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By Geri Hall
After grappling with the difficult tasks of caregiving to your
loved one at home, you may find it necessary to place him/her into a residential
care facility. Once you have selected the appropriate facility for your elder,
be it an assisted living facility or nursing home, all of you will have to deal
with the challenges of adjusting to new routines.
Some facilities have a "30 Day Rule" which allows them to decide
whether your elder "fits in" with their facility. The 30 Day Rule seems more
than fair to me. If a patient is going to show signs of adjustment the facility
will be able to make the appropriate decision. This protects them from having to
keep people they absolutely can't manage in their environment and who might
injure other residents.
- The vast majority of people with dementia have difficulty with
adjusting to a new home environment. For at least two weeks the person can't
find things, is besieged with new people and routines and has feelings of
frustration and/or anger. There are some ways to help your loved one adjust:
- Expect agitation for 2-3 weeks. You might ask your elder's
doctor for a light prescription for Ripserdal, Haldol, or Seroquel and use it
for a few weeks (in a VERY light dose) BEFORE the placement. The patient may be
confused, but not upset and agitated.Do not necessarily avoid visiting for two
weeks, even though the facilities suggest this. Follow a formula
something like the following:
- Expect the person to be agitated and angry, but stop beating
yourself about it. You did what had to be done. Your loved one needs to grieve.
To expect happiness is unrealistic.
- Plan a BRIEF visit. 10-15 minutes will be enough for you to
know your loved one is well-cared for and to give them reassurance. A 3-hour
visit is going to cause agitation. If the loved one demands to be taken home,
DON'T try to explain. Look at your watch and say, "I have to go now." It will
break your heart, but will minimize the behavior after a few times. Many
patients start the "take me home" stuff after a 30 minute visit when they get
tired. Take it as an indication that it is time to go.
- Take something to do. Do their nails, have a snack, listen to a
new piece of music or share an activity. Once you are done, it is time to go.
Have the staff divert your loved one to an activity such as a meal.
- Call before you come so you know what kind of day your loved
one is having. If you know they are agitated and having a bad day and if you
can't face it without becoming upset, don't go when they are agitated . . . or
go later.
- Talk with the staff. Smile. Find the staff doing something
right and complement at least one on each visit. There is nothing worse than the
family who comes in with their microscope looking for flaws. They will become
apparent soon enough -- we are talking working with demented adults here.
- Know that the facility and staff have no magic for dealing with
behavior problems. If it was difficult to manage at home, it will be worse in
the care facility -- especially with 7+ other people who are also demented.
- Before you leave, talk with an administrative staff member to
see how things are going and what you (as a team) can do to improve care
throughout the adjustment.
- I can not stress this too much: select an activity-based
program! And, if your loved one is not a socializer, make sure the staff knows
to let him have some time to himself daily and introduce him slowly to the
group.
- Last, do not let the adjustment period dissuade you from the
placement. It most likely will work out.
Geri R. Hall, PhD, ARNP, CNS, FAAN
Associate Director
for Outreach
University of Iowa Center on Aging
Source: ElderCare Online
Heritage Enterprises Inc.
115 W. Jefferson St., Suite 401
P.O. Box 3188 Bloomington IL 61702-3188
PH: (309) 828-4361 FAX: (309)
829-5477
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