It's 3 a.m. when your aunt with early-stage dementia calls in a panic. She lives alone but says there are strangers in her house who won't leave. What should you do?
A. Calmly assure her it's nothing, but promise you'll check her doors and windows in the morning.
B. Call 911, then drive to her house.
C. Change the subject so she forgets about the strangers.
Those "strangers" could be characters from an episode of Law & Order your aunt was watching—or actual burglars. "Until you identify a pattern of delusional behavior, always respond as if there is a real problem," says Molly Carpenter, caregiver advocate at Home Instead Senior Care and author of Confidence to Care. Moving forward, assess your aunt's house for lighting issues or shadows that might trigger a delusion. And don't spruce up her place by rearranging furniture or pictures. Familiar surroundings will reduce the chance of future 3 a.m. calls.
You're putting in long days caring for your dad, who lives across town. Not only are you exhausted, but your husband and kids say they never see you. It's time to:
A. Suggest your dad move in to eliminate your drive time.
B. Explain that your dad needs you more right now.
C. Solicit friends for help with household tasks.
D. Have a heart-to-heart with your family about how they can help you reduce your caregiving workload.
"Focus on quality—not quantity—of time when caring for an ailing loved one," suggests Patricia Moon, R.N., director of Family Care Services at Virginia Commonwealth University. "That will help you balance your and your family's needs with those of your dad." If family members, friends and church groups are able to lend a hand, set up a caregiving schedule for them with general chores (grocery shopping, mowing the lawn). That will allow you time for more personal tasks (bathing, help with eating) and some free time of your own.
Answer: C and D
On a recent visit, you notice that your father appears to have lost weight and his refrigerator is nearly empty. You realize you have to:
A. Gently scold your father for his poor diet choices.
B. Take dad to lunch to share your concern and offer to help him plan meals.
C. Research meal ideas for a single person.
D. Cook a week's worth of dinners for him.
Time to make a reservation at your dad's favorite restaurant. Once your meals arrive, ask if you can accompany him to his next doctor's appointment (if he doesn't have one scheduled, suggest you make one for him) to rule out any medical issues. Dental problems, illness, memory concerns, physical constraints and medications that suppress appetite can all compromise a senior's ability to eat. Then work with your dad to create a meal plan of easy-to-make foods and hang it up where he'll see it every day, suggests Carpenter.
Mom has misplaced her purse, which happens often due to her dementia. She's agitated and accuses you of stealing it. Slightly ruffled, you tell her:
A. "I would never do that!"
B. "How can you accuse me of such a thing? I'm the one caring for you."
C. "I am sure your purse is in a safe place. Let's look for it together."
D. "You probably just forgot where you put it. Do you remember when you last saw it?"
"People with dementia often become delusional and may say unthinkable things, like 'I didn't misplace it; you hired a team of thieves to steal it,'" says Jordan Klesmer, M.D., a geriatric psychiatrist in Great Neck, New York. Logic won't sway her. Instead, ease your mom's paranoia by reassuring her that you two will find the purse. And don't take it personally or expect an apology when the item is located. She may forget she even accused you. Instead, celebrate locating the missing purse.
No matter what you say, it's impossible to convince your uncle that he can no longer drive. To ensure his safety you:
A. Take a ride with him to assess his driving reflexes, judgment and timing.
B. Ask his doctor to tell him it's no longer safe to drive.
C. Hide his car keys.
D. Disconnect the battery cables so the car won't start.
Unless you're a trained driving instructor on a closed course, getting into a car with an elderly driver whose ability you question puts you both at risk. Instead of opting for a temporary fix, let the M.D. play bad cop. "It's easier to accept the loss of driving privileges if a doctor says he can no longer drive safely," explains Linda J. Welsh, a gerontologist at Parenting Your Parent, a geriatric management service.
It's been getting harder and harder to coax your mother with Alzheimer's to bathe. When she refuses to even freshen up for an upcoming doctor's appointment you:
A. Go to her house the day before the appointment and force her into the shower.
B. Take her to the appointment in her disheveled state so the doctor can see how she's behaving.
C. Explain the process of bathing in small steps.
D. Reschedule the appointment.
Your mom may no longer understand what a bath is. "She might even find the water frightening," says Carpenter. Try breaking tasks like this into simple steps. "For example, say, 'First, let's step into the shower,' then 'Let's put soap in your hand,' and 'Put your hand on your head and rub in the suds,'" says Carpenter. Create a spa-like atmosphere by playing music, dimming the lighting and using scented soaps.
Lately you've detected the smell of urine at your parent's house. Embarrassed, you decide to:
A. Be tactful but direct and ask about their bathroom habits or possible problems.
B. Drop hints about the smell.
C. Show up with an armful of air fresheners.
D. Order adult diapers online and have them delivered to their house.
Urinary incontinence is one of the main reasons people wind up in nursing homes, says geriatric specialist Terry Fulmer, RN, a professor and the dean of Bouvé College of Health Sciences at Northeastern University. Leakage can lead to infections or unsanitary conditions that require daily care. "Talk to your parent about available solutions, including pads (like Poise) and adaptive undergarments (such as Depend) as well as limiting beverages an hour before bedtime."
6-7 Caregiving Queen
You're calm and clever in the face of any challenge. Keep up the good work—by avoiding burnout. Try to get the same assistance from others that you give so well yourself.
Hone your skills by joining a support group to exchange stories of the challenges you face and share smart strategies for overcoming them.
0-3 Humble Helper
Don't despair. Being a caregiver—especially for your parents—isn't easy. Hone your skills by asking your relative's doctor for advice or taking an e-learning course.
Originally published in the April 2014 issue of Family Circle magazine.