A person who has dementia may have difficulty finding the right words; they may repeat certain sounds, words, and phrases, seem confused, and be unable to adequately express themselves. This frustrating condition causes people to feel helpless, anxious, irritable, and depressed – a very difficult state to witness, especially when it attacks a person who is very important to you. Many family members of dementia patients feel as if their loved ones have become mere shadows of their former selves. Fortunately, between the confusion, there are good days and bad, and remarkable moments when the loved ones they remember shine through.

If you are facing the challenge of communicating with a parent who has dementia, these guidelines may be helpful:

Avoid Distractions

Communicate with your parent in an area that allows her to focus all of her mental energy on the conversation. Do not attempt to converse in crowded place, in front of the TV, or while the radio is playing.

Be Prepared

If your parent wears glasses, make sure they are on before you begin so that she can see you clearly. If she has hearing aids, make sure they are in and working. Do not approach your parent from behind, as it may startle her.

Be Positive

Create a positive mood by speaking to your parent with a calm tone and pleasant approach. Be careful to avoid sounding condescending or disrespectful. Use facial expressions, gestures, movements, and touch to convey your message and show affection. Avoid using childish terms such as diapers, bibs, and potty.

Be Clear and Specific

Speak in a clear, distinct voice and use using simple words and sentences. Say your parent’s name, your name and the names of anyone else who is present or is the subject of your conversation and avoid the use of pronouns.

Keep Conversations Simple

Instead of asking your parent open-ended questions, like “Tell me about the house you grew up in,” frame your questions in a simple form that will require a simple answer like “Did you grow up in an apartment or a house?” If conversation becomes difficult, a pen and paper can sometimes be helpful.

Focus on One Topic

To avoid confusion, isolate your conversation to one topic at a time. As the illness progresses you may have to initiate and guide your conversations.

Utilize Non-Verbal Cues

Put your parent at ease with a smile, reassuring touch, and friendly tone. Position yourself at her eye-level and maintain eye contact.

Use Repetition

After listening to your parent, repeat what you understood back to her. You may need to repeat yourself several times. And, at times, it may be better to wait a few minutes before trying again to communicate.

Ignore Inaccuracies

With dementia comes confusion and delusion. Disagreeing with your parent’s statements is not likely to change her mind. When you disagree with what she is saying, whether it is due to logic or opinion, it’s best to let it go.

Reminisce

Reminding your parent of the good times in her life is likely to have a soothing effect. While short-term memories fade fast with dementia, long-term memory often remains in-tact.

Be Patient

Stay calm and expect communicating with your parent to take time. Do not interrupt her or finish her sentences unless she asks you to help her. If the time comes that your parent is unable to respond verbally, don’t give up; continue talking to her to demonstrate that you still care.

Laugh it Up

Whenever possible, engage your parent with humor to reduce stress and lighten the mood.

What Matters Most?

It is very difficult to see your parent losing their ability to communicate. Try to be patient and understand that even if she cannot properly express herself, she may be able to respond to you and fully experience feelings and emotions. The core relationship that you seek to cherish is still present.

The MacIntosh Company has multiple Ohio locations that provide short-term post-hospital inpatient rehabilitation and skilled nursing orthopedic, as well as respite care. Long-term services include assisted living, intermediate care, and memory care for your convenience. If you would like to know more about the options available at a location near you, please contact us.

Dear Tess,

My sister, who lives in the Columbus area, usually helps out Mom and Dad, because my husband and I live out of state. Although we try to visit during holidays, my sister is the one who takes care of my parents on a regular basis.

When we visited at Thanksgiving, I was appalled by my parents’ condition. Both Mom and Dad have lost weight. Mom is really unsteady on her feet, and although she insisted on trying to help prepare the meal, we had to watch to make sure she didn’t fall. Dad refused to wear his dentures, saying they hurt his mouth, and when I tried to persuade him, he smacked my hand away.

Dad was also complaining because my sister won’t let him drive anymore. He yelled at the kids for playing and frightened them. He just doesn’t seem like the calm, even-tempered father I remember.

When I tried to talk to my sister, she told me she’s suggested every kind of help possible—home health, senior daycare, even a nursing home. Dad has absolutely refused to consider anything.

I’m not an expert so I don’t know how bad their condition is. How can I find out what to do or where they should go?

Sincerely,

Gabrielle

Do Your Parents Need Immediate Help?

Dear Gabrielle,

It’s not uncommon for adult children who don’t live nearby to be shocked at a parent’s decline. Oftentimes, family members who see them frequently don’t even notice the signs. Your sister is certainly doing her part by noticing there’s a problem and attempting solutions.

Some of the signs a parent may need help are covered in our blog here. Your concern is whether they need help immediately and, if so, how to get it.

Signs Your Parents Need Help Immediately

Weight loss and a change in temperament are both warning signs, but your parents are in no imminent danger from those. However, I am concerned by your mother’s unsteadiness. She could easily fall. Falls are the leading cause of injuries—fatal and nonfatal—among seniors.

• Other signs that your parents need help immediately include:
• Burn marks on cooking ware that may indicate your mother is forgetting to turn off the stove.
• Unsafe or cluttered pathways in the home that may lead to a fall.
• Failure to take life-saving medication, such as cardiac or diabetes medicine.
• Skin breakdown, which may cause infection.
• Confusion when performing daily tasks.
• Difficulty standing up.
• Use of second-floor bedroom if a parent is unsteady on their feet.
• Uncontrolled diabetes.
• Rotted food in the refrigerator or cabinets.

Care Options

You and your sister are best suited to make an assessment of their home environment, but you should also take your parents to their doctor and express your concerns as soon as possible. Any one of the above problems can lead to life-changing consequences if you delay. If you determine your parents’ circumstances must change, you have three general options:

1. Hire a home health aide to help out and commit more time to their care.

2. Move them in with you or your sister or have your sister move in with them.

3. Find a nearby assisted living or skilled nursing center to keep your parents safe and happy.

If you decide your parents need to move, the general rule is that if an adult needs help with two or more activities of daily living (ADLs), such as walking, eating, dressing/grooming, toileting, bathing and transferring/standing up, they would do best in a skilled nursing center. Otherwise, they may enjoy assisted living.

Please don’t consider either placement permanent. At all our MacIntosh Company care centers, our goal is to help your parents become as independent as possible while staying safe. We’re very proud of residents who needed our skilled nursing care initially or temporarily and then were able to return to assisted living or independent living!

Their doctor can help you with an assessment, information, and recommendations. Please feel free to give me a call at Whetstone at (614) 457-1100 or contact one of our other Central Ohio centers online if we can help. While no one can perform an assessment over the phone, we can tell you how other Columbus-area residents have handled similar situations.

You may also want to search our blogs to find additional information to help.

Caregiver Help

I’d like to point out several resources for caregivers. They are:

• Long-Distance Caregivers and High-Tech Solutions

• How Online Caregiving Communities Can Help

• Holiday Survival Tips for Central Ohio Caregivers

Please keep in touch and contact any of our care centers if you have questions.

Sincerely,

Tessa Tweedlie, RN
Director of Nursing
Whetstone Care Center

Dear Tracy:

It looks like my grandfather will soon need skilled nursing. Our family has tried to help my grandmother keep him safe at home for as long as we can, but it’s becoming too dangerous for her to manage. He falls a lot and she is simply not able to help him get back on his feet.

We’ve been researching the costs of nursing homes in central Ohio, and it’s just not feasible for them financially. They live on a very fixed income. Their only real assets are their house and an older car my grandmother still drives. We’ve talked about applying for Medicaid to pay for Grandpa’s care, but we are worried they will take the house and leave my Grandma without a home.

What are the rules about Medicaid, nursing homes, income and assets in Ohio?

Danielle

Dear Danielle:

It sounds like your family is in a tough spot. We hear similar stories from families in your position quite often. Fortunately, the Medicaid laws in Ohio are much more practical than they used to be. The legislature recognizes that leaving a spouse without a home solves one problem for a family but creates another one.

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Applying for Medicaid for a senior? Here’s how to do it.

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Top Facts About Medicaid in Ohio

Here are a few things you should know about Ohio Medicaid:

• It will pay for a nursing home for an adult when it is considered to be “medically necessary.” This means the potential resident requires hands-on assistance with at least two of the activities of daily living: bathing, dressing, eating, grooming, transferring, toileting, and taking medication.
• Your grandmother will be allowed to keep her car and her home, provided she or a dependent family member still lives in the home.
• Your grandmother will also be able to keep some of the income and assets they share. How it works is that the state of Ohio assumes half of the assets your grandparents had at the time of your grandfather’s admission to a nursing home (referred to as the “Community Spouse Resources Allowance” or CSRA) belong to your grandmother and half to your grandfather, subject to a limit that changes annually. In 2022, that limit is a minimum of $27,480 and a maximum of $137,400.
• Your grandmother may also be able to keep part of their monthly income if her own income is less than $3,435 per month (2022 rate).  
• When you apply for Medicaid, Ohio Department of Jobs and Family Services will tell you just how much your grandmother will be able to keep.

If your income is too high, a Qualified Income Trust is an option. See our article for more information.

Hopefully this puts your mind at ease about your grandmother so you can focus on getting your grandfather the care he needs! Please feel free to give me a call at (614) 875-7700 if you have any other questions!

Warm Regards,

Tracy Woods
Patient Financial Services Representative

Dear Regina:

I went home to visit my mother in the Columbus area over the holidays. It was my first in-person visit with her since last spring. Besides losing weight, she seemed a little disorganized and nervous during my stay. I’m not sure if this is just normal aging or signs that she needs help of some kind.

How do I know the warning signs of something more serious are and what can I do to get Mom the help it seems like she needs?

Dan

Evaluating a Senior’s Safety at Home

Dear Dan:

Senior care providers often receive frantic phone calls from adult children during the holiday season who find themselves in a situation like the one you just described. Older parents usually don’t want to bother busy adult children with their problems, especially when the kids live far away.

Here are a few warning signs that suggest your mom needs help:

• Untidy home including piles of laundry, overflowing trash, and dirty dishes
• Expired foods and evidence of a diet that consists primarily of convenience foods (i.e. frozen dinners) and fast foods
• Decline in personal hygiene habits
• Change in personality such as overly weepy or sad, short-tempered, paranoid or anxious
• Unintended weight gain or weight loss
• Bills piled up unopened on the counter or desk
• Calls from creditors regarding unpaid bills
• Withdrawing from favorite social organizations, church groups and hobbies

If more than one or two of these could be used to describe your mother’s current situation, your concerns about her safety might be warranted.

The best next step to take is probably to encourage your mom to schedule an appointment with her family physician or to allow you to do that for her. Together you can share your concerns with her doctor and ask for their advice.

It might be that a poor diet has led to her decline. If you enlist the services of an in-home aide to help with grocery shopping and meal preparation, you might be able to get back on track.

Or the physician may suggest that being isolated and alone has led to depression. A move to a senior living community where she can be active and engaged with life again could be the best solution for your mom.

We welcome you and your mom to contact us if you need help understanding the senior care options that are available to her in the Columbus area. Our team will be happy to help answer your questions and connect you with the resources you need.

Ragena McGuire, RN, Director of Nursing