SELECTING THE RIGHT DOCTOR

Many primary care physicians (PCP) lack experience treating patients with dementia. There are advantages to continuing to use a PCP who has a long history of caring for your loved one.

But just as you might seek out a cardiologist for a heart condition or a dermatologist for a skin lesion, a patient with dementia needs to receive care from either a PCP with a great deal of experience treating dementia patients or a specialist (neurologist) who has specific training in treating neurodegenerative diseases. And the care of a neurologist will become even more important in the later stages of the disease.

Finding the “right” neurologist is a very personal search – one that, unfortunately, cannot be guided by a generic caregiver directory such as this one. The dementia caregiver should seek out recommendations from her PCP or other caregivers who are pleased with the neurologists who are treating their own loved ones.

Doctor, hospital and ER visits are especially difficult for dementia patients who are in mid- to late stages of the disease. They likely don’t understand why they are there, are confused by the unfamiliar surroundings, and can be easily agitated by a hands-on examination from someone they don’t know or trust. In some cases, the patient can become so agitated that they may require a sedative to relax them enough to be treated.

 

The following website provides some helpful hints on preparing for and managing these difficult interactions:

Home health care (aka home health) describes a broad range of in-home services provided (usually) by licensed health care workers as an alternative to in-patient care at a hospital, skilled nursing facility, or senior living community. The skill level of the care workers can vary from that of a certified nursing aide to a registered nurse.

Home health may be prescribed by a physician, but a prescription is not necessary to receive this care.

Home health is most often provided by a state-licensed agency, but under certain circumstances, states will allow an unlicensed person to provide home health services (e.g., an individual hired and paid directly by the patient or patient’s guardian). Certainly, there are advantages to hiring a licensed provider whose care procedures are regulated and monitored by state oversight, but some of the best and most compassionate home health providers are simply individuals who have the necessary training, experience, and compassion to serve an elderly person in the home (e.g., retired nurses).

Services provided by a home health provider include, but are not limited to:

  • Assistance with the activities of daily living (ADL’s) – bathing, dressing, toileting, food preparation, feeding
  • Medical care (administering meds, wound care, injections)
  • Companion care (combatting isolation)
  • Respite care (spelling the family caregiver for a few hours)
  • Hospice & palliative care
  • Supplement to facility staffing within a senior living community

North Texas home health companies generally charge $30-$40/hour and most require shifts of at least 4 hours – with many of them requiring 8-hour shifts. If asked, many home health aides will also perform light housekeeping duties and take loved ones out to lunch or to run errands.

The scope of duties to be performed by the home health team should be negotiated at the beginning of the relationship and documented in writing to ensure that all parties are on the same page as to the services to be provided.

Dementia patients carry an above-average risk for nutritional disorders as they (1) are prone to snacking and eating only what tastes good, and (2) in later stages, simply do not recognize that they are hungry. In fact, for many dementia patients, it is the refusal to eat that ultimately begins the spiral toward death as they do not sense hunger and simply fail to thrive on the few calories of food their caregivers can persuade them to eat each day. Similarly, they do not always recognize thirst and frequently become dehydrated.

Dementia patients also present their caregivers with a number of other mealtime challenges: difficulty in handling utensils, not recognizing what’s on their plate, choking, etc.

The following website presents some excellent information for caregivers whose loved ones are exhibiting a variety of mealtime challenges:

Click To Visit alz.org

A wellness check is a non-emergency in-person visit (usually by the local police department or other public safety resource) in response to concern by family members, friends, or neighbors that an elderly person is not being responsive to attempts to make contact.

If you have loved ones who live alone without any close friends or family living nearby, please check in on them regularly. And if they don’t respond promptly to your call or text, consider calling your local police department’s non-emergency phone line and requesting a wellness check for them.

“Taking care of yourself is not selfish — it’s necessary.”