What’s Going On?

Friends sometimes wonder about Kate and me when my posts are less frequent than usual. Most of the time it’s not because something is seriously wrong, but I often find myself occupied with other aspects of life that need my attention. Less frequent posts also reflect the changes that have accompanied Kate’s decline and the pandemic. Our world is smaller now than it was before, and we have settled into a routine lifestyle that leaves me with fewer new things to report. Here’s a quick update.

After being on a plateau most of the year with respect to her Alzheimer’s, Kate is exhibiting signs of another downward shift. I’ve mentioned some, perhaps most, of them in previous posts, but, in this one, I want to stress the point that she is falling deeper into a stage most people think of when they hear someone has Alzheimer’s or another form of dementia.

One symptom that carries a lot of weight for me is her increasing failure to recognize me, that is, in a cognitive or rational sense. It has been several years since she began to forget my name or that I am her husband. For a long time, that has come and gone from day to day or moment to moment. It is now a much more common occurrence.

The same is true for her own name or anything about herself and her family. In fact, the saddist moment I’ve had with her recently was when she was in a fog the other morning and asked, “Do I have a name?” I said, “Yes, you have a beautiful name, Kate, and your mother and daddy gave it to you.

On this occasion, I would say she was puzzled, not frightened, over her mind’s being blank. This now seems to be the best way to describe her morning “fog” whereas I used to say she was frightened, disturbed, or bothered.  

More often than not, she is still comfortable with me when these moments occur. She trusts me, likes me, and certainly feels dependent on me. When she wants me, she calls me by name or may ask the caregiver “Where’s my husband?” Sometimes it’s just a reflexive response. The other night, for example, we had an extended conversation in bed. She was very talkative, but delusional. Several times she referred to me by name.

On the other hand, there are more times when she doesn’t recognize me and asks, “Who are you?” She is often surprised when I tell her I am her husband. Sometimes she accepts the news without any emotion or receives it positively. As with other questions she asks, she sometimes says, “Who are you?” several times in not quite rapid-fire sequences.

I take these changes along with others like being less cheerful and her increasing aphasia to be critical markers of a new stage of her decline. More often than not, she doesn’t speak to people who speak to her. It saddens me to see this and recognize there is no way I can stop the progression of this disease that robs her of more and more aspects of her personality. Yet, we still enjoy life and each other, and I continue to see signs of the same Kate I met more than sixty years ago. It’s been more than 15 or 16 years since we noticed the first signs of her dementia. I feel sure she is getting along better at this stage than many, if not most, people “Living with Alzheimer’s,” and I am grateful.

One of Those Days

Kate and I have many good days, but not always. Sunday was one of those exceptions. It began around 9:00 when I got a call from the agency that provides two of our three caregivers. The one who was to come was sick, and they were looking for a replacement. They had identified someone who might be able to take her place, but she would be on overtime, and they wanted to know if that would be all right. I gave my approval.

A little later, I received another call telling me that person couldn’t come. After we hung up, I called them back to say that if they couldn’t get someone for the whole day, I would be happy to have someone for a short time to help me get her up for the day and return later in the day to help me get her to bed.

They found someone who could come under those conditions and that she would not be on overtime. They let me know that she was inexperienced and would need my help if I were agreeable. Since I’ve been an active participant in Kate’s care, I agreed.

When she arrived, I learned that she had been in training as a medical technician. She had taken a temporary position with the in-home care agency to make a little money before continuing her previous educational plans. It didn’t take me long to find out that she was not skilled in the kind of care Kate requires. She wasn’t good at changing or dressing someone in bed, and she had never used a lift for a patient.

This was not an ideal situation, but I began optimistically with the thought that I might have learned enough to make things go smoothly. I think of myself as a pretty good assistant to our regular caregivers, I quickly learned how unskilled I am in direct patient care and training of other caregivers. Trained and experienced caregivers clearly handle situations like this without any great difficulty. I won’t go through any of the details, but it took us at least twice as long to get Kate up and in her wheelchair. Fortunately, using the lift went more smoothly.

In addition, Kate was more confused and not as cheerful as she is other times. I’m not sure that I have mentioned that for the past 4-6 weeks she has had more experiences when she doesn’t recognize me. That normally disappears after I give her my name and tell her some of our history (where we met, falling in love, having children, that we have been happily married more than 58 years, and that I love her dearly ). After that, she usually responds to me as though she knows me. It usually lasts for the rest of the day or at least a few hours. On Sunday, she asked, “Who are you?” off and on until we retired for the night.

I’ve frequently mentioned that I like routine. This was a day that was far from that and, therefore, somewhat uncomfortable for me. That was particularly true in connection with the difficulties with a substitute caregiver. I had become comfortable and dependent on our regulars. A new and unskilled caregiver was an abrupt change.

Despite that, there are good things to report. For the first time, I took Kate for ice cream without a caregiver. We went down the main hallway that is officially named “Main Street.” Our building is at one end, and the café with ice cream is almost at the other end. It was a nice stroll and a treat to enjoy time to ourselves.

After the caregiver left that night, Kate and I had another good evening. At first, she couldn’t remember who I am. I gave her my routine explanation a couple of times and ended by telling her how much I love her. That seemed to stick. We watched YouTube videos with music by The Kingston Trio and The Brothers Four. The day ended well as it always has.

How is Kate?

Every day, people ask, “How is Kate?” That’s a question I’ve been asked since I became open about her diagnosis 4-5 years ago. Because I’m around people much more since our move, I hear it more often these days. For years, I said, “Remarkably well.” For the past couple of years, I’ve been more likely to say things like, “She’s having a good day.” “She’s happy.” “Our relationship is as strong as ever.” Sometimes I say, “She had a rough day yesterday.” Each of the things is true, but it never tells the full story.

Something similar is true about this blog. Over time, my posts convey a pretty good picture of how she is doing, but reading only a few posts can be misleading. For that reason, I would like to give you a better sense of how she is at this last stage of her Alzheimer’s.

I have focused heavily on Kate’s recovery from COVID since Thanksgiving. She had only one problem, but that was a significant one. She was frightened by everything that involved moving her. She has made slow, but steady progress. The fact that we are able to get her up every day and sometimes take her out of the apartment are the best indications of that.

That doesn’t come without any problems. She still protests a little when we change her. She is also bothered by minor bumps when she is in her wheelchair. For example, she feels even slight changes in elevation as we roll her from the floor to the carpet and back again and responds with an audible protest. Getting her into and out of bed with the lift is going much better as is getting into and out of a chair. Her responses also vary from day to day.

Our visits to the café where we get her a milk shake or ice cream have been especially good times. It’s not the ice cream that is the major benefit. She, the caregiver and I enjoy spending time in the seating area that looks onto a courtyard. It is relaxing for each of us. I also like the fact that it gives Kate the opportunity to see other residents. Not every interaction goes the way I would like, but I think it is good for her.

A couple of days ago, for the first time, she became belligerent when we were about to leave the café. She yelled and screamed when we tried to get her feet on the footrests of her wheelchair. I’m not sure why, but she doesn’t like using them. It is one of the things that frighten or bother her. Despite this, she is getting better. Two days this week, she didn’t protest at all and kept her feet on the footrests the entire time.

While she’s recovering from the trauma of COVID, she seems to be on a plateau with respect to her Alzheimer’s. She doesn’t seem very different than she was a year ago. In three ways, I believe she has declined. She seems to have fewer cheerful moments than in the past, although she periodically has very cheerful and talkative periods that can last several hours.

When these moments occur, they are usually rooted in a delusion in which she refers to people and situations that are not real. Her caregivers and I converse with her as though she is making perfectly good sense. We know that she is happy, and we are glad to see it. This experience is especially common around the dinner hour. She almost always enjoys her food and expresses it joyfully. In between these cheerful moments, she has longer periods in which she is more passive or withdrawn than she used to be. Thankfully, she is happy most of the time. Even when she is sleeping or resting, I often notice that she has a smile on her face.

Following a longtime pattern, she is generally “slow” in the morning and sometimes confused but improves throughout the day. She is at her best after 2:00 or 3:00 in the afternoon. This usually lasts until she goes to sleep.

Another change involves Kate’s interest in her photo books and her family. Her mother has always held a special place in her heart. Now, Kate expresses little interest in her mother’s pictures or even hearing about her. Similarly, she displays less interest in her children and grandchildren. The exception is when she talks with them by phone. Sometimes, she responds as warmly as ever.

She is also less comfortable with people who drop by to see us or those she meets when we take her out. She often fails to say anything at all. Sometimes she surprises me. She did that earlier this week when the caregiver and I took her to get a milkshake. A church friend stopped at our table and spoke with us a few minutes. Kate didn’t say a word even when the person spoke directly to her and asked a question. When our friend said goodbye, Kate responded to her as warmly as if the two of them had been talking for ten minutes.

There is one other change that is particularly significant to me. She has more moments when I am not familiar to her. It’s not that she doesn’t remember my name or that I am her husband. I feel sure that happens more than I know. The difference now is there are times when she responds to me like I am a stranger. Sometimes she doesn’t seem bothered by that and asks in a friendly voice, “Who are you?” That happened last night as we were enjoying a series of YouTube videos featuring Peter, Paul, and Mary. Several times in succession, she asked who I was. Each time I answered she repeated her question. Other times, she seems disturbed and doesn’t say anything or respond to my questions.

In either case, I tell her my name and that we have been together since college. I mention our falling in love, getting married, having children, and that we’ve been happily married fifty-eight years. This usually sparks a sense of recognition. Even when it doesn’t, she seems more comfortable.

We had an experience like that this morning. After telling her who I am, she was still uncomfortable talking with me. I reached for The Velveteen Rabbit on the end table and read it to her. She kept her eyes closed the entire time and didn’t respond in any way. At the end, I said, “I like that story. Thank you for letting me read it. I hope you liked it too.” She looked as though she might be asleep and didn’t say anything, but she nodded her head. She was going back to sleep, something not unexpected as she had been awake 2-3 hours earlier than usual. Did she “know” me then? I don’t know, but she was relaxed.

Except for this change in recognizing me, our relationship remains strong. She is glad to see me when I return after leaving her with the caregiver. Sometimes she is very expressive and says, “I’m so glad you’re here.” She still calls my name when she needs something or during times she when the caregiver is doing something she doesn’t like. Most of the time, she also responds rather quickly when I try to calm her as the caregiver changes her. In addition, she frequently grabs my hand in moments when she feels threatened (bothered?) by the caregiver’s efforts to change her or move her in any way.

Several other good things remain the same. Music is still an important part of our lives. At times when Kate is quiet, her caregivers and I often notice that she is moving her head or feet in rhythm with the music. I don’t read The Velveteen Rabbit to her as often as I used to, but I am pleased that she continues to enjoy it.

Most important of all, to me at least and I think to Kate, is that the best time of our day is after the caregivers leave each night. We both relax and enjoy being together. That is something I hope we can hold onto for some time to come.

Settling in Part 3: My Adjustment

Eleven weeks ago, Kate and I moved into our new home (apartment) in a local life plan retirement community often called a continuing care retirement community. In two previous posts, I described the changes in our in-home care and Kate’s adjustment to the move. Today’s post deals with how I am doing. With one exception, I can say that my report is just as positive as the others. Let’s deal with the positive first.

Shortly after moving in, I went through a period of disorientation. All of my routines were disrupted. It was a little like starting from scratch – new grocery store, new pharmacy, new part of town, new apartment and a bit of confusion over where various things had been put by the movers, as well as a temporary cessation in my daily exercise. Within 2-3 weeks, I was recovering from that and am now quite comfortable.

At the same time, I found our new environment very much to my liking. After months of preparation for the move, it was a relief to be settled into a new home. That likely would have happened no matter where we had moved, but there are several aspects of this community that I find especially appealing.

We’re in a new building that opened the end of February, and I like our particular apartment. I had had a little concern about living in a place one-third the size of our previous home; however, I had always liked the floor plan. Everything is very efficiently arranged. We have two bedrooms on either side of a large open area containing the kitchen, living area, and dining area. We also have a 16-foot balcony overlooking a courtyard below. It felt right the very afternoon we moved in. Now that we have been here a while, I find that it suits our life style quite well. I haven’t missed the space we left behind at all.

Apart from the apartment itself, there are other things that are more important to me. Some of them are things people generally expect from from life plan communities. They simplify life. I am relieved of almost all the personal responsibilities required in our previous homes. Not having to hire help with cleaning, repairs, or the wide arrange of maintenance issues was never a great chore, but it is nice to leave that behind.

Among the big benefits is availability of daily meals. I still fix my morning breakfast and like it that way. I value my morning routine that had been somewhat disrupted right after the move. For a short time, I continued to fix a simple lunch but gravitated to going downstairs to the salad, soup, and sandwich bar. I eat there every day but Wednesday and Sunday when I go to restaurants I have frequented for lunch for more than five years.

Kate and I do not eat lunch together. That’s because she doesn’t usually wake up before noon and isn’t ready to eat until 1:00 or shortly thereafter. At night, I bring in meals from the dining room. Kate and I eat together in the apartment. I like that.

Speaking of meals, living here has also been accompanied by a change in my eating habits. I eat more soup and vegetables than I ever have before. That relates directly to the way they are prepared. Most of the soups are quite good, and the vegetables are nicely-cooked. I’m especially fond of their broccoli and asparagus. For years, I have enjoyed salads, and the salad bar downstairs offers a wide variety of ingredients to make salads to suit my particular preferences.

Although our balcony doesn’t provide as beautiful a view as we had at our home, we have taken greater advantage of it than the patio we had. We spend some time there with the caregiver almost every day. Now that it is hotter, we are eating early. Then we go to the balcony until time for the caregiver to leave. It has provided more relaxing moments than I expected. By the way, I am writing this post on the balcony enjoying a gentle breeze (from our ceiling fan) and a light rain.

Our new routine also involves other relaxing moments as well. At the top of the list would be taking Kate around the interior of the buildings. It gives her a change as well as an opportunity to meet other residents and staff. Several times, we have gone to the ice cream shop. The ice cream is good, and we have spent as long as 45 minutes relaxing while encountering other residents.

That leads me to say what I believe is the most important benefit of living here. It provides significant opportunities for social activity and interaction. As my closest friends know, I’m a bit gregarious. Despite Kate’s Alzheimer’s and the pandemic’s lessening my social contact, I never felt isolated as do so many people in my situation. A lot of that was because we ate out for all lunches and dinners for at least eight years. I also remained in contact with people via email and telephone and continued to serve on committees at church and several community organizations.

The move, however, has substantially increased my daily social contacts, and I am thriving. It’s hard to walk out of the apartment at any time of day without bumping into someone and engaging in a brief conversation. One of our caregivers has joked with me about how long it takes me to run down to the dining room to pick up our dinner because I get into multiple conversations along the way.

So, what is the one exception to how positive my experience has been? Here it is, and it has nothing to do with the move itself. Several weeks before the move, I began to experience a rash on my back and other parts of my body. My dermatologist took a biopsy and found that I have eczema. She gave me a prescription for prednisone and a cream that helped but did not eliminate the problem. She recommended changing the detergent used to wash our clothes, the soap I used for bathing, and hand lotion. In addition, I started using an over-the-counter cream to replace the prescription that had expired.

The rash subsided somewhat but flared up in the past week. For the first time, it hit my face around my eyes as well as spots on the right and left sides of my neck. The itching isn’t pleasant, but I have been more annoyed by the places around my eyes. I feel awkward when I leave the apartment. I find myself explaining the problem everywhere I go. The good news is that the dermatologist gave me a new prescription that seems to be working. We have also scheduled an allergy test in an effort to determine what is causing the problem.

Other than that, life is good, and I am adjusting quite well.

Addendum to Previous Post: Another Breakthrough

Right after writing my previous post, we added another success to those I mentioned. For the first time since Thanksgiving (seven months), we gave Kate a shower.  Prior to that we had only given her bed baths.

The amazing thing is how well it went. It had been a day of ups and downs. She was awake early and not talkative but relaxed and in a good mood. I spent a good bit of time with her prior to the caregiver’s arrival. The first thing Adrienne does is to ask how Kate is doing. I told her it looked like a good day, but she was a bit slow in getting going.

I left for lunch. When I returned, Kate was in her recliner, but she wasn’t happy. I made an unsuccessful attempt to change that. I decided to do what Adrienne had already done, not bother her for a while. An hour and a half before dinner, I suggested we go out to the balcony. Kate said she didn’t want to go, but I reminded her how much we liked it. Then Adrienne and I took her. She was sullen the entire time.

On Monday, Adrienne and I had talked about the possibility of showering her on Tuesday. When the time came, her mood led me to table those plans. We decided to wait until she was in a better humor. That happened more quickly than either of us could have imagined.

Everything changed at dinner. She almost always enjoys her meals, but she was especially enthusiastic this time. She was on a high. I talked with Adrienne about going ahead with the shower, but I indicated I didn’t want to push her. She agreed.

I walked over to Kate and very calmly told her I thought that she might like to get a shower before getting ready for bed. I was prepared to say a lot more to encourage her, but she responded favorably. Adrienne and I went into action quickly but without rushing her. I changed into my gym shorts and warmed up the water for her. We transferred her from her wheelchair to her shower chair (that had never been used), and into the shower we went.

It went swimmingly well. Kate didn’t make even the slightest protest. At one point, she even lifted her arms, looked at Adrienne and said, “Over here” to get her to spray the water. Everything went well for all three of us. Adrienne and I are eager to try it again. We’re on a roll but not naïve about how quickly moods can change. This particular experience illustrates that beautifully.

Settling In Part 2: Kate’s Adjustment

In “Settling In Part 1,” I outlined the positive changes we’ve experienced with in-home care since our move. During the same time, there have been similar improvements in Kate’s behavior. She is much less frightened than she was when she came home from the hospital at Thanksgiving. That makes the experience of tending to her needs less disruptive for her. As a result, it is easier for her caregivers and me.

The biggest problems we’ve faced involve some of the basic things we have to do to care for her. That is mostly the process of changing her as well as getting her in and out of bed, her wheelchair and her recliner. As she has become more familiar with the process she has become less frightened and more cooperative. It’s not something she likes at all, but she is more accepting.

From the beginning, I’ve played an active role in these activities because her first response is to fight back with her hands. As one might expect, she has been particularly bothered by being changed. My part is mostly to calm her. In the gentlest voice I can muster, I tell her what is about to happen and that we need to help the caregiver by relaxing. I ask her to hold my hands tightly. That was tough for her at first, but in the past couple of weeks she has gotten much better. She seems to find security in holding my hands.

There’s a tendency to think that someone in the last stage of Alzheimer’s can’t learn at all, but we have seen signs that she can. This does not occur through her rational, but her intuitive ability. It’s not because she understands and remembers what we have told her to do. It is simply through experience that she is beginning to learn. One example involves our use of a lift to get her in and out of her bed as well as her wheelchair and recliner. She is learning where she needs to put her hands. That’s not only beneficial from a safety standpoint, but it keeps her from grabbing and holding on to something (like the arms of her wheelchair or recliner) that makes lifting more difficult for us.

She surprised me over the weekend when I took her on a tour around the other buildings. She told me to “watch out” as we approached an area where the tile floor ended and a carpeted section began. She has learned from experience that changes like these mean “bumps,” and she doesn’t like even small ones.

We’ve also been able to make important changes in her daily routine. We get her up daily, if not for the entire afternoon, for dinner. We relax on the balcony almost every day. Recently, she has been out of the apartment five or six times. Each time I have introduced her to other residents. Over the weekend, I took her out twice without the caregiver. One of those days, we stopped by our coffee shop for ice cream. I don’t know the full benefit of these outings and encounters, but I believe it’s good for her. It gives her a better feeling for everyday life, and I plan to keep it up.

I’ve also been pleased with recent efforts to read to her and to look through her photo books. Both of these have been of less interest to her in the past few months. I’ve had success with The Velveteen Rabbit in the past two weeks as well as at least one look through the photo book I gave her for our recent anniversary.

She still wakes up between 11:00 and noon, but she is occasionally wide awake much earlier. That allows me to get her morning meds earlier as well as getting her something to drink and a snack before the caregiver arrives. This is not a frequent occurrence, but it happens more often than in the past. The bonus is that several times I have gotten in bed beside her and read to her, looked at a photo book with her, or just worked on my laptop while she rested. It has been good to have that extra time with her without the caregiver’s being around.

We have two other goals: to get her hair done in the salon downstairs and to give her a shower. We may try the shower this week.

I should add that I attribute much of Kate’s improvement to the consistency we have with out in-home care. I am especially grateful to Adrienne, the caregiver who is with us 10 out of every 14 days. She has played a major role in the establishment of a regular routine.

There are two things that I don’t expect to improve. One is her Alzheimer’s. The other is her mobility. I don’t believe she will walk again although her recent progress has encouraged me to think about attempting it. That’s something I won’t pursue without the help of a physical therapist.

All in all, Kate seems more relaxed and happy. Her quality of life has gotten much better, and that means it has for me as well. We’re making progress.

On a 1-10 Scale, Wednesday was an 11.

Just over two weeks ago, Kate and I celebrated our 58th wedding anniversary. That morning I wrote a post saying the day before she gave me the perfect present. She was  in a cheerful mood all day. I commented that if she wasn’t the same way on our anniversary day, it was just fine. She had given me enough to keep me going for a while.

I bring this up because yesterday was my 81st birthday, and the day before that was even better than the day before our anniversary. My feelings were the same. Although I would have loved it, she didn’t need to be as upbeat as she was on Wednesday to make me happy. Experiencing the pleasure of her joyfulness will last a long time, and Adrienne, our caregiver, got as much pleasure out of it as I did.

She was just waking when Adrienne arrived at noon that day. I left soon after for my usual Wednesday lunch. When I returned, she was in her recliner. Adrienne said that she had been happy and cooperative when she got her dressed and out of bed.

An hour later, we took her for a stroll around the interior of the campus. We went to the wellness center and met three of the staff. Then we toured the chapel. Along the way we saw a number of people who hadn’t met Kate. I was glad for them to meet her and for Kate to have the experience of getting out and engaging in normal activities. She was enthusiastic about going out and continued to be expressive throughout out our tour.

When we returned, we went to the balcony where we relaxed about forty-five minutes before dinner. It was a very pleasant afternoon, and we went back to the balcony for almost an hour after eating.

She was very cooperative as we got her into and out of the lift as well as when we got her ready for bed. It was her best day in many months. Everything seemed to go right, and that is something to treasure.

Settling In Part 1: In-Home Care

Eight weeks ago, Kate and I moved into our new home in a local retirement community. Over the weekend, I met a couple who moved in two months before we did. He told me what a big change it had been after living in their home over forty years in the same town in which they had grown up. I could relate to what he must have felt. All my established routines were disrupted, and I’ve been working to establish new ones.

I’m happy to report that we’re making progress.  Over the past two weeks, I’ve felt much more settled. That relates to three aspects of our lives that have improved significantly. In this post, I’ll tell you about Kate’s In-Home Care and follow that with posts about Kate herself and then me.

Prior to Kate’s hospitalization with COVID eight days before Thanksgiving, we had help from caregivers three afternoons a week, Monday, Wednesday, and Friday, four hours for each day. We maintained that schedule for three years. We were fortunate that the caregiver who came on two days a week was with us the entire time. We had 3 or 4 for the remaining day. During this time, the demands on the caregivers were minor. I just needed someone to be with Kate while I was gone. They didn’t have to be in charge of any of her personal needs.

We were approaching the time she would require more care when she and I tested positive for COVID. Before she entered the hospital, I arranged for 8-hour daily care for her. Our regular agency was unable to fill the schedule. That led to my adding a second agency that provided help the four days not already served by the first agency. I’m grateful for their coming to my aid on such short notice, and I thought all of the caregivers were able to perform the needed tasks. Unlike our original agency, however, they never provided the consistency that I wanted. During the 5 months prior to our move, they sent us 6-8 different caregivers. They were all competent, but it was impossible for Kate to develop a comfortable relationship with them.

Our move required some adjustment. Our retirement community has its own home-care agency (Caring Hearts), but they do allow caregivers from other agencies to work here. There were two catches. The first is outside caregivers have to complete the same requirements as their own employees. That involves background checks, an all-day orientation, and health requirements. In addition, there was a $320 charge to me for each caregiver. As it turned out, only two caregivers chose to go through the process, one from each of the other two agencies.

The best news is that one of our caregivers, Adrienne, was already employed by Caring Hearts as well as the agency we had worked with for three years. She is also our best caregiver. As a result, it worked for her to cover 10 out of every 14 days. She gets every other weekend off as well as every Friday. The caregiver who has been with us over 3 ½ years continues to come on Fridays, and Caring Hearts is providing a new person for the weekend Adrienne is not with us.

These changes have had two major effects. First, our daily routine is decidedly more consistent. Adrienne shares some of my OCD tendencies and has a steady routine. Second, It gives Kate a chance to develop a closer relationship with her.  She has 3 different caregivers rather than 6-8. Only one of them is new. She is young (19) and has limited experience, but she is a certified nursing assistant (CNA) and is in school to become a nurse and then a physicians assistant. I’m optimistic about her.

I am especially pleased with the daily routine. When Adrienne is here, I feel more comfortable about leaving and regularly leave for lunch on Wednesday and Sunday very shortly after she arrives. She is the only caregiver that gets Kate up and dressed without any help from me; however, I have been helping her when we take Kate to the balcony or outside the apartment. I also help her get Kate ready for bed.

Apart from her routine, I like other things that she initiates on her own. For example, she has designated Wednesdays as “Spa Day” for Kate. On that day, she does Kate’s nails. She also takes more time getting Kate up each day. She works very slowly bathing, changing, and dressing her. She’s very good about making sure Kate gets her fluids, something I have found most of our past caregivers haven’t made a priority. I almost forgot to say that Adrienne always fixes a nice breakfast/lunch for Kate every time she is here. She is French and make French toast, French omelets, and fruit. On top of these things, she doesn’t ask if there is anything she can do for me. She just does the things that need to be done. She regularly takes care of washing and drying clothes, taking out the trash and recycling, organizing, and letting me know when we need new supplies.

This change in care has had a noticeable impact on both Kate and me. I’ll say more about that in my following posts. At the moment, I’m just glad that our in-home care is working well, and that makes life better for both of us.

An Important Breakthrough

Kate has not been outside since two weeks before Thanksgiving. There have been several exceptions. Four or five times we spent an hour or so on the patio before our move. Another was the ride in a wheelchair van when we moved, and since the move, four times on our balcony. That ended yesterday when her caregiver and I took her for a walk in her wheelchair around our building and the one adjacent to ours.

It started when I mentioned to the caregiver that I would like to arrange for Kate to have her hair done. I’ve talked with her hair dresser and the person who manages the salon on the grounds but have been concerned about how Kate might react. Yesterday, her caregiver suggested that we gradually take her outside the apartment and around the building. I agreed.

It wasn’t long before I saw that the caregiver was getting Kate out of bed and assumed that as usual she was either going to bring her to the living room or to our balcony overlooking a courtyard located between the two long arms of our U-shaped building. When I said something about going to the balcony, the caregiver said she wanted to take her outside our apartment. I was pleased with her desire and offered to go with them.

Kate was very quiet and didn’t protest as we walked into the hallway toward the elevator. We were encouraged but wondered how she would react to the elevator. As we approached, our next-door neighbor got off and walked toward us to her apartment. This was the first time any of the residents had seen Kate, and I took the opportunity to introduce her. I told Kate her name and explained that she lived next door. Kate didn’t say a word.

Then we proceeded to the elevator, backing her in because that seems to be less frightening for Kate. We entered without Kate’s protesting. The next step was the closing of the door and the motion of the elevator’s going down. Kate was very calm.

Once downstairs, we ran into the “Move-in coordinator.” She is the person we newcomers look to first when we have a question or problem. We walked over to her, and I introduced Kate to her. As with the previous introduction, Kate didn’t say a word, but she didn’t appear to be disturbed in any way.

From there, we went outside to the courtyard and walked around the outer walkway. Kate expressed neither concern nor pleasure. Her caregiver and I were encouraged that she seemed comfortable. I commented on the assisted living building that is located at the open end of our building. The caregiver offered to give us a tour.

As we entered, I took note of the fact that one of the first things I saw was the office of the geriatric physician whom I have known since the late 90s. A few months ago, Kate’s current doctor had mentioned that it might be good for Kate to transfer to this practice. I definitely plan to do this but also like her current doctor and haven’t been in a hurry to make the change. I knew it would be convenient, but seeing just how close it is to our apartment heightened my interest. I plan to bring up the subject of a change at our next appointment with the current doctor.

After walking through the assisted living facility, we walked back to our building and took a seat at an outdoor table at the soup, salad, and sandwich bar on the ground floor of our building. We relaxed about thirty minutes. Kate was quiet but did say that she liked being outside when I asked.

A few minutes later, she asked, “When are we going back up?” You might not think there is anything remarkable about this, but her caregiver and I did. She never seems to say anything that conveys awareness of where she is or the location’s relationship to some other place. The notable exception would be the many times she has said, “I want to go home.” (By the way, I’m not sure she has said that at all since we moved four weeks ago today.) The fact that she used the word “up” was striking to us. Was this just a random use of the word, or did she realize that we were downstairs? I’m inclined to believe the latter. If I am right, it shows a greater sense of awareness than I thought possible at this point in her Alzheimer’s.

It was just after 4:30, and I usually order dinner around 5:00, so we made our way back to the apartment and without any complications. Her caregiver and I hope that this is just a first of many such experiences in the days ahead. Kate may not have expressed any great enthusiasm, but her caregiver and I did. It was a refreshing outing for both of us.

The Final (?) Update on Kate’s Reflux

Yesterday was a good day for Kate. I gave her omeprazole in the morning and three doses of Mylanta during the balance of the day. I am glad to say that she had no recurrence of the episodes that had bothered her (and me) over the past week. Mylanta did the trick.

Tomorrow I’ll report the news to her doctor. I’ll see if she wants us to continue the Mylanta or simply rely on her omeprazole once a day. I suspect it will be the latter now that the crisis is over.

I will also speak with her about a transition to the physician’s practice right here, in fact, next door to our building. She had suggested this would be a good option for us at one of Kate’s recent appointments. I really like her present doctor, but I believe having her doctor next door would be an asset in the future. He makes house calls, something that would be of great benefit to us. I should add that I have known the doctor since at least 1998 when my mother became a patient at the geriatric practice with which Kate’s doctor is associated. The doctor here is the one who started that practice and was a neighbor of ours. I feel sure Kate would be comfortable with him, and I know I would.

I’m glad the mini-crisis is over. We can get back to settling into our new home.