Who’s The Captain? Why Reason & Logic Fail With Little Kids…And Dementia Patients – By Jennifer L. FitzPatrick, MSW, LCSW-C, CSP

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“I’m the Captain,” declared my 3-year old nephew Enzo as soon as he boarded our boat on a warm autumn day last fall.  Wearing the captain’s hat his mother had purchased for him on Amazon.com, he purposefully strode to the captain’s seat.  When he noticed our family’s amusement at his audacity, he looked directly at us and repeated, “I’m the Captain.  I am.” 

Obviously when my husband was ready to launch the boat we needed Enzo to move.  But did we sit him down and logically explain to him that he was not the Captain?  No.  We told Enzo that it was Uncle Sean’s turn to drive the boat and that he could have a turn later.  Enzo considered the statement, resisted briefly and then reluctantly moved to sit with his parents and cousins.

Could we have attempted to reason with Enzo?  Sure.  Would it have done any good?  Probably not.  I can only imagine how explaining to a 3-year old that he did not have the credentials to launch a 34-foot cruiser.  It probably would have gone over as well as trying to reason with someone who has advanced dementia.

People who suffer with advanced dementia are adults.  They are grown-ups who have lived full lives and are most certainly not children.  But as Alzheimer’s disease (or any other dementia) progresses, their ability to reason is comparable to a small child’s.

Nobody tried to reason with Enzo because we understood that he didn’t have the capacity to understand he lacked the skills to captain a boat.  But why is it that the same people who wouldn’t attempt to reason with a child try to do so with someone with dementia?

Countless times I have witnessed well-meaning, intelligent people try to “remind” their loved one with dementia that she is no longer allowed to drive.  Or that he has already eaten dinner.  Or that it is winter when their loved one is convinced that it’s summer.  And I can see why.  Dementia is tricky. 

There might be a moment in the day that Mom will remember that she is not supposed to drive.  But as the disease progresses, no amount of arguing, rationalizing, reasoning or logic will convince Mom that her doctor told her to stop driving.

Tell Mom you feel like driving today rather than reminding her that she is unsafe behind the wheel.   Just as it wouldn’t have been productive to tell Enzo he’s not qualified to be a boat captain, it wouldn’t be productive to tell Mom the whole family is afraid of her driving.

Treat your older loved one who has dementia with dignity because he’s an adult.  But remember that his capacity to understand logic and reason is often child-like.   

Jennifer L. FitzPatrick – MSW, LCSW-C, CSP
The founder of Jenerations Health Education, Inc., Jennifer FitzPatrick has over 20 years’ experience in healthcare and gerontology. The author of Cruising Through Caregiving: Reducing The Stress of Caring For Your Loved One, she is also a gerontology instructor at Johns Hopkins University. She helps you reduce stress and increase productivity, morale and revenue. Jennifer and Cruising Through Caregiving have been featured in Forbes, U.S. News & World Report, The Huffington Post, Reader’s Digest, Univision and The Chicago Tribune. She has also appeared on ABC and Sirius XM.

Should You Ever Reason With Someone Who Has Dementia? – By Jennifer L. FitzPatrick

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Most of us want to reason with someone when they don’t understand us.  We want to present our case.  Explain the facts.  Caregivers do this all the time when someone they love has dementia.  Is it ever ok?

Check out Jen’s video on this topic:

https://www.youtube.com/watch?v=SlD4SEAbhlA&t=67s

Jennifer L. FitzPatrick – MSW, LCSW-C, CSP
The founder of Jenerations Health Education, Inc., Jennifer FitzPatrick has over 20 years’ experience in healthcare and gerontology. The author of Cruising Through Caregiving: Reducing The Stress of Caring For Your Loved One, she is also a gerontology instructor at Johns Hopkins University and an Education Consultant to the Alzheimer’s Association. She helps you reduce stress and increase productivity, morale and revenue. Jennifer and Cruising Through Caregiving have been featured in Forbes, U.S. News & World Report, The Huffington Post, Reader’s Digest, Univision and The Chicago Tribune. She has also appeared on ABC and Sirius XM.

How Do You Break Unhealthy Promises? – By Jennifer L. FitzPatrick

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Most people don’t make promises with the plan to ever break them. But with good intentions, many caregivers often make promises to their older loved ones that are difficult, if not impossible, to keep. Such promises include statements like:

I will never … put you in a nursing home.
I will never … let strangers take care of you.
I will never … move you out of your home.

Caregivers take such promises seriously. But it’s important that caregivers make peace with the fact that they may not be able to keep these promises indefinitely. When promises like these are made, the caregiver typically doesn’t know what he or she is truly agreeing to. The caregiver had every intention to keep this promise but circumstances changed.

Maybe your older loved one’s dementia is so advanced that she is wandering out of the house each day, putting herself at risk. Since you can’t have your eyes on her at all times, 24/7 supervision at a senior living community or nursing home may need to be considered.

Maybe helping your older loved one bathe after his stroke is becoming too physically demanding for you. In this case, perhaps a home care agency can help. You may resist taking these options into account because of the earlier vow you made to your loved one.

So what do you do if keeping that earlier promise is becoming impossible?

If your loved one does not have memory loss, explain why you are changing course: What have the consequences been to your life by keeping this promise? For example, you may explain to your older loved one that because you are spending so much time helping out at his house, you have been late to work five times in the past month. Then you can discuss options such as hiring home care, a housekeeper or arranging to have meals delivered.

Frequently older loved ones will not be happy with changes they did not initiate, but the caregiver must set such boundaries to avoid burnout. In addition, many older adults do not want to impose on their family members so they will try to understand.

If you have already made a promise and your loved one has cognitive impairment, you may not be able to have a conversation where you can reason with him or her and discuss how the circumstances have changed. But it’s still important to let yourself off the hook. Talk to a geriatric care manager, a psychotherapist, your spiritual advisor or a supportive friend to deal with your guilt. Give yourself permission to reframe your earlier pledge.

Most people, especially older adults, want to remain at home without assistance for the rest of their lives. In an effort to make this dream come true, caregivers struggle with negative emotional, spiritual and physical consequences of trying to honor their loved ones’ wishes at any cost.

While it is admirable for caregivers to respect their loved ones’ preferences, it is critical to understand that many promises cannot and should not be upheld in many care situations. In order to be healthy themselves and provide the best care for their loved ones, caregivers must make peace with the fact that keeping earlier promises is often unmanageable.

If you haven’t made such a specific promise to an older loved one you are caring for, resist. Don’t do it. Instead say, “I will make sure you have the best care I can afford.” Or, “I will keep you at home as long as it is safe for everyone involved.”

While it can be very upsetting to both the caregiver and older loved one, often revisiting caregiving promises is essential. Further, sometimes even breaking those promises is absolutely necessary to ensure the safety and well-being of both the caregiver and the older adult.

Jennifer L. FitzPatrick – MSW, LCSW-C, CSP
The founder of Jenerations Health Education, Inc., Jennifer FitzPatrick has over 20 years’ experience in healthcare and gerontology. The author of Cruising Through Caregiving: Reducing The Stress of Caring For Your Loved One, she is also a gerontology instructor at Johns Hopkins University and an Education Consultant to the Alzheimer’s Association. She helps you reduce stress and increase productivity, morale and revenue. Jennifer and Cruising Through Caregiving have been featured in Forbes, U.S. News & World Report, The Huffington Post, Reader’s Digest, Univision and The Chicago Tribune. She has also appeared on ABC and Sirius XM.

 

 

How to Spot Red Flags of Clients at Risk for Exploitation – By Jennifer L. FitzPatrick

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Suzanne has been 82- year old Mr. Burns’ financial planner for the last seventeen years.  Mr. Burns has been very conservative with his investments and has never made a large withdrawal from his account.  Today, Mr. Burns calls to say he would like to liquidate his account so he can travel across Europe with his new 28-year old girlfriend.  Suzanne is perplexed by this—she has never known Mr. Burns to go on a vacation other than to visit his daughter who lives a few hours away.  This is also the first time Suzanne has ever heard about a new girlfriend.

Everything might be just fine with Mr. Burns; perhaps he has finally gotten the travel bug and has genuinely fallen in love.  On the other hand, this new behavior could indicate a change in cognitive status.

Many people understand that Alzheimer’s disease and other dementias include short term memory loss.  But what so many don’t understand is that unusual behavior, personality changes, lack of inhibition and getting lost in familiar places can also be red flags.

While financial planners advise and guide their clients, ultimately the client has a right to do what he wants.  Even though Suzanne may express concern about his liquidation request, she ultimately would have to follow his order. That’s why I am thrilled that FINRA has established these new rules to protect the older investor as well as the financial planner:

https://www.finra.org/sites/default/files/Regulatory-Notice-17-11.pdf

Beginning in February 2018, planners will have some options in cases like this.  Suzanne could put a temporary hold on Mr. Burns’ account.  She could also contact Mr. Burns’ trusted contact person who is listed on his account.  These rules offer the financial planner peace of mind when dealing with a client situation that feels “off.”

Once Suzanne exercises these options, it’s possible that it will be determined that Mr. Burns is cognitively intact. Maybe Mr. Burns knows exactly what he is doing and it will all work out fine.  He and the new girlfriend will live happily ever after backpacking across Europe.  Or perhaps Mr. Burns is being exploited and he will end up losing his life savings through a scam perpetuated by the new girlfriend.

With the implementation of these new rules, it is quite possible that Suzanne could save Mr. Burns and his family from the heartache of poor decisions made under the influence of dementia.

If you are a financial planner who wants more information about how to spot red flags of clients at risk for exploitation, join me for a webinar on the topic approved by the CFP Board: Thursday Dec 7–To register, click on http://jenerationshealth.com/online-events. I will also be on Sirius XM this week discussing this topic on Business Radio Channel 111 at 5pm EST on December 5.

Jennifer L. FitzPatrick – MSW, LCSW-C, CSP
The founder of Jenerations Health Education, Inc., Jennifer FitzPatrick has over 20 years’ experience in healthcare and gerontology. The author of Cruising Through Caregiving: Reducing The Stress of Caring For Your Loved One, she is also a gerontology instructor at Johns Hopkins University and an Education Consultant to the Alzheimer’s Association. She helps you reduce stress and increase productivity, morale and revenue. Jennifer and Cruising Through Caregiving have been featured in Forbes, U.S. News & World Report, The Huffington Post, Reader’s Digest, Univision and The Chicago Tribune. She has also appeared on ABC and Sirius XM.

What do you do about sex…and dementia? By Jennifer L. FitzPatrick

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How should senior living communities handle residents who have dementia who are “sexually aggressive?”  What do spouses and partners do about their sexual needs if their loved one has dementia?  Can somebody with Alzheimer’s disease or another cognitive impairment say “yes” to sex?  Check out Jen’s recent interview on Valda Ford’s Sex Is Not For Sissies show where we explore these complex questions:

http://www.spreaker.com/user/9496980/sept-11-jennifer-fitzpatrick

 

Jennifer L. FitzPatrick – MSW, LCSW-C, CSP
The founder of Jenerations Health Education, Inc., Jennifer FitzPatrick has over 20 years’ experience in healthcare and gerontology. The author of Cruising Through Caregiving: Reducing The Stress of Caring For Your Loved One, she is also a gerontology instructor at Johns Hopkins University and an Education Consultant to the Alzheimer’s Association. She helps you reduce stress and increase productivity, morale and revenue. Jennifer and Cruising Through Caregiving have been featured in Forbes, U.S. News & World Report, The Huffington Post, Reader’s Digest, Univision and The Chicago Tribune. She has also appeared on ABC and Sirius XM.