A Minor Bump in the Road

It has been almost ten months since I engaged the services of an agency to provide a sitter for Kate three afternoons a week. I agonized over this for several months prior to taking action. I was concerned about how Kate would respond. It turned out I didn’t need to worry. She responded quite well. During the first couple of weeks we tried several sitters that didn’t work out, but we quickly settled into the two who are with us now. Anita comes on Mondays. Mary comes on Wednesdays and Fridays.

Although things have gone well, I have never completely adjusted to leaving her with someone else. On several occasions, one of the sitters has been unable to be here. In these cases, the agency was prepared to send a new person. Each time I declined. I didn’t want a new person to come in without our meeting her ahead of time. I know we are going to need more sitters as time goes on, but to me it is important to have them come out to the house for an initial interview before I leave them with Kate. That leads me to what happened yesterday.

Last week, I received a reminder of a meeting of an advisory board on which I agreed to serve several months ago. I called the agency to see if they could arrange for either of our current sitters since my meeting is in the morning and this is not one of our regular days. The person with whom I spoke said that they were both assigned to other clients at that time, but she would see if she could do some switching. I waited until Monday and called back to see if she had been able to make a change. She said she was still working on it.

When I hadn’t heard anything by yesterday, I called again. The person who answered the phone told me they were sending a new person. Of course, I told her I didn’t want a new person and that if that were impossible, I would just miss my meeting. I felt the person giving me the news was not as understanding as she should have been. I did not have a problem with their not being able to provide the regular sitters. I did object to their not calling me to let me know. I felt the person I spoke with yesterday was being too defensive and didn’t show  proper concern for Kate’s or my feelings about the situation. That was especially true since I would have to leave for my meeting before Kate would be up. I didn’t want her to wake up and find a stranger to greet her.

This is not a big issue, but it is the second time in the past few weeks that they have surprised me. The first one was a phone call asking me if I still wanted a sitter on Monday. I told them I did but was curious as to why they should ask. She said, “We noticed that you haven’t had anyone that day in a while.” I told her that one of those days was because the sitter was sick. The other was Memorial Day. They had specifically called to see if I would need them on that day. I told her, as I have for other holidays, that would not be necessary. I felt that should not have been construed as a desire or intention to reduce our in-home care. In fact, when we began the service I had conveyed my desire to keep Kate at home. That would eventually involve 24/7 care. It just seemed like they didn’t understand our situation.

As with so many things, I believe the situation could have been handled better on both ends of the line. I should have been more specific about my desires for sitters. I depended on that’s being conveyed to the staff by the representative with whom I made the original arrangements. I think I need to go into the office and meet with each of the staff personally. Communication is always so difficult, especially when you are dealing with multiple people. There are at least 4 different people I talk with at the agency. I believe each of them has individual responsibilities and skills that are different from the others.

As I say, today’s issue is not a major one. I just want the agency to be more of a partner in Kate’s care. They need a better understanding of situation and our long-term plans. I’m going to see if I can facilitate that.

A Thought on Caregiving

At lunch with the Greens the other day, Angela told me a story of how a friend who was a caregiver for his aunt dealt with a situation all caregivers for people with dementia (PWD) face, what to do when your loved one keeps asking the same question over and over. She said he made signs that he could hold up and show his aunt. I said, “That sounds like something done for the convenience of the caregiver and not the PWD.” She went on to explain that she had heard that having a visual helps the PWD to remember.

Having reflected on this a bit, this approach misses something important. From my perspective, one of my pleasures is being able to help Kate with something that she either can’t do or finds difficult or inconvenient to do. Every time she asks me someone’s name, where we are, or anything else she has forgotten, she gives me an opportunity to do something for her.

I believe one of my greatest privileges is to walk with Kate through these last chapters of her life. I intend to keep answering her questions and to do it happily. These are things she wants to know, and I am glad to tell her. It will be sad day when she no longer asks me questions.

Memorial Day 2018

We’re off to a good start today. I woke up at 5:15 and thought about getting up since that isn’t too far off from 5:30 which I consider a good time for me. I checked the weather and discovered that it was raining, so I got back into bed. I woke again around 6:00. This time I just decided to stay there. The next thing I knew it was 7:00, so I finally got up.

Kate got to sleep easily last night after having slept late yesterday morning and taking a long nap in the afternoon. She was up at a typical time for her around 9:30. We are now at Panera where the crowd is slim this morning. I think a lot of people are out of town or were in earlier Kate is in a good mood, and we’re ready for a nice day.

As we started to get out of the car, she said, “What is your real name?” I said, “You mean my last name?” She said, “The one your parents gave you.” I told her, and she said, “I’ll bet that was your father’s name too.” It was.

I find myself analyzing Kate’s behavior in light of the book I finished reading yesterday, The Dementia Handbook. In this case, I could look on this incident with sadness. It is truly sad that she is forgetting my name. On the other hand, I have somehow been able to take pleasure in the things that she can do. I believe this one of the things that Cornish was trying to communicate in her book. There are many losses of “rational thought” for people with dementia, so we as caregivers need to focus on the many aspects of intuitive thought that our loved one’s still possess.

Interestingly (to me anyway), in the middle of the paragraph above Kate looked at me. I must have had a very serious, intent look on my face. She started to mimic my expression, and I laughed. She chuckled as well. Then I said, “You know, I think we were meant for each other.” She said, “If I could only remember your name.” Then I said, “Could I be serious a minute.” She nodded. I said, “Do you really remember my name right now.” She said, “If you tell me.” I did, and she said, “That’s what I thought.” It’s clear that she really is forgetting my name. It’s equally clear that she remembers me. I am glad that she can be so open about forgetting and that she can add a touch of humor to it. As I’ve said many times, my mood is heavily influenced by how she is getting along. When she’s happy, I’m happy. I’m looking forward to the day.

That takes me back Cornish’s thoughts about the retention of intuitive thought by people with dementia. Kate’s ability to correctly interpret and tease me about my serious facial expression indicates that her intuitive ability to read and respond to emotions is alive and well.

Travel can be confusing, especially in the middle of the night.

My mother had dementia. Dad cared for her without any help except for Wednesday morning when he dropped her off at an adult day care center. That allowed him to go to Kiwanis and then grocery shop. He told me very little about his experiences in caring for Mom. I do remember one thing. He said he tied a string from her arm to his when they went to bed so that he would know if she got out of bed. I feel a real connection to him now that I have become Kate’s caregiver. A large part of our responsibility involves either solving problems or preventing them. His use of string was one of the things he did. I have my own bag of tricks.

When Kate and I are traveling, I try, and usually succeed, in getting a room on the lobby level. That way I can get to breakfast and return to the room quickly. Before leaving on a trip, I also print signs that say “ We are in Lubbock (or wherever). Richard is having breakfast in the lobby.”

It’s impossible to prepare for everything. What happens in the middle of the night is one of those things. Last night, Kate got up to go to the bathroom. She found it easily since I left the bathroom light on and had her sleep on the side of the bed that is close to it. When she came out of the bedroom, she started walking toward the door to the hallway. (I always put on the security latch before coming to bed because she has started to go into the hallway on a previous trip.)

Recognizing that she would have no idea where we were, I said, “Kate, we’re in a Residence Inn in Lubbock.” 

She looked very confused and said, “Who are you?”
Richard: “This is Richard.”
Kate: “My husband?”
Richard: “Yes.”
Kate: “Where are we?”
Richard: “Lubbock.”
Kate: “Why are we here?”
Richard: “We are visiting Kevin and his family.”

She got back into bed and slept until almost 9:00. I can’t imagine what it is like to experience such confusion. I am amazed at how well she takes it. To me it would be frightening.

The Start of Travel Day 2

Good Morning, from Nashville. As I write, it is almost 8:30. I just got back from breakfast. Kate is still sleeping soundly. It was almost 10:30 when she went to bed last night. That’s later than usual for her. For a long time she has called it a day between 8:00 and 9:00. That has been inching up recently. If you’re a regular reader, you know that her sleeping has been become quite erratic. I hope this is not one of those days she feels like sleeping late. We need to leave the hotel by 10:30 in order to get to the airport, check in, and get lunch before our flight at 1:00.

In a way it’s funny how much of a burden someone with OCD tendencies puts on himself. Kate is quite relaxed about the trip. The only time she is bothered is when I rush her. That can be a real problem. I guess I am a little bit like a tour operator. I know there is a schedule we need to meet. In order to do that there are a whole series of things that have to be done before. I’m always at work trying to make this happen without rushing her. I’ve become more successful over time. It’s hard for me to remember her last panic attack. I don’t like to see these.

Increasingly, Kate has helped me by getting up without much problem even when she hasn’t wanted to. I’m going to count on that. I know it takes her an hour or hour and a half to get ready from the time she gets up. That means I can only let her sleep another thirty minutes or so. If she gets up easily, we’ll have no problem. That’s what I am counting on.

There is another thing that I have to plan around when we are traveling. I like to get up early and have breakfast while Kate is sleeping. I realize, however, that she won’t remember where we are. I don’t want her to be uneasy if she wakes up before I get back. Before we leave home, I create signs for each place we stay. For example, I have an 8 ½ x 11” sign that says, “We are at the Residence Inn, Nashville, TN. Frank is having breakfast in the lobby.” In addition, I make sure that I eat quickly or bring my breakfast back to the room. Fortunately, these are insurance measures. Kate almost never wakes up before I return. When she does, she goes to the bathroom and returns to bed.

I feel good about today’s trip knowing that we have a direct flight. In the past, we have changed planes in Atlanta. With Kate’s arthritic knee giving her trouble, that could be a problem. After losing Kate in the Atlanta airport for thirty minutes last fall, I am more than a bit skittish about going through that again.

Kate’s Treats

Yesterday after leaving the orthopedist, we went to Panera. We hadn’t made it in the morning, and Kate said she was a little hungry. I got her a muffin. There’s a nail salon a couple of doors down from there. It had been too long since she had had a manicure and pedicure, and they were able to get her in and out before dinner. I used to see that she went there at least once a month, but somehow got out of the habit. She doesn’t express any special pleasure when she goes, but she used to enjoy it. Besides she needs to have her nails trimmed.

Two or three years ago I also arranged for her to make regular visits to a nearby spa. She goes every two weeks and alternates a massage one time and a facial the other. This is not something that was a regular part of her life before I started it, but I thought it would be good for her to have something that was a treat and something she could do without me (except for making the arrangements and providing transportation). Like the mani/pedi, she doesn’t express a lot of enthusiasm, but I believe she must enjoy it. The only comment she makes is how soft and smooth her skin feels after the facial. She’s right. It does.

Living with Alzheimer’s often involves a bit of “Recalculating.”

Years ago when GPS devices were first on the market, I bought one for my car. I found it can be quite valuable, but sometimes I would take a wrong turn. When I did, the woman’s voice would say, “Off route. Recalculating.” She was determined and wouldn’t stop repeating herself until I followed her instructions.

I’ve always found that a metaphor for life. Everyone has had the experience of heading in one direction (a career goal, a financial goal, personal goals, big goals and small goals) when something happens, and find himself “off route.” Then it is time to recalculate, or, as some would say, “It’s time for Plan B.”

That is a message with which every caregiver for a loved one with Alzheimer’s can identify. It might be especially so for someone like me who is such a creature of habit. We are always encountering surprises and recalculating. We learn to be flexible or simply suffer. I like to choose flexibility. Let me give you several little examples from yesterday and this morning.

For the past two years, Kate and I have eaten almost every Sunday meal at Altruda’s, a local Italian restaurant. We split one of their chicken entrees each week. They have four that we choose from and rotate from week to week. We never have dessert although we both love them. Over the past couple of weeks, I have eaten a little more than I normally do and picked up a couple of pounds, so I decided to watch more carefully what and how much I eat. The server knows us well, specifically that we never get dessert, but yesterday she asked if we wanted one. I promptly told her no. When I did, Kate said, “Well, I do.” We asked what they have. The server showed us the menu but told us that they had a special dessert that was not on the menu – banana pudding cake. It sounded very rich, but I told her to bring us one. It was a bigger piece than I expected. In addition, it had a very thick, calorie laden icing, banana pudding between two of the layers, and icing on top of the bottom layer. So much for my watching what I eat. As I think about the future, I don’t want to look back and wish that I had not worried so much about my weight and put the emphasis on enjoying the experience with Kate. I believe I made the right decision.

Before going to bed last night, I picked up two glasses in the family room, took them to the kitchen, and put them in the dish washer. Last night I had put Kates meds in a small glass and water in another larger one. I noticed that all of the pills were gone from the small glass, but there was a milky colored liquid in the bottom of the other glass. It was obvious that she had dropped some of her pills in the glass of water. A little later, I gave her a Tylenol for some pain in her knee. I put it in a small cup and gave her a larger glass with water. She started to drop the Tylenol in the water. I decided giving her two glasses was confusing her. I won’t do that again. I had only done it because she has been dropping some of her pills and thought putting them in a small glass would prevent that. Solving one problem often introduces another.

Kate has surprised me twice this morning. I didn’t realize it, but she had gotten up while I was taking my morning walk. (I suspect that one of the pills that had dissolved in her glass last night was her Trazadone. That makes her sleep a little longer.) I walked into the kitchen and booted up my computer to check email, Twitter, and Facebook, and to write the story above. Before I got settled, Kate walked into the kitchen dressed and ready for Panera. I told her I would need to change out of my walking clothes and get her morning meds, and we could go.

That’s what we did. We arrived somewhat earlier than usual. After an hour, she was tired and wanted to go home. When we got inside, she went to the bathroom. In the meantime, I started to boot up my computer and turn on some music thinking we might go the the family room and enjoy a quiet morning. Remembering that she was tired, I went back to the bedroom to see if she was in bed. She was looking for her iPad, and said, “What can I do?” I asked her what she would like to do. She thought a moment and said, “Panera.” We had been home less than ten minutes. So here we are again. She is eating a sandwich. We’ll leave in another twenty minutes so that I can get ready for Rotary and the Y this afternoon.

Kate is especially cheerful this morning. It’s been a good morning. Recalculating has worked.

A Thought About Caregiving

I am reading an interesting book on caregiving, I’m Still Here by John Zeisel. His primary message is that even though someone has Alzheimer’s, they are still people with feelings and abilities. They just aren’t able to do all the same things in the same ways they have done in the past.

I like this perspective and have tried to follow it though not always successfully. The underlying assumption is that it is the caregiver’s responsibility to adapt to changes; the person with the disease can’t do it. This is not a new idea, but it is another reminder to those of us who have assumed this role. It can’t be said enough. I suspect many of the frustrations we experience might be reduced if we kept this in mind when we relate to our loved ones.

Occasionally, I have told a few people that a significant part of a caregiver’s time is spent trying to prevent or to solve problems. For creatures of habit like me, it can be a chalengel to continuously adapt in order to fulfill these responsibilities. We won’t always succeed, but we can keep trying. Years ago, I knew a counselor who worked with parents of children with behavior problems. One of the things he told parents is that they may do the wrong thing one time, but there is always a chance to do the right thing the next time. Caregivers also get multiple chances to do what works best. Most of us don’t come to this role with all the knowledge and skills to be effective, and we don’t develop them by simply receiving instructions. It takes practice. We have to develop patience with those for whom we care. Just as important, we need to be patient with ourselves.

What do I do next?

I am becoming more confident that Kate’s asking for permission is as much or more her asking “what should I do?” rather than “what may I do . . .?” It seems to be a little of both. I think she is unsure of herself and looks to me for guidance. Clearly, I do correct her on some things, so I do think she wants to please me. I don’t, however, see any sign either in the tone of her voice or the look on her face that seems to convey any resentment, just wanting to know what she should do.

Tonight we had another very peaceful and very pleasant evening together. We always do. We had spent almost an hour at Panera that was very relaxing. Then almost another hour at dinner. As we waited for our pizza, she looked over at me and said, “You know you’re the most important person in my life.” I suspect that is something that every caregiver would like to hear. Then we came home where she worked on her iPad while I watched the evening news. The next thing I knew it was 8:45. I went to take my shower. She continued with her iPad.

While I was in the shower, she opened the door to the bathroom and in a soft voice said, “Richard.” I said, “Yes.” Then she asked, “Can I get ready for bed now?” As always, I said, “Yes.” She is now in bed while I write this post. Chris Botti is playing on my sound system. It’s been another good day. I think I’ll join Kate.

How My Dad Influenced My Approach to Caregiving

Like many other people in their senior years, I am now much more aware of ways in which my father influenced me. I have been especially mindful of the way he cared for my mother who had an undiagnosed form of dementia and how his approach to caregiving has been a model for me.

Dad had three qualities that helped him to be a better caregiver. First, he was an optimist who responded to the problems in his life by focusing on how to solve them. He faced far greater problems in his life than I have, but he never let them get him down. That occurred early in his life when his father left him and his mother. As a teenager he had to help support the two of them. Not only that, he was a successful student and athlete. Later, in his own business he faced many challenges but faced them as opportunities.

Second, he was a man of initiative. He didn’t sit back and wait for things to happen. As he faced potential isolation as my mother’s sole caregiver, he became active in his Kiwanis club. He and my mother were active in a local senior center. The two of them were volunteers with Meals on Wheels. At the time, I thought it was just a way to be active, and it was. But there was more to it. I now suspect it was driven by his own attempt to keep my mother engaged.

Even though he was in his 80s, he became an avid user of the computer and kept up an extensive communication with many people. He was also very extroverted and engaged in conversations with other people wherever he was. As Mom declined, he continued to take her with him wherever he went except to his Kiwanis club. During that time, he dropped her off at a daycare center for people with dementia. Otherwise, he had no help.

Third, although he had no special skills or knowledge about dementia or caregiving, his love for my mother coupled with the two qualities mentioned above made him a successful caregiver. Looking back, I realize that Dad did not tell me much about what he was going through. I do recall his saying that she would get really mad at him and then would be over it in a few minutes. I also remember his describing how he tied a string around his wrist and Mom’s wrist. That way he would know when she got up during the night. I recognized the toll it began to take on him. My brother, Larry, and I worked hard to arrange in-home care to help him. To put it mildly, he was very resistant to having such help. He was determined to do it himself. She slept in the same bed with him until a few nights before she died. At that time, he was turning her every two hours where she lay in a hospital bed beside his own bed.

As I said earlier, Dad had a more challenging life than I have had, but I am a lot like him. I don’t think he was as analytical about what he did as I am. I think he simply did what he felt was right. His qualities naturally helped to keep his stress at a minimum while also taking care of my mother.

I have had much more experience with caregiving and with a lot of the written work about caregiving, how to care for your loved one, and how to take care of oneself in order to be a better caregiver. I still believe that the qualities I inherited from him and observed in his life have been the most significant influences on the way that I am caring for Kate. I am grateful to him.