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Old 04-17-2009, 06:02 PM   #46
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That is only true of early stages of Alzheimers, and yes, the patients have an uncanny ability to remember what happened 80 years ago, but not what is happening to them this week.

But in the later stages, this is no longer true. They lose even the very basic ability to remember that they should eat and drink, so I would not say that their memories are there; it is a definite degeneration as you approach the end.

yes.

my grandmother went from complaining about how her father was going to marry "that girl" after the death of her own mother in 1955 and how she wanted to go back to her place on a very specific street to being unable to say my name or even recognize my presence in the room except for a few brief moments of clarity when she'd smile at me, and then it was back to absolute vacancy. the breakdown of her language skills and memory was gradual, and very clear, and it took nearly 5 years for her to go from a cute elderly person with occasional senility who couldn't find her keys to someone who was for all intents and purposes already departed from the earth.

the more you know about the disease, the easier it is, imho, to watch it happen because, as awful as it is, you're at least prepared for the inevitable regression into total infant-like helplessness.

death is almost a relief as much as it is a release for that person.
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Old 04-17-2009, 06:41 PM   #47
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Most of the Alzheimer's patients where my mother lives are advanced-stage, and yes, my impression is that these patients are essentially no longer capable of speech and, as Irvine put it, 'absolutely vacant' most of the time.
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I work in an 'old folks' home. I can say outright that the number one goal of these places is MONEY. They will sell any employee downriver for trying to help if it's in a way they feel draws attention to their inadequacies.
Yes, eldercare is also an industry and a business. It's certainly apparent to me that staff turnover is moderately high where my mother lives, and that most of the staff receive very low wages despite the labor-intensive and emotionally challenging nature of the work. Anyone who is considering placing a relative in an eldercare facility should definitely make several visits to any facilities being considered first, ask to see their inspection reports, review their reputation with a geriatric social worker, speak with families of current residents, etc. That won't be foolproof, but anyone who's diligent about it is definitely likely to conclude that some of the facilities on their initial list are out of the question. Unfortunately though, circumstances don't always leave much of a choice.
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Old 04-17-2009, 10:01 PM   #48
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Yes, eldercare is also an industry and a business. It's certainly apparent to me that staff turnover is moderately high where my mother lives, and that most of the staff receive very low wages despite the labor-intensive and emotionally challenging nature of the work. Anyone who is considering placing a relative in an eldercare facility should definitely make several visits to any facilities being considered first, ask to see their inspection reports, review their reputation with a geriatric social worker, speak with families of current residents, etc.
I have to say that we all felt that my grandmother got excellent care in the home where she lived for 3 years. And it wasn't the most expensive home either, it was probably something mid-range? But anyway, the staff there was absolutely wonderful, we formed real relationships with them, and there didn't seem to be a high turnover among the staff which is a good sign. After my grandmother died, my parents took a bunch of chocolates and gift certificates to things like Starbucks to many, many people there, because we appreciated so much the care that she received.

Sure, it is a business, but that's not to say that you can't get very good care.
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Old 04-18-2009, 09:26 PM   #49
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The "an industry and a business" comment was an acknowledgement in response to Butterscotch's "the number one goal of these places is money"...I didn't mean to suggest by it that the standard of care is therefore destined to be poor. Sure, there are many first-rate facilities out there. I'd describe myself as 'mostly pleased' with the standard of care my mother's received, but there have been some issues that no amount of talking with supervisors or for that matter occasional food gifts to staff (though I'd do that anyway) have done much to address. And as far as staff turnover rates--which I do think contribute to said issues, because most of them basically amount to consistency and information-relaying problems--there simply aren't any facilities in my area where they're not fairly high. If I lived in a more urbanized area (plus my mother's insurance were better), then I suppose I might've been in more of a position to insist on finding a facility where that wasn't the case, but, oh well. I do understand it; most of the staff are hourly workers earning around $20K a year, and for those wages you'd better both really love what you do and feel good about the particular place you work at, assuming you're able to make ends meet on it in the first place.
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Old 04-19-2009, 06:38 PM   #50
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Sure, it is a business, but that's not to say that you can't get very good care.


my grandmother received outstanding care as well. it really could not have been better.

what makes me ill, though, is how i remember when she first moved into assisted living and she was far more lucid then and she took me aside at one point and vowed that this place would not be her final home. she was absolutely sure of that.

it was her final home.
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Old 04-19-2009, 08:47 PM   #51
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I think my grandma who is in a home is also receiving good care. It's not the nicest place, but the care is more consistent and much better than what she was getting insisting on living at home with grandpa taking care of her. I know the turn around is high (b/c a lot of my high school friends worked at this place as a high school job) but so far I don't know of any major mix ups. Of course it's costing over $6000 a month for her room not including all the medical stuff.

What does annoy me is that I feel like some of her doctors should come see her. For example, she's had all these infections on her leg and MRSA several times. Her leg has been an open wound for years and would be cut off if she could survive the surgery. A "wound nurse" comes to change the dressings, but a doctor is in charge of how it's being treated. Bringing my grandma to a doctor is really a day long process and she really has to be up to it. She has been a patient for years and is a pretty severe case, would it kill the doctor to just come see her in the nursing home? Maybe he would but she refuses to ask, I hope that's the case.

I feel bad for her b/c so many of the new friends she made have already died. She tells me about the people she eats lunch with and how they say ridiculous things, and on the outside she laughs about it but it's really sad. In their common room they have this large glass box that's a cage with a bunch of live finches. Someone accidentally rammed their power chair into it and punched a hole in the glass. It's funny for a minute, but then depressing.
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Old 04-20-2009, 07:08 PM   #52
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what makes me ill, though, is how i remember when she first moved into assisted living and she was far more lucid then and she took me aside at one point and vowed that this place would not be her final home. she was absolutely sure of that.

it was her final home.
Trying to convince an elderly relative that they need more assistance--or more assistance than family are in a position to provide--when they're convinced they don't has got to be one of the toughest, most draining and distressing things. Especially when the solution is going to involve them moving someplace they don't want to go, especially too when it's your own parent (or perhaps sibling) you're talking about. I suppose in some ways I'm grateful, if that's the right word, that there was no need to go through this with my mother, because what happened was so sudden and the resulting incapacitation so unambiguous. When she was in the rehabilitation facility during the first few months after her accident, she was constantly trying to escape, constantly agitated, and if you were visiting her she'd be in tears when you left, demanding to know why she couldn't leave with you, and there was really nothing reassuring to say because she didn't understand anything that was happening anyway. And that was bad enough. But at least there was never a need to plead and argue with her about making desperately needed lifestyle changes for her own safety.
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What does annoy me is that I feel like some of her doctors should come see her.
Yeah, unfortunately most doctors won't make nursing home calls. I think there might be some legal concerns involved there, greater risk of malpractice suits or something, but I'm not really sure. Usually a nursing home will have a 'house physician' who briefly checks in at regular intervals on any resident whose family has requested it, but of course that's not sufficient to address every medical issue of every resident. Taking my mother to the doctor is a pretty big production too, even with transportation assistance from the nursing home, so I can sympathize. Fortunately she doesn't need it much--an occasional trip to the neurologist, had to take her to a dermatologist once for what turned out to be some kind of allergic rash, but that's about it. She was always kind of afraid of doctors anyway, and now she tends to get pretty combative as soon as any poking or prodding starts.

The finch cage reference made me laugh; that seems to be a ubiquitous feature of nursing homes, along with aquariums and, surprisingly, a resident cat or two. It's not a bad idea; some residents clearly enjoy stopping to look at it now and then, and with some it can be a good conversation-starter too.
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Old 07-13-2009, 10:59 PM   #53
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Saw something today while visiting my mother that made the hairs on my neck stand up and put a lump in my throat, all at the same time.

I was in the residents' dining room keeping an eye on my mother, who tends to need prompts and redirection while eating, and as usual the other woman who sits at her table--an Alzheimer's patient, I assume--was sitting there slumped over in her wheelchair with a vacant look on her face, completely unresponsive to what was happening around her and unlikely to eat anything until an aide had time to sit down and get her started. Meanwhile my daughter was hopping around a few feet away singing that cloying little 'You Are My Sunshine' ditty, which I guess they'd been doing in school or something. I was just about to turn around and tell her to keep quiet when this other woman suddenly straightened up and started singing along--at first robotically and clearly almost by reflex, but then my daughter walked over and put her hand on her arm, they both kept singing, and the woman's voice became stronger and clearer and full of feeling. She remembered all the verses. When they reached the end of the song, she beamed, spontaneously hugged my daughter and exclaimed, "You're so sweet! I love you!" It was the first time in all my months of sitting across from her a few times a week that I've ever heard her say anything or show the slightest awareness of her surroundings.

It was really rather eerie--like seeing a coma patient briefly come around and laugh at a joke--but so moving at the same time, saccharine as it may sound. How little these things which have the power to make us feel safe, grounded, exhilaratingly alive often are.
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Old 07-14-2009, 01:54 AM   #54
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We forget how powerful those little things are, the tiny connections, a piece of music that takes you back to what you once were. Your daughter is kind. That is a much rarer quality than being nice.
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Old 07-14-2009, 12:36 PM   #55
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That's beautiful
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Old 01-11-2010, 01:34 AM   #56
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So I haven't been around much lately, and for now I'm still frantically busy working out syllabi for the courses I'm teaching here in Hong Kong this semester...but, since I started this thread, I thought I'd bump it to mention that my mother died--almost exactly a month ago now, actually. It was mercifully quick; she came down with one of these potent strains of pneumonia you see in nursing homes and hospitals, and died within a couple weeks. Although she'd generally been well physically other than the brain injury, I'm sure two years of wholly sedentary living after a lifetime of being highly active must've taken their toll, so while sudden, I can't really say this was a 'surprise.'

The timing was pretty headspinning for me--had to scramble to find a last-minute flight back to the US at the height of Christmas travel season, plus I wasn't actually returning 'home,' but rather back to Mississippi where I grew up, so that we could bury her next to my father. Since none of us live in that area anymore, this meant sitting shiva (the weeklong Jewish mourning ritual for immediate family) in the house of a very generous old family friend who also happens to be a National Baptist Convention minister, a scenario which occasioned numerous jokes ("...So, a rabbi, a therapist, a professor, a social worker, and a Baptist minister are tucking into the fried chicken at the funeral reception, and the minister turns to the rabbi and says..."). But--if it's even appropriate to use such terms when describing the experience of a parent's funeral--honestly, after what the last two years of her life were like, it truly felt elating to me to gather together one last time with people who remembered her as a colleague, a teacher, a civil rights activist, a neighbor and a friend...not as a demented, volatile, helpless invalid who didn't know her own name most days. My brothers and I were walking around wreathed in smiles half the time while we were there, some tears too for sure, but all of it genuine--it just brought such a welcome feeling of release to see this sad little coda to her life, a life which effectively ended two years ago, conclude for good, and there's no doubt whatsoever that for her part, she'd have much preferred never to have lingered on in that condition at all. I feel so grateful to have had that closing groundswell of support from old friends and associates of hers and my father's as we laid her to rest.

Then it was back onto a plane--for no more than a day's return to HK, after which it was back onto a plane yet again, this time for a family holiday in Java and Bali, which we'd scored cheap tickets for back in November. Like I said earlier--headspinning timing...still, a fascinating trip and, thankfully, clearly a great time for all three of our kids, which'd been our main concern about going there; Indonesia's not one of Asia's easier countries to travel in. I may try to write up a blog entry about it, once I get through these initial cold-water-shock days of teaching stuff I've never taught (the Odyssey, Hamlet, Confucius, Mencius) seminar-style, to Chinese students who've never taken seminar-format anything, let alone studied Western literature. Not that my own meager background in Chinese philosophy affords much grounds for confidence in teaching that to them, either...ulp! But, the great thing about seminar format is that it maximizes your opportunities to learn from your students.

Anyways, for now
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Old 01-11-2010, 02:28 AM   #57
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Wow, I'm so sorry Yolland. My deepest condolences to you and your family.
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Old 01-11-2010, 07:53 AM   #58
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My sincere condolences, Yolland. It's hard enough being on the other side of the world and for tragedy to strike during the holidays when travel is even more difficult, well...I'm sure you're glad to be stepping into a new normal. Good luck with the new classes.
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Old 01-11-2010, 09:27 AM   #59
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Yolland, so sorry to read the news.

We've also had three grandparents die since this thread began. The two remaining (my dad's mother and my mom's father) do have some pretty serious health issues but at the moment are under control and able to live on their own (both as part of a senior facility...not in assisted living, but already in "the system" so we are easily able to move them into assisted living when the time comes).

The most recent was my grandmother, who had the most issues and I think I posted about her earlier. She died on Tuesday and I still feel rather numb about the whole thing, being that she has always been my "favorite" person. I remember a few years back thinking to myself that I would never be able to go on living without my Grandma, and when she actually died last week I thought back on that moment and wondered how I had become so numb. The only explanation I have at this point is that I have already been grieving her for years. I am 25 years old and have no memory of my grandma without pain and dibilitating disease. People keep coming up to me and asking me how we all coped and I say, it sounds rather apathetic but you honestly just get used to it, especially when the person in so much pain will never let on the extent of her suffering.

Anyway, my grandpa and grandma always had their senile gripes about this nurse or that nurse but we all know that the nursing staff was always gentle and kind and patient with my grandma and they were noted in her obituary. When she went downhill rather quickly, the nurses basically cared for her every minute until she died. She would not have survived a move to a hospital even before she fell ill (and honestly I still do not know *what* happened last week, but I won't pry my mother about it right now). The nurses kept her comfortable on oxygen and morphine. They kept her mouth and her eyes hydrated, they let us in after hours and kept a room open for our family. I don't know if it matters but my grandma was in a private facility costing $6800 a month (some funded by her Medicare, and my grandpa is a retired city worker so he gets a pension).
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Old 01-11-2010, 06:48 PM   #60
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I'm sorry, yolland.
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