdom.

I have discovered that you cannot give anyone your wisdom, they have to
discover it for themselves, one way or another.

For Daphne's mother's sake, I hope she finds her courage now.

Daphne, you are in my prayers.   Please take courage and do what you need to
do to bring some sanity to your mom's life.

Signature

Evelyn

(To reply to me personally, remove sox)

Daphne - 19 Feb 2004 03:26 GMT
I'm here  - - I've read Paul's letter and your comments, Evelyn.
Strange timing.  I spent a couple hours with a good friend (who
happens to be a retired nurse) this afternoon and she gave me some
suggestions - - and support.

I just got off an hour long conversation with my brother.  Oh Lord,
I've been crying for the last half hour.  He told me how much my
parents need me.  How he is doing well (financially) as is my sister
(only because she married someone with some money).  He said I have no
plans, no retirement (to speak of) and I'm 52.  That taking care of my
parents would set me up for life.  Apparently they have money.  I know
they're comfortable but I  have never known their finances.

Now not only do I feel guilty for complaining, I feel like a big loser
who has *nothing* and if I agree to stay with my parents I have the
horrible feeling I'm being paid to care for them.  And children
shouldn't have to be paid, should they?

But he's right, I have no job (since being laid off last month) - - no
a shiney future, and maybe I should just get over it and feel grateful
that I might not have to live on social security.

My brother said he would guarantee my mother makes her March 3rd
doctor's appointment (even though my father said she won't).  I guess
I just have to decide if I can hang in here for a couple more weeks
and see what happens then.

Paul, what became of your parents?  You were so right about your
mother becoming mindless.  That's how I feel my father is.  Do you
think when Alzheimer patients cry and fight and say they are
physically hurting, they really are?  I mean, is there something in
the back of her brain that's registering all this?  I would like to
think that if she's not responsible for her actions then maybe she's
not aware of her feelings?  Does that make sense?

I really need some advice.  I can't believe how this has caused such
pain to everyone in the family.  I know, I'm only one in a million who
is dealing with this, but I sure feel alone.

Thanks for your prayers and support.

Daphne

> > Daphne
> > Please, listen.
[quoted text clipped - 47 lines]
> Daphne, you are in my prayers.   Please take courage and do what you need to
> do to bring some sanity to your mom's life.
Gwen Love - 19 Feb 2004 05:26 GMT
Daphne, when my dad was in the NH he would not let anybody get close to
touching him if he could help it.  The nurse said to me, "Maybe it does
hurt him when he is touched".
I'm sure they can still feel; maybe they just don't recognize all the
different feelings, physical and emotional, that they feel.
Gwen

Signature

=============================================================
A man's character is like a fence. It cannot be strengthened by whitewash.
=============================================================

| I'm here  - - I've read Paul's letter and your comments, Evelyn.
| Strange timing.  I spent a couple hours with a good friend (who
[quoted text clipped - 90 lines]
| > Daphne, you are in my prayers.   Please take courage and do what you need to
| > do to bring some sanity to your mom's life.
Nancy Young - 20 Feb 2004 15:27 GMT
> Daphne, when my dad was in the NH he would not let anybody get close to
> touching him if he could help it.  The nurse said to me, "Maybe it does
> hurt him when he is touched".
> I'm sure they can still feel; maybe they just don't recognize all the
> different feelings, physical and emotional, that they feel.

Once, my sil took my fil to a barber (more to get his hair washed
than anything), they gave him a trim.  Afterwards, my fil complained
that the barber had stabbed him in the head with the scissors.  I
gather AD patients just have a heightened sense of pain, even where
none exists.

nancy
Tumbleweed - 19 Feb 2004 07:41 GMT
> I'm here  - - I've read Paul's letter and your comments, Evelyn.
> Strange timing.  I spent a couple hours with a good friend (who
[quoted text clipped - 8 lines]
> parents would set me up for life.  Apparently they have money.  I know
> they're comfortable but I  have never known their finances.

Translation = Your brother has discovered an easy way to get rid of the
situation without getting involved himself.
Translation = Your brother has no concept of the issues, of the fact that 1
person cannot care for an Az patient 24x7 without eventually coming to
emotional, mental and physical harm themselves.

> Now not only do I feel guilty for complaining, I feel like a big loser
> who has *nothing* and if I agree to stay with my parents I have the
[quoted text clipped - 9 lines]
> I just have to decide if I can hang in here for a couple more weeks
> and see what happens then.

Translation = yet another reason for not doing something. After that doesnt
happen, your brother will "guarantee" the next one. Then, when/if one does
happen, you'll find your mother wont take the tablets and your father wont
press her. And your brother will guarantee

> Paul, what became of your parents?  You were so right about your
> mother becoming mindless.  That's how I feel my father is.  Do you
[quoted text clipped - 5 lines]
>
> I really need some advice.

Translation = I have had lots of advice here, its all the same,but Im going
to ignore it

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Dennis P. Harris - 19 Feb 2004 07:51 GMT
> Translation = I have had lots of advice here, its all the same,but Im going
> to ignore it

yeah, it certainly sounds like it.  like i said yesterday, SHE
NEEDS TO GET UNSTUCK.

and you're right about her brother and sister shoving the problem
off on her.
Dennis P. Harris - 19 Feb 2004 07:49 GMT
> Now not only do I feel guilty for complaining, I feel like a big loser
> who has *nothing* and if I agree to stay with my parents I have the
> horrible feeling I'm being paid to care for them.  And children
> shouldn't have to be paid, should they?

don't let your unfeeling, unreliable, unsympathetic siblings
guilt trip YOU into doing what they will not.  my advice would be
for you to get Adult Protective Services to take over, and for
you to remove yourself from the situation, since you obviously
are not suited to take charge and care for them either.

you need to get your folks into a care situation THAT DOESN'T
INVOLVE YOU so that your own financial situation doesnt become
tied to caring for your parents, and so that you can have your
own life.  then you need to get a job and a place to live away
from the chaos, and visit your parents periodically to make sure
that they are well cared for.
Evelyn Ruut - 19 Feb 2004 12:28 GMT
> I'm here  - - I've read Paul's letter and your comments, Evelyn.
> Strange timing.  I spent a couple hours with a good friend (who
> happens to be a retired nurse) this afternoon and she gave me some
> suggestions - - and support.

That is good.

> I just got off an hour long conversation with my brother.  Oh Lord,
> I've been crying for the last half hour.  He told me how much my
[quoted text clipped - 3 lines]
> parents would set me up for life.  Apparently they have money.  I know
> they're comfortable but I  have never known their finances.

Unless you went to an attorney and they signed papers for you to take care
of them and their money, you will never see a dime of that money used for
anything for their care when their house of cards finally collapses and they
go to a nursing home.

You may not have any great personal prospects other than caring for them at
this time, but unless your brother or someone has Power of Attorney to
administrate their money, you won't get paid for their care, and you will
get ground down to less than nothing emotionally, dealing with what is going
on in that house, where no one listens to you.

You see, you have to have some power to enact some changes, and they are not
listening to you about going to the doctor or taking medicine or taking a
bath, or even giving you some remuneration for their care.

> Now not only do I feel guilty for complaining, I feel like a big loser
> who has *nothing* and if I agree to stay with my parents I have the
> horrible feeling I'm being paid to care for them.  And children
> shouldn't have to be paid, should they?

Everyone needs to be remunerated for their work.   I believe that if there
is some money that is going to be spent on the person's care, that is how it
should be.   But unless SOMEONE has legal power of attorney, and elects to
pay you this certain amount of money for doing this certain job, then you
are getting nothing, just as you are now.

Do you realize your parents can live for MANY years in this condition?
That you could be spending the rest of your life not getting paid and being
miserable?   In a place where no one listens to you and no one bathes and
crazy people are screaming all the time?   Is this the kind of life you
envision for YOURSELF?

> But he's right, I have no job (since being laid off last month) - - no
> a shiney future, and maybe I should just get over it and feel grateful
> that I might not have to live on social security.

He has not done anything to pay you thus far for your efforts has he?
He is just using you as a buffer so he himself doesn't have to do anything,
Daphne.   I am sorry to tell you this, but you are being made the bad guy so
he can play the good guy.

> My brother said he would guarantee my mother makes her March 3rd
> doctor's appointment (even though my father said she won't).  I guess
> I just have to decide if I can hang in here for a couple more weeks
> and see what happens then.

The doctor isn't a magical miracle worker, and he won't know what is going
on in that house.   Sometimes people with Alzheimers can put on a very sane
front in front of the doctor.   He won't know about her screaming and all of
that.    Someone will have to tell the doctor.  Will you have the strength
to tell it like it is in the doctors office?

> Paul, what became of your parents?  You were so right about your
> mother becoming mindless.  That's how I feel my father is.  Do you
[quoted text clipped - 3 lines]
> think that if she's not responsible for her actions then maybe she's
> not aware of her feelings?  Does that make sense?

They forget everything as soon as it happens.

> I really need some advice.  I can't believe how this has caused such
> pain to everyone in the family.  I know, I'm only one in a million who
> is dealing with this, but I sure feel alone.
>
> Thanks for your prayers and support.

Daphne so many of us have tried to help you and given you advice on what
needs to be done.

You have to find the strength, and yes, I think you need to be paid for your
efforts there.   You need to have some authority to help in that household.
If not they will drag you down with them.   It might actually be better for
you to live alone, with little money, and get by on your own than to subject
yourself to this wild and confused existence with people who won't get help
and who won't let anyone else help them.

I still see the only way is to get outsiders involved.   Your brother is
copping out and not dealing with it either.

Regards,
Evelyn
Tumbleweed - 19 Feb 2004 21:39 GMT
<snip>

> > My brother said he would guarantee my mother makes her March 3rd
> > doctor's appointment (even though my father said she won't).  I guess
[quoted text clipped - 6 lines]
> that.    Someone will have to tell the doctor.  Will you have the strength
> to tell it like it is in the doctors office?

Agreed, and even if her mother gets drugs, then in the **best possible
case** she will get slightly better and then stabilise for a year or two,
and then start declining back to where she is now, and then she'll get
worse.

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Nancy Young - 20 Feb 2004 15:32 GMT
> You have to find the strength, and yes, I think you need to be paid for your
> efforts there.

I agree, because when push comes to shove, if Daphne thinks she is
going to inherit the whole estate, she's in for a big shock.  Unless
there is a will naming her the heir, her siblings will be first in
line to get theirs.  You can bet the ranch on that one.

What's wrong with taking a paycheck, anyway?  People have to live,
being paid a wage is nothing to be ashamed of.

nancy
Evelyn Ruut - 20 Feb 2004 16:32 GMT
> > You have to find the strength, and yes, I think you need to be paid for your
> > efforts there.
[quoted text clipped - 8 lines]
>
> nancy

I think getting a paycheck neutralizes a LOT of what could easily become
resentment and definitely helps one take the job of caregiving more
seriously.
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Tumbleweed - 20 Feb 2004 22:22 GMT
> > > You have to find the strength, and yes, I think you need to be paid for
> your
[quoted text clipped - 13 lines]
> resentment and definitely helps one take the job of caregiving more
> seriously.

Lets not forget that one person CANNOT look after an Az patient full time
without eventually breaking down, and putting their and the patients health
in serious risk.

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Evelyn Ruut - 21 Feb 2004 00:47 GMT
> > > > You have to find the strength, and yes, I think you need to be paid
> for
[quoted text clipped - 18 lines]
> without eventually breaking down, and putting their and the patients health
> in serious risk.

Hi Tumbleweed,

Everybody is different, but in Daphne's case I would say she doesn't seem to
be made of the stuff needed, even though her heart is in the right place.

You have to be a real "take charge" type,.... no nonsense and no guff.
Daphne seems (from what we see here) to be a little too easily taken back
from what she knows needs to be done.

She wants to please everybody too much and that is not always possible if
you are going to be effective at caregiving.

Ida didn't want to take a bath or change her dirty clothes either, but
persistence and insistence won out.   If Daphne were in my shoes, Ida would
have "won" too easily, much to her own detriment.   It is scary to have to
order a parent around, and it isn't easy.

You know yourself, there is a sort of a reversal that takes place.  Suddenly
the parent becomes your "child" and the you have to be the one to make all
the decisions and call the shots.  It isn't an easy transition.
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Paul R. Bennett - 20 Feb 2004 00:02 GMT
Dapne
Okay, tough love time here.
You are not going to like it.  First up, I am fifty three, worked all my life for what I have got, done my
damnedest for my family, 'cause I love 'em.
Well freaking OFF!
Excuse me while I go ballastic.
Set up for freaking life.
Daphne, I am a simple electron pusher, a computer tech, a long way from wealthy.  Caregiving for my parents
left me so far in debt we just don't want to talk about it.  I will probaly die in debt.
Okay, tough love, for caring about people, how ever much it hurts.
First, ask yourself honestly, can you take care of your parents?  Physically, emotionally, mentally,
financially?
Don't hand me excuses, can you take care of them?
I doubt it
Tough love, remember?  For their sake, and yours.
Number one rule for a caregiver, if you can't, or don't take care of yourself, you can't take care of a loved
one.
Here is the bottom line, if you want to take care of your loved ones, you MUST take care of yourself, you must
get your own life straight.
I am saying this out of love.
Everything you are saying reminds me too much of what I went through, and had to fight against.  I have been
there, fought against the monster.
First, you need to get the State involved.  Really... You don't have the resources, and the "set for life"
comment just infuriates me no end.  It puts me too much in mind of the "rich batchelor" and "state
employee"comments I heard from my family.
But lets first address your life.
Daphne, this is a situatiation ripping you apart.  You MUST get your life together first.  You must, before
you can even think about trying to be a care giver.
No B.S., my lady, please, remember I have been a care giver, had to make the decisions, fight the family, and
the state, and the doctors.
Get your own act together first.
Evil smile time, with reason... So, your brother is so well off, is he?
So, he has the resources, get the state involved legally and point them at him... What the hey, I was barely
scrapeing buy and had the state on my butt while richer family members ran the other way.  And, when the rest
ran the other way, I did my best, took the lumps.
At this point Daphne, you have a choice, it is your decision, both for your parents, and your life.  I can not
make it for you, nobody here can.
You have to decide to quit wafflling and wailing and dig in your heels and fight.  You have to decide to get
your own life together befroe you can even think of trying to be a care giver.  Bottom line.
I am talkng tough love here.
If you see an ugly situation that needs addressing, and you don't have the resources, then pull an R. Lee Ermy
and get the folks who can help involved, both for you and your parents.
Sorry if I am ot making a lot of sense, just got back from the sentencing hearing for the "person" who
murdered my niece.  Watched her grow up.  The judge slammed him with forty years for murder two.
I have watched so many loved ones die.

Paul

> I'm here  - - I've read Paul's letter and your comments, Evelyn.
> Strange timing.  I spent a couple hours with a good friend (who
[quoted text clipped - 90 lines]
> > Daphne, you are in my prayers.   Please take courage and do what you need to
> > do to bring some sanity to your mom's life.
Gwen Love - 20 Feb 2004 01:55 GMT
Paul, so sorry about your niece.  Hope that person doesn't get out on
parole any time soon.
Gwen

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=============================================================
A man's character is like a fence. It cannot be strengthened by whitewash.
=============================================================

| Dapne
| Okay, tough love time here.
[quoted text clipped - 138 lines]
| > > Daphne, you are in my prayers.   Please take courage and do what you need to
| > > do to bring some sanity to your mom's life.
Evelyn Ruut - 20 Feb 2004 12:34 GMT
Paul, the post below was very heart rending as well as knowledgeable and
compassionate.   I want you to know that you and your family have my deepest
sympathy on the loss of your niece.    You have had more than your share of
heartache.

For what it's worth, I think they aren't tough enough on guys who murder
young women.  I hope they don't parole that one too soon.

Signature

Evelyn

(To reply to me personally, remove sox)

> Dapne
> Okay, tough love time here.
[quoted text clipped - 43 lines]
>
> Paul
Trish Knight - 21 Feb 2004 17:38 GMT
Wow, Paul, you have really been through the wringer!  And I am so sorry about
your neice!

Trish

> Dapne
> Okay, tough love time here.
[quoted text clipped - 43 lines]
>
> Paul
Kay - 19 Feb 2004 15:42 GMT
Daphene,
 The advice you are getting is all good.  But only you can determine
if it is right for you.  You know how your family works so don't let
anyone bully you into doing something you don't feel is the right
thing.  Many times it takes lots of suggestions for you to gleen
through and pick out what is right for you.   And accepting the
turnabout in the family structure (ie the parents becoming the
children ) often takes time and is rarely easy.  Not only is it hard
for you, it is harder for the parents.
  That said,  you really do need to hide the lighter.

Kay
Paul R. Bennett - 28 Feb 2004 23:03 GMT
Kay
You asked what the result of my efforts was.  I don't get on line much
and I think both you and Daphne need to hear this.  And I agree that
Daphne needs to make her own decisions.  All I can try to do is share
what I experienced with her.
I saw things going wrong, realized that intervention was needed, made the
calls, because it was a situation way wrong.
Bullying.
Kay, you were not there, towards the end I was afraid to go home.  Mom
was irrational, Dad was both irrational and violent.  I would go home and
spend several days, taking sick leave from work.  And I honestly was not
sure I would wake up, or I would have to deal with a violently irrational
parent who "should" have serious intervention, and not that I did not try
to get it.  I still went home, and I used all the resources I could find,
and the rest of the family pulled the "bully" on me.
You were not there.  You were not the one calling the doctors, begging
them to talk to you.  And being ignored.
Dad was becoming violent and I tried my best to get officialdom involved
because I realized that this was a situation far beyond my ability to
handle.
At the time, my vehicle was a '74 Dodge Powerwagon pickup. And, weird
though it may sound, when her tranny went, it may have actually saved
me.  I could not afford to fix it and I could no longer drive to my
parents.
Not that it meant much, I still got calls from dad demanding this or
that, threatening suicide or to dump mom, and every time I got one of
those calls, I gave a call of my own to the local 9-1-1, or the State
elder abuse line, described the situation.
I knew this was a bad situation, far beyond what could be resolved by
just a care giver.
Think abut those kind of calls.  I know they are cries for help, but
those cries need help from a much higher level than I could provide.
Kay, I tried my best.  But we are talking major intervention here, the
kind that needs professional conselling.  We are talking the point where
someone needs help and must admit it to, and seek it for themself.
And finally, after Mom died, Dad stuck a rifle in his mouth and pulled
the trigger.  It was loaded with rat shot, so he survived, but I thought,
forgive me, thank god, finally, finally, someone is going to listen to
me, realize something bad is happening, and I had the State involved, I
was talking to social workers and case workers, trying to get him the
help he needed.
Then he disappeared, literally.  He was signed out of the hospital by his
brother and jsut dropped of the map. The state could not find him, I did
not know where he was.  It all went for nothing.
Kay, what do you want or expect?  I had done my best, I have gone from a
cash only life style to over my head in debt, my beloved nearly thirty
year old truck is worn out, I can not afford to fix it.
And then, after the rest of the family has finally fought so long among
themselves and been run off and I am finally beginning to get somewhere
in actually getting help for folks I love, I get short circuited yet
again.
Dad kept trying to dangle "inheritance" over me, and I kept telling him,
"inheritance" can not replace him, or mom.  I loved them, no amount of
money could ever replace them.
Kay, think about this carefully.  I have problems, those years left me
with mental and emotional scars that I am doing my best to deal with.
Every pay check I try to pay a little bit more than I have to, to try to
pay down the debt.  My dear old truck is gone,  I replaced it with a
lovely little '95 station wagon I managed to scrape together barely
enough to pay cash for.  I am fighting back as best I can.
I am not trying to bully anyone.  I have "Been There" and "Done That" and
I know how much it really hurts.
I am giving people honest advice based on what I went through and how
much it hurt.
You asked a question, you got an answer.  I got short circuited at every
turn, for feel good happy answers that did little more than slap a fresh
coat of paint over a deeply rooted problem.  And Kay, yes, believe me
that I do have a very clear understanding personally of the impact and
experience of the kind of intervention that was really required can
have.  Been there, done that, you don't want to see me on
anti-depressaants or anti-anxity meds.... "Somebody grab a butterfly net
quick!  Paul is about to pass overhead!"
Guess why I get more than a bit nuts.  Guess why I say, and try to share
my views on things that are not happy.  I have seen the hurt and pain and
lived through it.
I am thinking of the Caregiver, and the AD loved one, and the rest of the
family, and I am saying that the Caregiver needs time and life.  The
Caregiver needs to keep involved, keep living, needs respite.
Not making much sense, another bad weekend.
I would try to say that, if some drugs of whatever type, can keep an AD
victim to the point where he, or she can still participate in life, can
go out, enjoy, even at the level of a child, it is good.  If they can
help both the patient and the caregiver to continue with life, to enjoy
life.
Like I said, bad week, probably not making sense.
I am just trying to share where I have been, hoping that it will be like
a watershed, where a new caregiver will hear, think, learn, won't get
over their head, won't hurt.  Will be able to succeed where I was not
able to.

My apologizes to the folks here

Paul

> Daphene,
>   The advice you are getting is all good.  But only you can determine
[quoted text clipped - 8 lines]
>
> Kay
Patty - 29 Feb 2004 03:53 GMT
"I would try to say that, if some drugs of whatever type, can keep an AD
victim to the point where he, or she can still participate in life, can
go out, enjoy, even at the level of a child, it is good. If they can
help both the patient and the caregiver to continue with life, to enjoy
life."

THIS IS CERTAINLY  HITTING THE NAIL ON THE HEAD!

As I have previously stated....I work in a beautiful Alzheimer's Unit.
We see all sorts of "Families in Crisis"...among siblings"...and
Daphene, everyone here has given you some wonderful advice.
It's coming from the heart. They have been...or are going through these
sad times.
One of the first things we were taught in class was the fact that the
caregivers are the ones that need time to get away.....go out....you
CANNOT be the sole caregiver 24/7. That is not even possible....and
still keep your sanity at the same time.

I know in some Families, if they could afford to put their Parent in
Adult Daycare for the week OR a couple of days....this would give them
some relief. If this isn't possible, and it reaches the point of someone
being home alone all day....somehow you must get some help and look for
a nursing home.
I definately realize just the thought will make one very guilty, an
upset. But let me tell you that many of our Familes feel that way at the
beginning, BUT after visiting and seeing what goes on and how the
Resident is treated, they are actually so happy and relieved, because
they know the Parent is is in good and loving hands.
They also put them on medications (in conjunction with a Dr. and Family
Members, and our facility keeps very close tabs on their
medications....if they are getting too much of one med...or not
enough....depending on the behavior. And a Family Member is always
called if the Residents Meds change, if they fall, room changes...etc.
It's really something to look into, Daphne...
Best of luck, Patty


htouldew@search26.com - 07 Dec 2004 08:55 GMT
http://www.zared.com/Regional/North_America/United_States/Washington,_DC/Health/
Adult_Daycare/

 
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