A Caregiver’s Guide: Adapting Caregiving Strategies Throughout the Stages of Alzheimer’s

In health care settings, the body gets medical attention, but the mind and soul matter, too. Older adults in medical care face a battery of health questions, but too often the most consequential one goes unasked and unanswered: What does a good day look like for you today?Medicare requires people to receive a spiritual assessment within their first five days of admission into hospice. Many states allow a nurse to conduct the initial spiritual assessment, but I think it helps both the person and the health care provider for the assessment to be done with someone who has theological training. Many have been certified in clinical pastoral education, or CPE. Nurses can get so focused on the technical to-do lists of medical work  the measurements, the tests, the drug regimens that it can be hard to make time for the issues that matter most to the living human, namely, their happiness, peace and contentment.  As a spiritual care provider with 17 years in senior care facilities, and as a chaplain in the Army National Guard and Air Force National Guard, I have counseled hundreds of people in the final days of their lives.  For older adults and their families, one of the most valuable resources is also little-known a Medicare option that provides spiritual counseling for people in hospice. Longing for ConversationToo often older adults in care are being talked at, not listened to. Many times, I've found that people in the last chapter of life want to discuss their path to the end more than their medical professionals and, especially, more than their loved ones.  It often helps to have that discussion with a professional who is trained to hear them, and, if requested, to comfort and advise them.  RecommendedOpinion: Why I Went on Hospice Even Though I'm Not Dying | Personal PerspectivesThe code of ethics for the leading chaplain and spiritual care associations all prohibit proselytizing. A spiritual care provider should be able to work with someone on their own terms, no matter their beliefs. The United States may be turning more secular, but the fact remains that older adults are the most faith-affiliated of any demographic age group.This initial spiritual meeting is likely to be about the basics: Is the person religious? What is their support system? Will a certain faith-based ritual bring meaning or comfort? Do they have a preferred faith leader? Or is a secular discussion a better fit for the person's beliefs? 

Guardianship is a serious legal process that serves as a last resort for caring for an elderly parent who can no longer make sound decisions for themselves. It requires a court hearing and confirmation of incapacity by medical providers.What is Guardianship?Guardianship means an individual is appointed by the court to make medical decisions and manage daily care for an elderly parent. This typically occurs when an elderly parent:Is diagnosed with cognitive impairments like dementia or Alzheimer's diseaseHas suffered brain injuriesExperiences serious health conditions that impair decision-making abilitiesKey Considerations in GuardianshipEmotional ChallengesDeciding to pursue guardianship often involves mixed emotions. Adult children may feel uncomfortable, especially if family members disagree about the necessity of guardianship.Legal RequirementsTo establish guardianship, documentation must be submitted to the court that:Substantiates the degree of cognitive impairmentProvides evidence of poor decision-makingIncludes a medical assessment, potentially a neuropsychological evaluationTypes of GuardianshipGuardian ResponsibilitiesMake medical decisionsManage daily careAdvocate for the elderly parent's best interestsFollow the principle of substituted judgment (making decisions the parent would make)ConservatorshipIn most situations, a conservator is also appointed to manage money and property. This can be the same person as the guardian or a separate individual.Challenges of GuardianshipAdvocacy and Medical InteractionsGuardians must:Navigate complex healthcare systemsCommunicate with medical professionalsUnderstand and research medical conditionsMake thorough, prudent decisionsFamily DynamicsGuardianship can create:Potential conflicts between family membersDisagreements about care and spendingEmotional stress that may damage relationshipsState-Specific ConsiderationsGuardianship laws and terminology vary by state. Some states have:Different definitions of guardianshipVarying availability of professional guardiansUnique legal frameworks for elder careImportance of PreparationRecommended StepsHave early discussions about care preferencesDocument the elderly parent's wishesUnderstand the full scope of guardianship responsibilitiesSeek support and resources for caregiversAs the population ages and chronic diseases become more prevalent, understanding guardianship becomes increasingly important for families caring for elderly parents.

Check In on Your Loved One During the Holidays The holiday season is a time for family gatherings, traditions, and reconnecting with loved ones. Its a wonderful opportunity to catch up and celebrate, but its also the perfect chance to check in on elderly parents or relatives to ensure theyre doing well. Sometimes, these visits can provide insight into their health, well-being, and overall quality of life that you might not see from a distance.Here are some signs to look for during your visit: Changes in personal hygiene: Noticeable neglect of bathing, grooming, wearing clean clothes, or maintaining trimmed nails. Pay attention to mobility issues, recent falls, or unexplained bruising. Medication management: Look for missed doses, expired prescriptions, or general confusion about their medication routine. These are all signs they might need help managing their health. Living space upkeep: Take note of unkempt homes with piled laundry, misplaced items, spoiled food, or clutter that could pose a fall risk, like throw rugs or poorly placed cords. Emotional or cognitive changes: Watch for signs of depression, forgetfulness, confusion, loneliness, or isolation. These shifts can indicate underlying health issues. Financial management struggles: Keep an eye out for stacks of unopened mail, unpaid bills, or disorganized storage of important documents. Difficulty handling finances is a common red flag. Driving concerns: If theyre still driving, check their car for signs of accidents, such as scrapes or dents.What to Do if You Notice Changes If you spot signs of decline, here are steps you can take to address your concerns:1. Take notes: Write down your observations. Keeping a detailed list of your concerns will help when speaking with your loved one or their healthcare provider. 2. Start the conversation: Share your observations in a compassionate and nonjudgmental way. Use this as an opportunity to discuss their needs and explore support options, such as assistance with daily activities, companionship, or meal services. 3. Consult their doctor: Reach out to their primary care provider to share your concerns and learn about any recommendations. The doctor may already have insights into their health or suggest scheduling a physical or needs assessment. 4. Explore senior living options: If additional support seems necessary, consider visiting senior living communities to understand the available levels of care, such as independent living, assisted living, or memory care. Touring a community can help determine if its the right fit for your loved one.Tips for Having the Conversation Discussing a loved ones needs can be delicate. Here are some tips to make the conversation more effective and compassionate: Pick the right time: Choose a quiet, private moment to bring up your concerns. Avoid discussing sensitive topics during large family gatherings or high-stress situations. Be empathetic: Acknowledge their feelings and emphasize that you want to support them in maintaining their independence and quality of life. Involve them in decisions: Wherever possible, let them take an active role in deciding how to address their needs. This helps them feel respected and in control. Focus on solutions: Frame your concerns around finding practical ways to help, rather than simply pointing out problems.Why the Holidays Are a Perfect Time to Check In The holidays offer a rare opportunity to see your loved ones in person and observe any changes in their behavior, health, or environment. With everyone gathered together, its also easier to have collaborative conversations with other family members about how best to support them.By being proactive during your holiday visit, you can help ensure your loved one gets the care and support they need to stay happy and healthy. Whether that means arranging for extra assistance at home or exploring senior living options, taking action now can make a meaningful difference in their quality of life.