Caring for Aging Parents

For eleven years I pleaded with my elderly father to allow a caregiver to help him with my ailing mother, but after 55 years of loving each other he adamantly insisted on taking care of her himself. Every caregiver I hired to help him sighed in exasperation, "Jacqueline, I just can't work with your father–his temper is impossible to handle. I don't think he’ll accept help until he's on his knees himself." My father had always been 90% great, but boy-oh-boy that temper was a doozy. He never turned it on me before, but then again I'd never gone against his wishes either. When my mother nearly died from an infection caused by his inability to continue to care for her, I flew from southern California to San Francisco to try to save her life–having no idea that in the process it would nearly cost me my own.

EARLY SIGNS OF DEMENTIA? I spent three months nursing my 82-pound mother back to relative health, while my father said he loved me one minute, but then he’d get furious over some trivial little thing, call me nasty names and throw me out of the house the next. I was shocked to see him get so upset, even running the washing machine could cause a tizzy, and there was no way to reason with him. It was so heart wrenching to have my once-adoring father turn so much against me. I immediately took my father to his doctor and was flabbergasted that he could act so darling and sane when he needed to. I could not believe it when the doctor looked at me as if I was the crazy one. She didn’t even take me seriously when I reported that my father nearly electrocuted my mother, but luckily I walked in three seconds before he plugged in a power strip that was soaking in a tub of water–along with my mother’s feet!  Much later I was furious to find out my father had instructed his doctor (and everyone) not to listen to me, because I was just a (bleep-bleep) liar and all I wanted was his money (I wish he had some).

Then things got serious. My father had never laid a hand on me my whole life, but one day nearly choked me to death for adding HBO to his television, even though he had eagerly consented to it just a few days before. Terrified, I dialed 911 and the police took him to the hospital for evaluation. I was so stunned when they released him right away, saying they couldn't find anything wrong with him. What is even more astonishing is that similar incidents occurred three more times.

CAREGIVER CATCH 22. I was trapped. I couldn't fly home and leave my mother alone with my father, she'd surely die from his inability to care for her. I couldn't get healthcare professionals to help, my father was always so normal in front of them. I couldn't get medication to calm him and even when I did, he refused to take it. He threw it in my face or flushed it down the toilet. I couldn't get my father to accept a caregiver and even when I did, no one would put up with him very long. I couldn't place my mother in a nursing home, he'd just take her out. I couldn't put him in a home, he didn't qualify. They both refused Assisted Living and legally I couldn't force them. I became a prisoner in my parents' home for nearly a year trying to solve crisis after crisis, crying daily, and infuriated with an unsympathetic medical system that wasn't helping me appropriately.

GERIATRIC DEMENTIA SPECIALIST MAKES DIAGNOSIS. You don't need a doctorate degree to know something is wrong, but you do need the right doctor who can diagnose and treat dementia properly. Finally, I was directed to a neurologist who specialized in dementia who performed a battery of blood, neurological, memory tests and CT/P.E.T. scans. He reviewed my parents’ many medications and ruled out numerous reversible dementias such as a B12 and thyroid deficiency.  And then, you should have seen my face drop when he diagnosed Stage One Alzheimer's in both of my parents, something all their other doctors had missed entirely.

TRAPPED IN OLD HABITS. What I'd been coping with was the beginning of Alzheimer’s (just one type of dementia), which begins very intermittently and appears to come and go. I didn't understand that my father was addicted and trapped in his own bad behavior of a lifetime and his habit of yelling to get his way was coming out over things that were illogical, at times. I also didn't understand that demented does not mean dumb (a concept which is not widely appreciated) and that he was still socially adjusted never to show his "Hyde" side to anyone outside the family. Even with the onset of dementia, it was amazing he could still be so manipulative and crafty. On the other hand, my mother was as sweet and lovely as she’d always been.

BALANCING BRAIN CHEMISTRY. I learned that Alzheimer's makes up 65-70% of all dementias and there's no stopping the progression nor is there a cure. However, if identified early there are four FDA approved medications that in most people can mask/slow the symptoms of the disease, keeping a person in the early independent stage longer, delaying full-time supervision and care.  The medications are Aricept, Exelon, Razadyne and Namenda, with many more in clinical trials. After the neurologist treated the dementia, and the depression (often present with dementia) in both parents, he prescribed a small dose of anti-aggression medication for my father, which helped smooth his temper without making him sleep all day (I wish we’d had that fifty years ago)! It wasn’t easy to get the dosages right and not perfect, but at least we didn’t need police intervention any longer!

CREATIVE BEHAVIORAL TECHNIQUES. Once my parents’ brain chemistry was better balanced, I was able to optimize nutrition, fluids, medications and treatments with much less resistance. I was also able to implement techniques to cope with the bizarre behaviors. Instead of logic and reason, I used distraction, redirection and reminiscence. Instead of arguing the facts, I agreed with and validated frustrated feelings and lived in their realities of the moment.  I learned to just “go with the flow” and let unpleasant comments roll off.  And if none of that worked, a bribe of ice cream worked to cajole my father into the shower, even as he swore a blue streak at me that he’d just taken one yesterday (over a week ago). I was also finally able to get my father to accept two caregivers (he’d only alienated 40 that year, most only there for about ten minutes), and with the benefit of Adult Day Care five days a week for my parents and a support group for me, everything started to fall into place.

IF WE ONLY HAD LONG TERM CARE INSURANCE! Before long my parents’ life savings was gone and we were well into mine. I was advised to apply for Medicaid for them and after months of paperwork they were approved for financial help from the government. I was so relieved, until I learned that it would only pay to put my parents in a nursing home, not keep them at home with 24/7 care.  And, since my mother needed so much more care than my father they’d be separated, something they would never consent to, nor could I bear to do. I could not believe it, I finally had everything figured out medically, behaviorally, socially, two wonderful caregivers in place, the house elder-proofed, and all I needed was some financial help to keep them at home. If I’d just made sure my parents bought Long Term Care Insurance when they were healthy and before the diagnosis of dementia, it would have covered the cost of their care at home. Now I tell everyone to look into LTC insurance early, so they aren’t caught financially unprepared like we were.

ALZHEIMER’S / DEMENTIA OFTEN OVERLOOKED. What is even more upsetting is that no one ever discussed the possibility of the beginning of Alzheimer’s disease (or any type of dementia) in my parents with me that first year, which happens far too often to families. Alzheimer's afflicts more than 5.3 million Americans and 36 million worldwide, but millions go undiagnosed in the early stage because intermittent warning signs are chalked up to a normal part of aging. Since one out of every eight by age 65, and nearly half by age 85 get AD, healthcare professionals need to know the “Ten Warning Signs of Alzheimer's” and educate families to save them time, money, and a fortune in Kleenex!

TEN WARNING SIGNS OF ALZHEIMER'S, (Reprinted with permission of the Alzheimer’s Association) 1. Memory loss 2. Difficulty performing familiar tasks 3. Problems with language 4. Disorientation of time and place 5. Poor or decreased judgment 6. Problems with abstract thinking 7. Misplacing things 8. Changes in mood or behavior 9. Changes in personality 10. Loss of initiative https://www.ElderRage.com/Alzheimers.asp

Jacqueline Marcell is an INTERNATIONAL SPEAKER , host of the COPING WITH CAREGIVING radio show, and author of ELDER RAGE , a Book-of-the-Month Club selection receiving 50 endorsements, 304 five-star Amazon reviews, is required reading at numerous universities and being considered for a film.  http://www.ElderRage.com Jacqueline Marcell Author, Radio Host, Speaker Elder Rage, or Take My Father... Please! How to Survive Caring for Aging Parents Book-of-the-Month Club Selection.