The Abusive Relationship - Understanding the Difference Between Compliance and Change

Can the abuser change? The short answer: Yes.

Anyone can change. It's a matter of desire, will and motive. Healthy people are generally desirous of change when they genuinely care about how their actions affect others and will accept an opportunity to contribute to their relationships in a meaningful way.

Does the abuser really want to change? The short answer: No.

Abusers don't care if you're happy; they care if they're happy. Their control is far more important than your happiness. Therefore, on the occasion where his enabler-victim identifies an area of dissatisfaction or conflict in the relationship, the abuser will quickly attempt to squelch any discontent through verbal jeopardizing, diminishment or yelling.

However, there are times when a victim is committed to requiring that the abuser face and address an issue. It may reflect a legitimate need for additional help around the house, an increased measure of financial responsibility, or more freedom for a family member to pursue a favorite hobby, pastime or academic objective. When the abuser feels truly cornered, he may agree to accommodate his enabler's request.

But, is he committed to change? Or is what he offers merely compliance? There is a cavernous difference between them. As enablers, we are often quick to accept the abuser's smallest measure of movement toward meeting our needs as evidence of sincere change. But, what is he offering: compliance or change?

Remember, an abuser doesn't want what is best for the relationship; he wants what is best for him. With this in mind, when you confront him, often he will initially deny there is any problem at all. The problem is yours. You are wrong.

Then, he may become resentful that you are asking him to alter his behavior at all or contribute to a greater degree to the relationship. You are being selfish.

Under pressure, he may concede. You are willing to accept this concession as a sign of his deep-down love for you. You tell him how much you appreciate his willingness to help. You think he will see that such a small gesture makes you happy - and that will make him happy. In truth, he believes that you are demanding. You are asking something of him that he does not want to give. He simply wants to get you off his back.

What happens over time will begin to tell the story. Here are some clues to tell you if he is intent on changing or if he is merely complying.

• Real Change is Voluntary; Compliance is Obligatory


• Real Change is Sincere; Compliance is Half-Hearted


• Real Change is Lasting; Compliance is Temporary

These stark differences reflect attitude, motive and commitment.

Attitude In a healthy relationship, a mature and genuinely caring husband wants his wife to feel supported, fulfilled and encouraged. He wants her to know she is appreciated at home, and he is willing to help her (as she is similarly willing to help him) with the management of the household, children, finances, and the balanced fulfillment of her life's goals.

When it is understood that there is an imbalance, he will willingly commit to additional responsibility, even acknowledging some inconvenience and flexibility as he adapts to change. If the change is genuine, you will see a positive attitude. If it is merely compliance, his attitude will be one of benign or perhaps even resentful accommodation.

Motive

In the days that come, you may see a little extra effort. You embrace it with gratitude and believe that he will see that his contribution makes a positive difference that benefits the household. You are almost gleeful that he is willing to contribute to the relationship in a more meaningful way. Don't get too excited yet.

An abuser often rejects boundaries or limitations on his life, and views them as unacceptably confining or rigid. Although he may initially conform, his tendency will be to sabotage the change using any number of subtle or not-so-subtle strategies.

He will forget.

He will perform his duties poorly.

He will become frustrated.

He will make excuses.

He will complain.

He will make himself unavailable.

He will fall ill.

He will claim he is too tired.

He will claim he is incapable.

He will decide the duty is "not for him."

The abuser is determined to find a way to get you to let him off the hook, or conjure up evidence that you're nit-picky or demanding. This is not change.

Commitment Sometimes the signs of compliance may not be so overt. The abuser may initially accommodate your request. It may just be that the "change" is temporary, fading into nothingness over time. You feel obligated to pick up the slack as a means of trying to show that you can be flexible and to set an example of the give and take that is evident in a healthy relationship. You once again assume his share of responsibility, and he readily absolves himself and allows you to carry on. In fact, he seems so much happier when you relieve him of his obligation that you feel guilty asking him to share the burden when other needs surface. The gradual fading away of your original understanding could give way to frustration and anger, yet should you confront him, he will likely assert that:

You're impossible to please.

You need to accept him as he is.

He did what you asked.

It's your job, anyway.

You're a nag.

You have learned that it is simply easier to do things yourself to shield yourself from the anxiety and disappointment, even while recognizing that the imbalance remains. Best of all (for him), the abuser got what he wanted, which is not to have to do what he doesn't want to do.

My former husband was habitually late to virtually every commitment and appointment. I once asked him why he never made an effort to arrive on time, and he responded quite matter-of-factly, "Because no one is ever going to tell me when I have to be anywhere." From what I have been able to tell, that attitude is pretty indicative of an abuser's mindset. It makes no difference to him whether what he is being asked to do is helpful, cooperative, considerate, beneficial or necessary.

Unfortunately, the abuse victim may have difficulty grasping that the abuser doesn't want to contribute anything unless he is assured of a direct and immediate benefit as a result. Even though an abuse victim has witnessed - perhaps time and time again - the deterioration of what she had optimistically embraced as evidence of change, the abuser's initial effort is enough to keep her hopeful. True, the abuser didn't meet her expectations in this particular instance - or did so only temporarily. But, surely his fleeting consideration must be a sign that - somewhere deep down - he is genuinely receptive to her needs and desires, right? Or perhaps it is too much trouble to even beg for his attention. Instead, she may do her best to accommodate her abuser's every whim and live in his shadow, ever hopeful that one day he might want to change while history cautions that compliance may be all she ever gets.

Clearly, compliance and change are not synonymous. Do not confuse the two.

Copyright 2010 All Rights Reserved

Certified Nursing Assistant (CNA) - Good Income, Great Job Satisfaction

The course to become a certified nursing assistant requires some classroom as well as hands-on training. The candidates undergo intense study of skills and knowledge to become a certified nursing assistant. The students are made aware of the job requisites and familiar with terminology and treatment to help the patient. The practical training is provided to train students in real life situations which they will have to face during the real job. Students, during there courses are taken to the field to experience the things under expert supervision. They are also given exposure to treat patients with mental and physical abnormalities. They are thus made familiar with tough situations so that they can deal professionally manner.

The training include classroom sessions, video instructions, lectures by experts and professionals from industry, audio/video instruction manuals and live demonstration by other / senior CAN's. There are some institutes which offer online classroom facility to better adjust with students' time constraints.

Job Opportunities for Nursing Assistants, Personal Attendant, Respite Worker

There are several options for the certified Nursing Assistants, Personal Attendant and Respite Workers. They are always in demand at some healthcare centers like:
- Retirement Homes
- Nursing Homes
- Group Homes
- Hospice Centers
- Day Care Centers
- Health Care Agencies
- Private Homes
- Hospitals
- Old age homes
- Rehabilitation centers
- No-profit Organizations

Students are provided hands-on training and practical exposure during their education so that they can easily be placed to paid positions immediately after their training. These training institutes are contacted by many employers for their requirements of CNAs, which in turn send their students for these positions.

What a Certified Nursing Attendants (CNA) does:

A trained Certified Nursing Attendant, Personal Attendant or Respite worker is equipped with skills and experience both to bring positive impact on lives of those who need to use their services. Here are some important services that a qualified PSW take cares of -

Personal Care - the worker will provide basic care of elderly residents or patients during rehabilitation period.

Restorative Care - these workers will provide palliative care service for the dying hospitals, physical health

Care Duties - the workers may also be required to keep medical records of their patients updated, procedures.

There is a steep rise in nursing homes and long-term care facilities in all the developed countries like US, UK, Canada, Australia, etc. and so is rising the demand of Personal Support Workers. This is going to be great job prospects for certified PSWs in the field of Nursing Assistant, Health Care Aid, Home Support Worker, Personal Attended or Respite Worker.

How To Choose The Right Type of Assisted Living or Care Home For Your Senior Loved One

Your parent or elderly relative has reached the point where they can no longer live on their own, and now you must find them a solution. The idea of finding senior housing or care home for your loved one can seem overwhelming at first, but having a better understanding of all the available options can definitely make the process much easier and less stressful. Read on to learn about the types of assisted living and care home options for seniors.

Senior Independent Living

Independent living communities (also referred to as retirement communities) are the ideal option for healthy and active seniors who want to live independently amongst other seniors who they can join in educational, cultural and other social activities for entertainment. Many retirement communities feature extensive amenities such as hiking trails, swimming pools, golf courses, fitness clubs, monthly activities, and more.

A Senior Independent Living Community (Retirement Community) may be the right option if:

• The senior does not require medical assistance
• The senior prefers a low-maintenance home and/or lifestyle

Assisted Living

An assisted living facility is suitable for seniors who want to live independently but need help with day-to-day activities. Among assisted living communities there is a wide variation in the level of care that may be provided, however most assisted living facilities generally offer meals, housekeeping, social activities, and transportation. However, seniors in this type of housing should not have any serious medical conditions as most do not offer 24-hour supervision, and they are not required to have nurses and/or doctors on site at all times.

Assisted Living may be the right senior care home option if:

• The senior wants to maintain independence
• The senior is still active and wants to participate in social activities
• The senior needs help with activities of daily living
• The senior does not require 24-hour supervision

Nursing Homes

Nursing homes provide medical care for seniors with serious medical conditions 24 hours a day, 7 days a week from a registered nurse, licensed vocational nurse and/or certified nursing aide. Residents typically share a room, are served meals in a central dining area, and have the opportunity to be involved in social activities.

A Nursing Home may be the right option if:

• The senior has a serious medical condition that requires around-the-clock nurse assistance
• The senior experiences mobility issues

Alzheimer's Care

Alzheimer's care facilities specialize in the dedicated treatment and care of people with Alzheimer's and dementia. Residents generally live in semi-private apartments and have structured activities with staff members. Similar to an assisted living community, an Alzheimer's care facility will also provide personal services like help with eating, toileting, bathing, grooming, dressing, etc. Additionally, most Alzheimer's care facilities feature 24-hour support, a higher level of security to protect wanderers, and color-coded and/or circular layouts to prevent confusion.

Alzheimer's Care may be the right option if:

• The senior requires specialized care for Alzheimer's disease or dementia

Continuing Care Retirement Communities

Continuing care retirement communities are senior care facilities that offer flexible accommodations intended to meet the changing needs of seniors. They provide appropriate levels of senior care support for independent living, assisted living, or nursing care all in one facility so that seniors can move there and never worry about moving again.

A Continuing Care Retirement Community may be the right option if:

• The senior would like to select from a wide range of services and amenities
• The senior prefers privacy, but may require assistance later on

It's a big change for both you and your aging loved one to move to an assisted living or senior care home, but by gathering information prior to the need arising, you will have more time to fully explore all the possibilities, making the transition much easier.

Elder Care Facilities and Children

Bringing children to visit grandparents in an elder care, assisted living, or similar residence is not only a valuable experience for everyone, but recommended. Many residents of elder care facilities feel isolated from the outside world. Visits from their grandchildren or great-grandchildren often brighten their days as well as those of many of the residents who live in the facility.

Before the First Visit

Don't take your children to visit Grandma or Grandpa until he or she settles into their new place. It may take a few days or even a few weeks for some elderly residents to get used to their new homes, so it's best to wait until then. You also want to talk to your children about where their grandparent lives.

Explain that some people who live there are lonely and don't have anyone to visit them, so they will be very happy to see some young faces. You can also read one of the many children's books available on the topic or if they are old enough, sit down and honestly explain what the facility is like. Tell them they may see residents in wheelchairs or with walkers, the building may have unfamiliar smells and they may come in contact with unresponsive residents.

Some general guidelines to consider before visiting an elder care facility with children include:

• Planning the visit in advance; you may need to check with facility to find out if/when children can visit


• Scheduling your visit during off-times such as mid-morning (9:30-11:30 a.m.), mid-afternoon (1:30-4:30 p.m.) and sometimes in the early evening (6-7:30 p.m.)


• Making sure you don't visit during a scheduled activity or when your loved one is at a doctor's appointment

On Visiting Day

The day of your child's first visit to an elder care facility is exciting. Make sure you bring quiet and small toys or other items to occupy your children and don't visit during their meal or nap times. Consider visiting after he or she eats and is well-rested. Other things to consider are:

• Talking to your children about being quiet and not running around as some residents may not take well to loud noises or sudden and quick moves from children


• Telling them what parts of the facility are off-limits such as offices, other residents' rooms or apartments, restrooms without your consent, etc.


• Reiterating that some residents may have memory impairments or other ailments that cause their unresponsiveness


• Be sure to talk to your children about being quiet and not running around as some residents may not take well to loud noises or sudden and quick moves from children


• Telling them what parts of the facility are off-limits such as offices, other residents' rooms or apartments, restrooms without your consent, etc.


• Reiterating that some residents may have memory impairments or other ailments that cause their unresponsiveness


• Remembering not to overstay your welcome. Especially on first visits, children may not last a long time without getting fidgety or restless. Don't overwhelm the residents either by staying a long time.

Activity and Gift Ideas

If your children can bring gifts or crafts to do with their grandparent, make sure you bring enough for several residents. You don't want anyone feeling left out! Gift ideas include:

• Homemade cards


• Fresh or silk flowers


• Plants


• Allowable treats (check with caregivers ahead of time for a list)


• Colored or drawn pictures


• Small stuffed animals


• Knitted or crocheted items such as lap blankets or scarves


• Puzzles to do together


• Books to read together

Make Special Memories

Visiting an elder care facility is a valuable experience for children. It will brighten the day for many of the residents, especially the loved one living there. Make sure to take pictures and create a scrapbook of the visit. It will be something the grandparent and child will value and remember for a long time.

Paying For Nursing Homes

When senior citizens are considering moving into a nursing home or receiving long-term services from elder care providers, it is important that they also consider the available options for funding this type of support. The options that many people consider include paying for these services out of pocket, receiving aid from the state that they live in, or applying for Medicaid when they are eligible. People can switch between different methods of payment, but most senior citizens will continue to be covered by insurance for medical procedures while living in a nursing home. Medicaid should not be confused with Medicare. Although Medicare does provide funding for senior citizens, it does not typically cover elder care services other than coverage for short term nursing aid after hospital stays.

Some senior citizens do not receive Medicaid coverage for elder care, so they either use personal savings or special coverage plans provided by their insurance companies. Policies like these allow for people to use life insurance funds for this purpose. It is important to understand any insurance policy fully before making a decision about a certain type of coverage.

Medicaid is a funding program, organized by both federal and state government, that finances many nursing home residents. An individual's eligibility for Medicaid or Medicare depends on:

• The nursing home that they wish to live in (whether these facilities accept Medicaid or have a bed available for those who wish to pay with Medicaid)


• Personal income and resources


• The state they reside in

Sometimes senior citizens will not qualify for Medicaid unless they have used some of their own money first. While living in a nursing home and receiving Medicaid, the government cannot lien on a senior citizen's home - that is take, sell, or hold property to recover benefits. If the owner of the property dies while in the nursing home, the government still cannot seize property if the spouse, sibling (with equity interest or lived there one year prior to their sibling's admission into the nursing home), or adolescent relative with disability is living at that residence.

Before becoming eligible for Medicaid, senior citizens are required to possess only a certain amount of assets which are specified by Medicaid. In special instances where the husband or wife of an individual who lives in a nursing home continues to live in their old residence, the spouse on the outside does not have to reduce their assets. They are allowed to keep up to half of joint assets as well as maintain a monthly income allowance. This allows one spouse to receive Medicaid while only being required to reduce half of the assets they share with a partner who may not qualify or wish to quality for Medicaid. The government works to prevent a spouse from losing assets due to costs of elder care - which is why they created "spousal impoverishment laws." This can involve the spouse legally keeping a portion of the joint assets or remaining entitled to a portion of the income the spouse in the nursing home receives on a monthly basis from respective programs.

The process of reducing an individual's assets is limited in that one is not allowed to give these away to family or friends as an alternative to putting them towards compensation to the state for elder care. That is, it is expected that individuals who wish to become eligible for Medicaid because of reduced assets will not give those assets away freely in order to receive funding from the state.

Medicaid can monitor transfer of assets within 5 years of applying for Medicaid and afterward. These transfers can be viewed as for "less than market value." This results in Medicaid not funding elder care for a certain period of time depending on how many assets were given away in order to be eligible. As before, there are exceptions to this penalty if the asset transfer involved a spouse, sibling, or disabled adolescent family member.

Another alternative to government aid or personal savings as a means to fund elder care is long-term care insurance. The advantage to programs like these is that there is much more variety in what insurance policies can cover depending on the specific plan and provider of the individual receiving elder care.

The Holiday Blues: How to Help Seniors Overcome Seasonal Depression

It's common for the holiday blues to creep up on us...and especially on seniors. Symptoms include sadness, weariness and exhaustion, inactivity, and a loss of appetite. Reasons for the holiday blues can vary - from memories of happier times to declining health, loss of a spouse or friends, and medical problems that can amplify seasonal depression. And while it isn't unusual for anyone to feel a bit down in the winter, it isn't healthy for seniors to be left alone.

Below are three ways to help seniors beat the holiday blues. Since many people feel that the holidays are a spiritual time, most of the activities listed below can take place through a senior's church or religious organization. Additionally, churches offer a variety of wonderful opportunities for seniors - from caroling and baking pies to visiting other church members in the hospital.

1. Socialization
Senior living facilities have activities available year 'round, and there are many opportunities to meet new people, socialize and have fun. In fact, many facilities invite seniors from nearby communities to visit and take part in the activities - creating ways for seniors who live at home to make new friends and learn about different pastimes. Lonely seniors should schedule time to get together with a large group of friends to share the latest pictures of grandkids and catch up on each other's lives. Activities - especially social activities - are an excellent way to keep the blues at bay, whether it's a cooking club, church choir or a group of seniors getting together to bake.

2. Exercise
One of the most effective ways to drive away the blues is with exercise. Whether it's a power walk or a nice stroll by the lake, exercise gets the blood pumping and produces endorphins which decrease and sometimes even eliminate feelings of depression. On nice, sunny days, it's important to get seniors out of the house. And on cold and gloomy days, exercise should still be a top priority. Local senior centers, churches and the YMCA offer exercise classes for seniors.

3. Volunteering
Volunteering is an excellent way for seniors to connect with other folks in their local community. There are so many volunteer choices in every community, from a local soup kitchen to a charity or educational organization. Volunteering lets seniors get out of the house and help others in need. And helping others doesn't just boost their spirits - it also increases a senior's self-confidence!

Keeping the holiday blues away is important for everyone - especially seniors - and staying occupied with positive activities is a surefire way to stay happy and healthy this season.

Caring For Someone With Alzheimer's Disease

In Home Care

Providing home care for senior citizens with Alzheimer's disease can be difficult. Symptoms progressively worsen, and predicting how quickly that progression will be or which behavioral changes will occur each day is impossible. Both the person with Alzheimer's and the caregiver may have a hard time carrying out activities of daily life, such as eating, talking, sleeping, and coming up with activities to do. The following is a set of ideas that may help you deal with issues related to elder home care for people with Alzheimer's.

Daily Activities

It may be challenging to think of activities that will be possible and interesting for a person with Alzheimer's to do. Trying activities that build on present strengths and abilities is usually more successful than attempting to teach a new skill.

• Try not to set your expectations too high. It may be best to do simple activities that employ current abilities.


• Assist the person in starting the activity. Take the activity one step at a time, and praise the person each time he or she completes a step.


• Take note of agitation or frustration with each activity. If you notice a negative change in mood, gently try to help him or her with the activity or subtly change to a new activity.


• If you notice that the person enjoys a particular activity, try to make that activity a part of your schedule at a similar time each day.


• Make use of adult day care centers, which provide activities and support for the person with Alzheimer's along with relief from caregiver tasks. Often, meals and transportation are provided in the cost of using these centers.


• Communicating with the person may be difficult-both understanding and being understood may become an issue. Try to use simple words and short sentences in a calm tone of voice.


• Refrain from talking to the person as if he or she were a child or talking as if the person were not there. To help the person focus, minimize background noise by turning off the radio and TV.


• Before talking, call the person by name to get his or her attention. Allow ample time for a response, and try not to interrupt.


• When the person with Alzheimer's struggles to communicate a thought or idea, try to gently suggest a word or idea he or she seems to be thinking of.


• When asking questions or giving directions, frame them in a positive way.


• Meals and eating can be a challenge-some people with Alzheimer's want to eat too often, whereas others may forget that they should eat. Provide a calm, quiet atmosphere during meals; this can allow the person to focus on eating.


• Offer limited choices for meals and serve small portions. Several small meals throughout the day may be a better option than three larger meals.


• Using straws or lidded cups may make drinking easier. Finger foods may be easier to handle than utensils, and bowls may be easier to use than plates.


• Keeping healthy snacks in a visible place will encourage healthy eating.


• See a dentist regularly to keep the person's mouth and teeth clean and healthy.


• Many people with Alzheimer's become restless, agitated, and irritable at night, usually around dinnertime. This is called "sundowning syndrome," and some planning might be necessary to ensure that the person goes to bed early and stays in bed through the night.


• Encourage physical activity and discourage naps during the day, but allow time for ample rest-fatigue can increase the likelihood of restlessness during the late afternoon and night.


• Schedule more physically demanding activities early in the day. Try giving a bath in the morning and having large family meals earlier than normal.


• It is important to set a quiet, calm atmosphere in the evening to encourage sleep. Dim the lights, turn off loud sources of noise, and play soothing music if it helps the person.


• Encourage sleep at about the same time each night-routine may be helpful.


• Refrain from offering the person caffeine during the late afternoon or evening.


• Set up nightlights in the person's room, hall, and bathroom if darkness scares or disorients the person.

Tips for Providing Personal Care

Providing personal care for people with Alzheimer's, such as bathing, brushing teeth, or dressing, can be difficult. Below are some helpful tips to make personal care easier.

• Planning in advance for baths can help if the person with Alzheimer's finds bathing frightening or confusing.


• Schedule baths during the time in which the person seems to be the calmest during the day. Developing a routine may help.


• Consider the fact that bathing might be scary or confusing for the person, and respect his or her feelings. Remain calm, gentle, respectful, and patient.


• Let the person know which step is coming next, and let him or her perform steps he or she is capable of doing.


• Prepare beforehand. Have everything you need in the bathroom and draw the bath before he or she enters.


• Consider the temperature. Test the water temperature beforehand, make sure the bathroom is a comfortable temperature, and keep extra towels and robes nearby.


• Limit safety risks by using a handheld showerhead, shower bench, grab bars, and non-skid bath mats. Do not leave the person alone in the shower or tub.


• A sponge bath may be a good alternative between bathing instead of bathing every day.


• Getting dressed may pose a challenge; deciding what to wear, getting certain articles of clothing on and off, and fumbling with zippers and buttons might be difficult. Plan ahead to minimize the confusion and difficulty in this task.


• Schedule dressing for the same time each day so the person can get used to having it in his or her routine. Encourage the person to perform as many steps as possible, and plan enough time to allow for difficulty.


• Present a few choices of clothing each day, and if the person has a favorite outfit, you may want to consider purchasing multiple sets.


• Lay out the clothes in the order they should be put on to help the person move through the process more easily.


• Provide clear, step-by-step instructions if the person is having difficulty.


• Pick out clothing that is comfortable, easy to get on and off, and easy to care for. Clothes with elastic waists and Velcro will eliminate problems with buttons, zippers, and tying. Take note of discomfort from tight clothes or pricking from a safety pin. The person may become irritable for seemingly no reason, but painful clothing might be the cause.


• With the progression of Alzheimer's, many people may become incontinent (lose control over their bowels or bladder). This can be upsetting for the person with Alzheimer's and is sometimes a sign of physical illness. Be sure to discuss this with a doctor.


• Develop a routine for taking the person to the bathroom and follow it as closely as possible. You may want to guide the person to the bathroom every few hours, for example. Do not wait for the person to ask or tell you.


• Notice signs of the person having to go to the bathroom, like restlessness or tugging on clothing. Respond to these signs quickly.


• Try to be understanding and considerate when accidents occur. Remain calm and reassure the person if he or she is upset or frustrated by it. Keep track of when accidents occur, and try to plan ways to avoid them.


• Preventing nighttime wetting may include limiting certain types of drinks later in the day, such as drinks with caffeine. If you plan on taking the person out, be aware of where bathrooms are located and have the person dress in clothing that is easily removable. Bring along an extra change of clothes in case of an accident.

Residential Care

Many caregivers eventually find that it is too difficult to continue providing in home care. When this happens, the person with Alzheimer's will have to live in a place where care is provided at all hours of the day and night. Two types of residential care are available: assisted living and skilled nursing facilities.

Assisted living homes are set up in large apartment or hotel-like buildings or as a "board and care" home for a small group of residents. Each offers a different level of care, but most include meals, recreation, security, and help with bathing, dressing, medication, and housekeeping.

Conversely, skilled nursing facilities (also referred to as nursing homes) include 24-hour services and monitoring. They are able to provide medical care and rehabilitation for people who are very frail or are going through the later stages of dementia.

Health care providers sometimes provide different levels of care at a single site. This is called a "continuing care community," and it is set up as two buildings, usually next to each other, to allow for ease of movement between assisted living and skilled nursing facilities. Some of these communities have programs for couples when one spouse is fairly healthy and the other is disabled.

Choosing a facility can be a difficult decision to make. Collecting information about services and options in anticipation of the need to relocate can be helpful in giving you time to weigh the options and choose the facility that best meets your needs.

Doctors, friends, relatives, social workers, and religious organizations may be able to help you locate nearby facilities. If you are looking for a facility farther away, it may be useful to hire a professional care manager to help you figure out specific care needs and identify community resources.

Compose a list of questions for the staff of each facility. This might include questions about what is offered at the facilities, such as activities, transportation, or units specifically for people with Alzheimer's. Contact the residences you are interested in, and make an appointment to visit. Talk to as many people as possible while you are there, including administration, nursing staff, and residents. Take note of how the facility is run and how the residents are treated. Dropping by unannounced might also be a good idea to ensure that your first impressions were correct.

Do some research to determine whether each facility has Alzheimer's-specific programs and services. You may want to ask whether the staff is trained in dementia care and if the facility allows family participation in planning personal care.

Other things you may want to consider are room availability, cost and payment method, and participation in Medicare or Medicaid. If there is a waiting list, you may want to put your name on it even if you are not completely ready to make a decision about long-term care. When you do make a decision, be sure to understand all of the terms of the contract, including the financial agreement. Looking over the documents with a lawyer before you sign may be helpful.

Relocating will cause a substantial change for the person with Alzheimer's as well as the caregiver. Working with a caregiver can help you plan for and adjust to the move. Having a support system is important during this time.

Making visits to people with Alzheimer's is very important, even though they may not remember who the visitors are. The value lies in human connection and social activity. Some ideas for people who are planning a visit to a person with Alzheimer's disease are the following:

• Visit at a time of the day when the person is at his or her best. You may want to bring an activity to do, such as a familiar book to read or a family photo album to browse, but be prepared to give up the activity if necessary.


• Remain calm and quiet. Try not to use a loud tone of voice, and refrain from talking to the person as if he or she were a child. Be considerate of the person's personal space, and try not to get too close if he or she seems uncomfortable.


• Make eye contact and call the person by name to get his or her attention. Remind the person of who you are if he or she does not remember you.


• Do not argue with the person if he or she is confused. Respond to the feelings being communicated, and subtly distract the person by bringing up a different topic if necessary.


• Try not to take it personally if the person does not recognize you, acts unkindly, or responds angrily. The disease causes confusion that the person is responding to; it is not your fault.

Safety Issues

It is very important to consider safety when caring for a person with Alzheimer's disease. Accidents are possible even if plans are made and adhered to. A couple ways to minimize dangerous situations are making sure your home is safe and preventing the person from wandering or driving when skills decline.

Home Safety

People who are providing home care for senior citizens with Alzheimer's must examine their homes thoroughly to identify and change possibly dangerous objects or setups. The creation of a safe environment can minimize dangerous, stressful situations. Here are some things to do when preparing to provide in home care:

• Put in secure locks on outside doors and windows, especially if the person tends to wander. Install a keyed deadbolt or additional lock higher or lower on the door. A new latch or lock might help if the person can open the door due to its familiarity to him or her. Conversely, removing locks on bathroom doors will ensure that the person does not accidentally lock him or herself into the bathroom.


• Install childproof latches on kitchen cabinets and cupboards as well as places where you keep cleaning supplies and other chemicals.


• Make sure medications are labeled and locked away. Keep dangerous objects like knives, lighters, matches, and guns out of reach. Put away and secure anything that poses a threat to safety, both inside and out.


• Maintain a tidy, well-lit environment. Remove scatter rugs or other objects that might cause the person to slip and fall.


• Think about installing an automatic shut-off switch for your stove to minimize the risk of burns or fire.


• If the person goes out, make sure he or she is carrying identification and is wearing a medical bracelet. If he or she becomes lost and cannot effectively communicate, this will let people know the person's identity and alert them as to his or her medical condition. Make sure to have a recent picture or video of the person in case he or she gets lost.


• Ensuring safety is one of the most important tasks of caregiving. People with Alzheimer's sometimes wander away from their homes and caregivers, so knowing what to do to prevent wandering is of utmost importance.

Driving

After making the difficult decision that someone with Alzheimer's is no longer capable of driving, sharing the decision with that person should be done carefully and sensitively. The person may become upset, but it is extremely important to consider his or her safety as well as the safety of others on the road. Here are some ideas to help you decide whether someone with Alzheimer's should no longer drive and to guide your communication with that person:

• Look out for signs that the person can no longer drive safely, such as becoming disoriented in familiar places, driving too fast or slow, not heeding traffic signs, or becoming angry or confused.


• When you tell the person about your decision, try to be sensitive to the person's feelings, but remain firm in your request that he or she not drive. It is also important to be consistent when you have made a decision-even on a "good day," do not let the person drive.


• Ask for help from a doctor. The doctor may be seen as more of an authority figure, and the person may be more willing to stop driving. The doctor may be willing to write a "prescription" to stop driving as well as to call the Department of Motor Vehicles to request a reevaluation of the person's driving ability.


• If it becomes necessary, take away the car keys. If holding onto keys is important to the person, substitute a different set of keys.


• If nothing else seems to be working, you may want to disable the car or move it to a place where the person can no longer see it or access it.

Caregiver Support

When learning that a loved one has been diagnosed with Alzheimer's disease, you may become stressed, frightened, and overwhelmed. Some helpful tips for dealing with the new diagnosis are listed below.

• Ask the doctor questions you have about Alzheimer's, including which treatments might be the most useful in alleviating the symptoms or controlling behavioral problems.


• Certain community groups offer classes to teach caregiving problem solving and management techniques.


• Locate a support group where you can talk about your concerns and emotions. Fellow members might have ideas and resources to share based on their own experiences. If you would like to find a support group but would rather stay at home, there are many support groups online.


• Map out your schedule in order to identify times in which you can create a normal routine to make activities run more smoothly. If certain times of the day are better for the person with Alzheimer's in terms of behavior and emotions, try to plan your schedule to make the most of those times with the person. The person's behavior may change from day to day, so be prepared to be flexible and change your schedule as needed.


• Think about using adult day care or in home health care services to allow time for your own relaxation. By using these services, you can have a break from the demands of caregiving while knowing that the person is safe and cared for.


• Try to plan ahead. This may mean collecting financial and legal documents, exploring long-term care options, and figuring out which services are covered by health insurance and Medicare.