dementiafiles

The most pressing issue facing assisted living and independent communities is attracting more seniors, right?  Well, not really. Waiting lists are long, the aged boomer population (or “Silver Tsunami” as some like to call it) is growing exponentially, and as soon as a community is built, it seems as if it fills up.  For a variety of reasons, once seniors choose and move into a community, they are unlikely to leave.  Of course, it is difficult to move at any time in life, but for seniors who need a large support network, moving becomes even more difficulty both physically and psychologically.  In addition, most communities embrace the concept of “aging in place,” and so they do not encourage their residents to leave when health needs become more intensive.   For these reasons, many have noted that assisted living communities–generally marketed to the “active senior”–are becoming the new nursing homes, complete with locked units, intensive nursing care, and hospice.

Given this increase in both population and acuity, the real challenge for assisted living communities is in attracting, recruiting, and retaining caregivers with sufficient skills to provide the level care necessary promised to those seniors when they moved in.  Currently, training and education of assisted living workers is abysmal.  In many states, there is no real oversight, and the industry has cobbled together a patchwork of short-term fixes.  Often, caregivers are offered little more than hour-long “inservice” presentations by whoever the administrator can get to come and give a free talk.  This degenerates into promotional opportunities for the representatives of various senior service companies wanting to market to a captive audience.  (We discuss this in great detail in our book, The Insider’s Guide to Dementia Care available on amazon.com).

We need for the assisted living industry to value their employees as much as other industries do.  This means paying for quality education in the areas that will enable employees to perform their jobs at the highest level possible.  This means that the excuses such as “we don’t have money for training,” or “there is such high turnover that we can’t invest in training,” must be set aside in favor of true culture change.  A culture change that recognizes the value and dignity of employees by providing quality education for quality care.  In a climate of sufficient clients, but dwindling workforce, such culture change will benefit both the industry and the seniors it serves.

If my loved one would just accept that they have dementia, all of the obstacles to care and assistance will disappear, right?  Well, not really.

One of the most heart wrenching experiences for families  is taking away the autonomy of their loved one who has dementia.   Families frantically search for some explanation for “resistance” to care or assistance.  We have heard from families such things as, “My dad was always so proud that he can never admit he has Alzheimer’s,” or “Mom is embarassed by her memory problems, so she won’t accept any help,” or “Doctor, if you tell her she has Alzheimer’s and must get help, she will agree.”  More recently, we have even seen families turn to the courts to obtain guardianships in the belief that a judge and legal documents will be able to convince their loved one of the diagnosis.  Needless to say, it never works that way.

A cardinal feature of Alzheimer’s is lack of insight and awareness of one’s condition.  It’s part of the disease, and no amount of persuasion, logic, argument, or authority will change that part of the disease.  The more you try to convince the person about their dementia, the more they will respond with paranoia.  For example, if you try to get the doctor to “explain” the disease, your loved one may accuse you of bribing the doctor for your own ends.  Most physicians, courts, and attorneys are unaware of this. 

A better way to approach this problem is for you to accept the necessity of assuming a parental role, anticipating that you will be viewed by your loved one as “the bad guy.”  You need to recruit a community of people who can work with you inspite of the paranoia of your loved one.  Alzheimer’s is a terrible disease, but if you approach it without sufficient knowledge, it’s even worse.