Laughter is the Best Medicine

Below is a list of some of the more gentle, often humorous signs of aging.   We hope it brings a smile to your face like it did to our staff at North River Home Care.

1. Your back goes out more than you do.
2. You quit trying to hold your stomach in, no matter who walks into the room.
3. You’re proud of your lawn mower.
4. Your best friend is dating someone half his/her age… and isn’t breaking any laws.
5. You sing along with the elevator music.
6. You’re asleep, but others worry that you’re dead.
7. You’d rather go to work than stay home sick.
8. You constantly talk about the price of gasoline.
9. You enjoy hearing about other people’s operations.
10. You consider coffee one of the most important things in life.
11. You no longer think of speed limits as a challenge.
12. People call at 9 pm. And ask, “Did I wake you?”
13. You send money to PBS.
14. You know what the word equity means.
15. You can’t remember the last time you laid on the floor to watch television.
16. Your ears are hairier than your head.
17. You get into a heated argument about pension plans.
18. You have a party and the neighbors don’t even realize it.

– Anonymous

Posting complements of the staff at Caring.Com

What to expect

The cost of in-home care usually ranges between $10 and $30 an hour, depending on the location (urban areas tend to be more expensive), the type of care needed (simple help around the house is less expensive than skilled help with bathing, toileting, and safely getting in and out of bed, for example), and whether the caregiver comes from a licensed home care agency (more expensive) or is an independent home care worker (less expensive).

Here are some of the options you can explore to help pay for in-home care:

Look into public benefit programs

If your loved one has very low income and few assets other than the home he or she lives in, some public benefit programs — including Medicaid, PACE, VA benefits for veterans, and Cash and Counseling — pay a limited amount for care.

Consider private insurance options

There are at least two options worth looking into: If your loved one has a long-term care insurance policy, it may include coverage for in-home care. He or she might also consider converting a life insurance policy into cash to help pay for in-home care.

Use personal and family assets

Like most families, you’ll probably have to rely on your loved one’s and other family members’ personal assets to pay most in-home care costs. There are several ways personal and family assets can be used help pay for in-home care, including tapping into the equity in your loved one’s home and gathering contributions from those family members who aren’t actively helping with daily care.

Get creative

In addition to public benefits, private insurance, and personal assets, you might want to explore some other avenues to help fund paid in-home care, including assistance from local churches, high schools or colleges, and adult daycare centers.

Thank you to Joseph L. Matthews, Caring.com Senior Editor for this article.

Wouldn’t your loved ones prefer to live out their lives in the comfort of home rather than in a nursing facility?  Most older adults, needless to say, would choose their own homes.  But for any number of reasons, from physical or mental health issues to dwindling finances, staying at home doesn’t always seem possible.  If someone close to you appears to be headed for a nursing home, there are alternatives that can (sometimes indefinitely) forestall the need for such a move.

Here are ten ideas for keeping your loved one at home:

1. Share care.  As an older adult’s need for in-home care begins to mushroom, even the combination of paid and family caregiving may quickly become too expensive, too time-consuming and exhausting, or both.  Many people discover they’re able to share caregiving (and its costs) by pooling their resources.

Examples include: 

• Moving in with a relative, friend, or neighbor:  Living alone increases the need for caregiving. Many older adults address this problem by sharing their living space with someone else who’s in similar circumstances. This might mean sharing one or the other’s existing home, or getting a new place together.  Roommates can then help support each other while sharing some family and paid caregiving, reducing both the burden and the cost.
• Simultaneous family-and-paid caregiving shared with a neighbor:   There may be someone who lives in the same building or on the same block as the person you’re caring for who also needs regular in-home care. If so, and assuming that the two of them get along and accept the idea, it may be possible for them to share some in-home caregiving. One of them could be taken to the other’s home — and, if both physical setups allow, this could alternate between the two places — and be cared for there for a day or a few hours, either by a paid or family caregiver. A comfortable chair or bed could be added to one or both places to make this more workable.

2. Move to a less expensive area.  If in-home care gets too expensive, consider moving your loved one to a different, less costly, location.  The cost of living — including both the regular expenses of daily life (housing, food, utilities) and the cost of an in-home caregiver — varies substantially in different areas of the country. For example:

• Urban areas tend to be more expensive than rural ones.
• Both coasts are generally more expensive than the South, the Southwest, and much of the Great Plains and Rocky Mountains.

By reducing costs, it may be possible to afford considerably more in-home care in a new, less expensive location. When making such a move,
consider:

Moving your loved one near a family caregiver:  Making a major move may be most sensible if it’s to a place near one or more family members who will be involved with caregiving. Even if most in-home caregiving continues to be paid, having a  nearby family member who’s responsible for overseeing that care and for providing extra care and other assistance when needed will further reduce costs.

Consider a move out of the country:  Entire retirement communities that cater to older Americans have sprung up in a number of countries, such as Mexico, where the cost of in-home care is much lower. Even if you’re caring for someone with family or friends who’ve made such a move, be sure to thoroughly investigate these costs before relocating. Be aware, too, that there may be local immigration restrictions on moving to certain other countries. Equally important: Medicare provides no health insurance coverage outside the U.S., so
some alternative medical insurance program would need to be available.

3. Use adult daycare.  One way to make in-home care work — both in terms of cost and preventing family caregiver burnout — is to supplement it with adult daycare.  Your loved one can spend from a few hours to a full day at an adult daycare center while the primary in-home caregiver sees to other matters or simply gets a break from caregiving.

The benefits of adult daycare aren’t just for the caregivers.  Adult daycare centers typically offer meals, activities, exercise, and
transportation, providing the person in your care a change from the isolation of home, socialization with others, and activities he or she might not otherwise participate in. Many adult daycare centers accept, and have special services for, people with mild to moderate Alzheimer’s or other forms of dementia.

Adult daycare centers charge considerably less per hour than in-home caregivers — $25 to $75 for a full day, depending on location and
services provided. Also, many centers offer sliding-scale fees.

Neither Medicare nor other health insurance pays for adult daycare, but long-term care insurance does, as do many state Medicaid programs.  Also, the Department of Veterans Affairs (VA) operates its own adult daycare centers for veterans who qualify.

There are more than 3,500 adult daycare centers currently operating in the United States; probably at least some are centers close to you.

4. Hire free or low-cost companion care.  Skilled in-home care can cost $20 to $30 an hour — and even more. If the number of hours needed for care begins to mount, consider what type of help is actually necessary. Can your loved one get by with skilled in-home assistance for only a small part of the day (first thing in the morning, for example, or at bedtime), and for most of the day have a nonprofessional caregiver who simply provides companionship, helps with small household chores, and provides a presence for safety and security?

If lower-cost (or free) “companion care” is workable for your family member, here are some sources of such help:

• Senior-to-senior programs.  In some areas, local government or nonprofit organizations operate an agency or referral service that connects local senior volunteers with other seniors in need of companion care. To learn about whether such a senior-to-senior program exists near you, check the Eldercare Locator or call toll-free at 800-677-1116.
• Churches.  Some churches have programs in which congregation members volunteer to provide free in-home care for older adults.
  These programs usually provide only a few hours of help a week, but even that can make a big difference to a family caregiver and to overall costs. If you or your loved one belongs to a local church, find out if it has such a program, or if it knows of congregation members who provide this kind of unofficial help on their own.
• Local high schools and colleges.  Many high schools and colleges offer community service programs in which students volunteer to provide free local services, such as in-home care for older adults. Student volunteers aren’t usually capable of providing extensive care (such as managing medicines or bathing), but often they can run errands, perform household chores, and provide
  companionship for an older adult for several hours a week. Also, many colleges have student employment centers where students list their availability to provide care for pay, usually at rates considerably lower than those of professional caregivers.
• In-home care agencies.  Most in-home care agencies offer different levels of care, including lower-cost companion care. Here’s one way to find out about and compare in-home care agencies near you.

5. Check out your own backyard.  For some people, having a loved one move in with them would make providing care much easier — in fact, it could eliminate the need to move to a nursing home. But lack of space and the intrusion on the privacy of both the family and the person being cared for often make such a move impractical.

One solution is the addition of a small, separate living unit in the backyard or other open space at a family home. The space, sometimes called an ECHO — Elder Housing Cottage Opportunity –unit or accessory dwelling unit (ADU), may be temporary or permanent and can
be fitted with special features (safety rails or an easy-access shower, for example) designed for older adults.

The addition of a separate living unit is neither simple nor cheap. There may be zoning issues, and the cost can run between $25,000 and
$75,000 to purchase the unit, or between $1,000 and $3,000 per month to lease it. Still, these costs are considerably less than even one year in most nursing homes. Also, once the unit is no longer needed, it can either be removed or kept and used for other purposes.

Although several companies, such as MedCottageand PALS, operate multistate businesses that build these units, finding a company that
sells and installs them near the person you’re caring for may not be easy.  You’ll need to search online using the keywords ECHO housing, accessory dwelling, or backyard housing to find local sources.

6. Get creative with financial tools.  If lack of cash is the reason your loved one can’t remain at home, and you think you’ve exhausted all possibilities for raising funds, consider two often-overlooked sources:

• Reverse mortgage.  If your loved one owns the home he or she lives in, a reverse mortgage might raise enough money to pay for a considerable amount of in-home care. Unlike a conventional mortgage, none of the reverse mortgage loan amount has to be repaid until the homeowner dies or permanently leaves the home. This means that all the money from a reverse mortgage is available to pay for in-home care, or for any other expenses, as long as the homeowner continues to live in the home.
• Cash for life insurance.  Certain life insurance policies can be cashed in with the insurance company itself for 50 to 75 percent of the policy’s face value. Some policies permit these “accelerated benefits” or “living benefits,” as they’re called, only if the policyholder
  is terminally ill. A “life settlement” (also called a “senior settlement”) may also be possible, which involves selling the policy to a life settlement company for a lump sum. The amount of the settlement — 50 to 75 percent of the policy’s face value — depends on the policy benefit amounts, the policy’s monthly premiums, and the policy holder’s age and health. The settlement company pays
  the policy’s premiums until the person dies, and then it collects the life insurance benefits.

7. Investigate the Department of Veterans Affairs (VA) Benefits.  If your family member is a veteran, or a spouse or surviving spouse of a veteran, he or she may be able to qualify for a number of different VA benefits that will enable him or her to remain at home instead of entering a nursing home. These benefits include:

• In-home care and adult daycare programs.  The VA provides a number of long-term in-home and community care programs,
  which the VA refers to as “extended care.” These programs offer nonmedical assistance to help certain veterans maintain their independence. Extended care is available to a veteran with a service-connected disability or to any veteran who has very low income and needs long-term care. Extended care can include:
• In-home health aides and homemaker services
• Adult  Daycare,  which provides health maintenance and rehabilitative services to veterans in a group setting during daytime hours, either at a VA or community facility
• Community living centers,  which offer short-term residential and ongoing community care for veterans with chronic stable
  conditions (including dementia) and veterans needing rehabilitation or short-term special services
• Home modification grants.  Being able to remain at home sometimes depends on the physical configuration of a person’s living space. The VA offers several types of cash grants to help a veteran modify his home in order to remove barriers and to make it safer.
• Cash benefits.  Eligibility and amounts for veterans and their spouses vary depending on the nature of military service, existence of a service-connected disability, and income. Some of the benefits include:
  • VA pension benefit,  which is for veterans who served at least 90 days of active military service (24 months for those who entered after September 7, 1980), at least one day of which was during an official period of war; has low income; and is age 65 or older or permanently and totally disabled (the disability does not need to be service-related). The pension can be as much as about $1,000 per month (more for a couple) and depends on the veteran’s income.
  • VA service-connected disability compensation,  which pays monthly benefits to veterans with a physical or mental-emotional condition that affects the vet’s ability to perform the activities of daily life. The condition must have resulted from, or have been aggravated by, injuries or diseases that struck while the veteran was on active duty. The amount of compensation — from $123 to $2,673 per month –depends on the seriousness of the disability and whether there’s a dependent spouse.
  • VA aid and attendance benefit  is available to a veteran who’s also eligible for a VA pension or to a veteran’s survivor who’s collecting a VA death pension (see above). Aid and attendance benefits can add up to about $700 per month extra to
    a veteran’s VA pension, and about $500 per month extra to a survivor’s VA death pension. To receive an aid and attendance benefit, the veteran or surviving spouse must either require regular assistance to safely perform activities of daily living, be bedridden, or be blind.
  • VA housebound benefit.  A veteran who’s receiving a VA pension, or a survivor receiving a VA death pension, may also be eligible for housebound benefits if he or she has a 100 percent-rated (by the VA) disability that substantially confines him or her to home.

To get free information or assistance regarding any VA benefit, contact one of the VA’s Vet Centers, which are located in every state. You can also get assistance by contacting the VA’s Veterans Benefits Administration office nearest you.  The VA’s toll-free telephone help line, at 800-827-1000, is also available for any questions.

8. Consider assisted living.  Even though assisted-living facilities are sprouting up everywhere, many older adults and their caregivers don’t realize that an assisted-living facility — usually far less costly and less institutional than a nursing home — may be right around the corner. Or there may be assisted-living facilities near a family member who can provide regular companionship and extra support beyond what the facility offers.

If your loved one needs regular monitoring but not round-the-clock supervision, and assistance with some but not all aspects of daily living (such as bathing, eating, walking, getting in and out of bed, using the toilet), then it may pay to look into an assisted-living facility. Some
things to know:

• Assisted-living facilities offer a separate, private living space — from a single room to a one- or two-bedroom apartment, usually with kitchen facilities — in a building of 20 to 150 units that house other older adults.
• Assisted-living facilities offer basic supervision and services — meals in a common dining area, housekeeping, help with activities of daily living, monitoring of medication, transportation, and social and wellness activities.
• Many assisted-living facilities provide specialized care and services for people with Alzheimer’s or other forms of dementia.
• Assisted-living facility costs vary by area, size of the individual unit, and level of services, but they generally range from about $2,000 to $7,000 a month.

What are the advantages of assisted living facilities over nursing homes?

• More privacy.  Because each assisted-living facility resident has an individual living unit, there’s much more privacy than in a nursing home.
• Greater independence.  Assisted-living facility residents come and go as they please, can choose to join others for a common
  meal and social activity, or instead have their meals and socialize privately in their own units. They may also have outside visitors in their private residences.
• Less institutional.  Many nursing homes tend to look and feel like hospitals. Assisted-living facilities are much more homelike, both in the common areas and in the private units, where residents can have some or all of their own furnishings.
• Cost.  Assisted-living facilities tend to cost a third to a half less than nursing homes in the same geographic area.

Find out about and compare assisted-living facilities in your area.

9. Look Into Medicaid.  Medicaid (the medical insurance program for people with very low incomes and few assets) does not include nonmedical, long-term, in-home care as a standard part of its coverage.  But for those who qualify for Medicaid, the program has begun to recognize that the alternative to unaffordable in-home care is entry into a nursing home, which Medicaid does pay for. So, as a way of
allowing Medicaid recipients to remain at home — and thereby saving Medicaid the cost of full nursing home coverage — some state Medicaid programs have established what’s called Home & Community Based Services (HCBS).

HCBS programs offer Medicaid coverage for a limited amount of in-home care and adult daycare. These programs only operate in some states, and the eligibility and benefits rules vary from program to program.

To find out more about the availability of an HCBS program where your loved one lives, contact a local Medicaid office at Benefits.gov.

10. Ask about the PACE program.  If you’re caring for someone with low income and few assets other than the home he or she lives in, and who needs more in-home care than you can provide or pay for, it’s worth looking into the Program of All-Inclusive Care for the Elderly (PACE).

• Benefits:  The PACE program provides full medical coverage plus comprehensive community care — mostly at adult daycare centers but also in-home care, transportation, meals, social services, and so on — for frail older adults who would otherwise need to be in a nursing home. If someone is accepted into PACE, a program team will assess his or her specific care needs, develop a care plan, and be responsible for providing all medical and other care services.
• Eligibility:  PACE is only available in certain areas, and eligibility is restricted to low-income adults over age 55, usually those
  eligible for Medicare. Some PACE programs are limited to people who are eligible for Medicaid, and for these enrollees, the program is entirely free. Other PACE programs also accept some people whose income or assets are slightly too high for Medicaid eligibility, and in these cases there is a monthly premium for medical care.

To learn more about the PACE program, see the Centers for Medicaid and Medicare Services information sheet Quick Facts About Programs of All-Inclusive Care for the Elderly — PACE. To learn whether there’s a PACE program operating where you live, and, if so, how to contact the program, see the Medicare official website list of PACE programs.

Article by Joseph L. Matthews at Caring.com

1. A GPS system

Remembering routes can be challenging, especially if they’re not frequent destinations. And following written directions can be difficult for someone with early dementia, or anyone who doesn’t want to be a distracted driver.

Simple solution: a global positioning (GPS) navigation system in the car. Prices have been dropping since these gizmos were first introduced; you can buy a simple unit for less than $200. Many drivers find it easier to follow verbal instructions than to have to read them. And if you make a mistake, the GPS autocorrects and redirects you.

2. Medication reminders

Medication management is the bane of both caregivers and relatively healthy adults looking after themselves. Fortunately a variety of tools exist to help you remember to dispense, or take, meds on time.

Medical alarms can be programmed to send you an e-mail message or a beep to a special watch. Some pill containers themselves will send visual messages. Learn more about medication management for no more missed pills.

3. A small portable notebook

Not all memory aids are high-tech. The lowly notebook can be a lifesaver when it comes to remembering names, details, and to-do lists. The trick is to have the notebook handy at all times. Very small books (such as Moleskine’s 2.5 by 4 inch extra-small version) that slip into a pocket or purse work well.

Train yourself to write down everything you don’t want to slip away — the names of those present at a meeting, the sudden thought to call for a haircut appointment, items to pick up at the grocery store on your way home.

The act of writing it down helps to secure a thought in your mind — and if you forget, you can look it up.

4. A don’t-lose basket or shelf

This idea amps up the old adage about “a place for everything.” Dedicate a single basket or box to all key items that are often misplaced: car keys, house key, reading glasses, sunglasses, medications, and anything else used regularly — even cell phone, TV remote, and sweaters. (Note: For someone with dementia, you’d want to store medications out of sight and out of reach, to avoid accidental overdosing.)

5. A centralized household calendar

It’s hard enough to remember your own priorities, let alone everyone else’s. Whether your household contains five people and three generations or just one person and a pet, post an oversized calendar in a central place (such as the kitchen). Use a different colored marker to write down each family member’s appointments, invitations, and travels (or, for a pet, dates with the vet or groomer).

Get in the habit of looking at the calendar every morning and consulting it before you make new appointments. Electronic calendars work well for many people, but for others, they’re “out of sight, out of mind.” A large planner in your line of vision every day is harder to ignore.

Thank you to Paula Spencer Scott, Senior Editor at Caring.com for these tips!

These 39 homes rolled up perfect 5-star ratings from the government for 4 straight quarters!

Each year, U.S. News and World Report releases its list of “Best Nursing Homes,” determined by quarterly ratings from the Centers for Medicare & Medicaid Services (CMS), and it also issues an Honor Roll which consists this year of 39 nursing homes that earned the highest possible ratings in all four quarters of 2011.

Notably, three East Coast states (Connecticut, Massachusetts, and New York) have three or more nursing homes on the Honor Roll, while eight more states, including California and Maine, have two or more homes on the list.

The 39 nursing homes on the Honor Roll are the only ones out of more than 15,500 that U.S. News reviewed to receive the four straight quarters of perfect five-star ratings from CMS in all three areas of consideration: health inspections, nurse staffing, and quality of care.

Click here to view the 2012 Honor Roll of Best Nursing Homes and learn three helpful tips in selecting the right nursing home for your loved one.

 Written by Alyssa Gerace of Senior Housing News.

“We know that sometimes it is difficult to make care decisions when you don’t have specific experience with an agency.  It was our goal to provide families with the ability to make an informed decision, have tangible ways to measure quality and help them find a comfort level when choosing an agency to work with,” commented Aaron Marcum, founder of Home Care Pulse.

Home Care Pulse, a company which measures client and employee satisfaction, created the certification program to measure key satisfaction aspects of its in-home care delivery as well as the level of satisfaction of the caregiving staff.  Home Care Pulse believes that certifying agencies can both educate and help families to make better care decisions for their aging loved ones.

The Home Care Pulse Certification requires an agency to be reviewed monthly and includes the evaluation of areas such as client satisfaction, benchmarking improvements, employee interviews and satisfaction, and caregiver performance to name a few.

“We want to congratulate North River Home Care for becoming a Home Care Pulse Certified home care agency and commend their commitment to placing high priority on client and employee satisfaction,” concluded Marcum.

To find out more about the Home Care Pulse Certification, please visit www.homecarepulsecertified.com

]]> http://www.northriverhc.com/north-river-home-care-receives-home-care-pulse-certification/feed/ 0 http://www.northriverhc.com/new-years-resolutions-for-seniors-in-2012/ http://www.northriverhc.com/new-years-resolutions-for-seniors-in-2012/#comments Thu, 12 Jan 2012 21:35:25 +0000 heather http://www.northriverhc.com/?p=1591

Happy New Year! It's time to do something good for yourself!

 It’s never too late to start a New Year’s resolution!  

We recently came across a list of New Year’s resolutions for senior citiziens.  They are designed to help you maintain your physical and mental health, improve your social life and help you live a happier and fuller life.  We hope you’ll consider giving them a try!

Visit your local senior center If you haven’t been to your local senior center, check it out. Senior centers are alive with all sorts of activities including games, crafts, lectures, lending libraries, exercise classes, educational courses, special interest clubs, entertainment, travel, parties and dances and hot lunches. Involved seniors are a lively bunch and in reasonably good health. It’s a perfect place to kick off 2012.

Increase your social contacts  You can make new friends at the senior center and church, or reach out to your neighbors and host a small get-together.  Studies continually show that people involved with other people stay healthier and live longer. Try to make at least one new friend this year.

Consider getting help if necessary  If you live alone and don’t have family or friends that you see regularly and are finding it difficult to get out to shop, houseclean, do laundry, or get out of the house for pleasure or for appointments, consider contacting North River Home Care to refer you to a screened and qualified caregiver for a few hours each week. A caregiver can keep you company, help you to get out, cook a meal, houseclean, shop, run errands and provide transportation to appointments and events. Even a short visit can make a big difference and be something you look forward to.

Learn how to use the Internet  It’s never too late to learn how to use the Internet. This skill will open up a whole new world of interesting information and communication possibilities to you. Ask a family member, especially grandkids, to teach you. It’s easy, and you can use the computers at the library or senior center. Email on the Internet will provide you with an easy, fun way to stay in touch with family and friends. Want a recipe? Look it up on the Internet. Want to purchase a special, obscure item, or can’t get to a store? Find it and purchase it on the Internet. You don’t need to understand how a computer works or other technical stuff. All you need to know is the Internet and email.

Schedule regular exercise  As you age, even a little regular exercise will help you feel better, maintain muscle tone, improve balance and keep those joints loose. Walking is great exercise. Plan on a daily walk. Walk with a friend or engage a companion to walk with you.

Get your papers/affairs in order  Do you have your important documents and information (insurance, social security number, mortgage/deed/lease, investments, savings accounts, auto registration, will, Medicare/Medicaid info, etc.) together in a safe place? Does anyone else know where to find them? Get them together in one safe location, make a list of them and let someone know where to find them. While you are at it, get a “File of Life” (call our office) and post your important medical information in a conspicuous place for emergency responders to find. And have a happy, healthy, satisfying NEW YEAR.

Thank you to Abby Services for use of their article.

Sylvia Carlson, age 102, returns home after recovering from a broken hip.

I had to stop by and see this with my own eyes today.

Sylvia Carlson is back in her own home in Quincy after successfully completing rehab for a broken hip at Hancock Park Rehab & Nursing Center.

She just got back home yesterday and spent much of today being interviewed by the North River Home Care agency staff who are staying with her and helping her.

It’s great news because a broken hip can mean the start of a long decline for some elderly people 20 years younger. Sylvia proves the opposite: even at such an advanced age, it is possible to recover and rebuild strength.

Sylvia is fiercely independent and was determined to get back home if she could. Things appear to be going very well and her many friends wish her the very best with continued improvement.

“She is amazing,” the home care aide nursing aide said who answered the door and let me in.

I only stayed a few moments, but long enough to see Sylvia ansering questions for a nurse with her usual sharp mind and good spirits.

By Sue Scheible , PatriotLedger.com

“Mother, it’s me, David,” he says.  “I didn’t steal your money.  You don’t keep money in the room.”

“You’re lying, you thief.  Get away from me.”  She was looking for something else to throw.

Stung by her words, he felt anger well up in him.  He wanted to scream back, but he turned and left the room, closing the door behind him.

His mother has been living with Alzheimer’s for almost a decade.  Her memory for names and recent events has diminished more and more over time, as has her ability to deal with situations that diverge from her routines.  She can no longer manage her finances, shop, cook or keep herself clean.

David is the child who has stepped in to make sure she has everything she needs and spend time with her.  Today’s outburst stunned and hurt him.  He was uncertain what to do.

He is far from alone.  Nearly 6 million people in the U.S. have Alzheimer’s, many of whom are in the early stages and can manage without much help. But caregivers of those with more limited functional capacity face difficult challenges virtually every day.  Dealing with distrust and anger is one that emerges from time-to-time.  What should they do?

David’s instinctive reaction to walk away was a good one.  Screaming back would have frightened his mother and accomplished nothing.  It’s even possible that this was a passing moment and that she will forget her suspicions and be herself when he returns to the room.

But if it is not a fleeting experience, what could be happening and what can be done?

It is tempting to think that Margaret’s feelings and behavior are the result of Alzheimer’s because the condition involves changes in brain function that often make it difficult to contain emotions.  But most people with dementia do not behave abusively toward people caring for them, and Margaret and David have had a warm relationship until today.  Something must be troubling Margaret today!

It could be that something in the situation itself set her off.  Perhaps David’s knock on the door startled his mother awake from a nap.  Perhaps his voice through the closed door was muffled and merged with something ominous that she was dreaming.

There may be a physical cause.  Is she constipated or does she have an impacted bowel?  Does she have a urinary tract infection or a toothache?  Has she been sleeping enough or possibly too much?  Is she having trouble hearing?  Has her vision blurred or darkened?  Is she taking a new medication?  Physical conditions such as these can have a terrible impact on mood and behavior.

It is also possible that her “paranoia” and “irritability,” her suspicions and anger, are psychologically rooted.  A psychiatric evaluation and non-pharmacological interventions, such as structured activities or psychotherapy, can be helpful for people with co-occurring dementia and psychiatric disorders.  Psychiatric medications are sometimes indicated but must be used with extreme caution because of their risks to the physical health of people with dementia.

David’s mother’s distrustfulness could reflect distress about a change in her physical or social environment.  Has she moved?  Has the place where she lives been renovated or rearranged?  Is someone she cares about sick?  Has someone died?  Has there been a change in caregivers?  Have eating or other routines changed?  Changes in environment or routine can both cause confusion and distress in a person with dementia.

David’s mother’s anger might be justifiable but aimed at the wrong person.  Has something been stolen?  Has someone been harsh with her?  Has someone hit her?  Has she been molested?  It may seem a long way from being insulted to becoming convinced that your son has stolen your money, but the mind follows its own path.

Sometimes it is fairly easy to figure out what is going on.  Sometimes it may seem impossible.  But there is always a reason — a reason other than, “It’s the dementia.”

Here are some rules of thumb that may help you when faced with anger.

• Never yell back.  A shouting match may succeed in winning a frightened silence, but you will not achieve a change of inner feeling.

• Deal with your own emotions about being distrusted by someone you care for and for whom you are doing your best.  It can be very hard to take, but it’s probably not something that the person with Alzheimer’s can control voluntarily.

• Don’t try reasoning (“Mother, you don’t keep money in your room.”) People with or without dementia who are angry and suspicious are almost never moved by reason and logic.

• If conversation is possible, ask questions about the situation and listen attentively to whatever explanation is given — sensible or not.  You may get a clue to what’s going on.

• Avoid disrupting the routines of the person and, if there are changes, get back into the routines as soon as possible.

• If there were only one rule of thumb it would be: Be kind.

Co-writen by Nettie Harper, MSRS, Director of Operations at Hearthstone Alzheimer Care and Michael Friedman, L.M.S.W.,  founder of the Geriatric Mental Health Alliance and teacher at Columbia University’s schools of social work and public health.

Roughly 1 of every 3 people age 65 and older is injured from a fall every year. Reducing the risk of a fall can help seniors live healthier and longer lives.

The key takeaways are:

• Talk to your doctor if your medication makes you feel lightheaded or confused
• Have your eyes examined to see if you need new glasses or contacts
• Speak up when you need assistance getting up – even in the hospital
• Exercise to improve strength and stability.