Are You Essential?

Another month has passed, and it feels simultaneously like everything has changed and nothing at all. In the senior living world, we’ve received new guidelines to follow and are in the process of dissecting a complex, verbose, somewhat disheartening 41-page Executive Directive. It outlines what each stage of our phased-in approach to reopening will look like, as well as what parameters must be met in order to advance. At first glance, I was thrilled to see that indoor visits would again be permitted; as nice as the outdoor ones have been, they’re completely dependent on weather and it’s so hard for residents to hear their loved ones from 6ft apart and with all the background noise. As I read on, though, my excitement faded.

Indoor visits are to be limited to “essential caregivers”. In other words, there are very specific people who will be able to enter the community (and for very specific reasons). Each resident can have up to two adult ECs total, regardless of how big their family is. In order to be considered, one must apply and explain why they feel they are essential. Once accepted, they can visit up to twice a week for two hours per visit. Of course, they’ll have to be pre-scheduled, screened, COVID negative, and in full PPE.

So, what does it take to be considered essential? According to our governing body, an EC is someone who was “previously actively engaged with the resident or committed to providing assistance with activities of daily living”. Some examples provided by the DOH include a family member who visits twice a week to assist a resident with a shower, an individual who visits weekly to fill the resident’s pill box, and the like. Oh, you know, just the stuff they moved in with us to get help with in the first place. The things their family could no longer manage, hence them ending up in assisted living. Makes sense.

ECs can’t come just to hang, either; there must be an essential reason for the visit, which is forbidden from being social in nature. They have to be providing assistance with a task that they helped with prior to COVID, like cleaning hearing aids or shampooing the carpet. Changing sheets and cleaning out refrigerators count, too. Again, these are actual examples provided by the DOH.

You know what’s essential? Human touch. Hugging your family, including your great grandkids who are under 18 and can’t make the cut. Socializing with your friends is pretty important, too, while we’re at it. Sharing a meal together. Stepping foot outside of the same apartment you’ve been trapped in for 5½ months (without being told to turn around & go back). Having the right to choose which risks you’ll take. Living out the rest of your life with dignity and love, on your own terms. All essential. Not one on the list.

I feel more helpless now than I have this entire pandemic.

Operation Green Sheets

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One of my favorite nonnos of all time passed last week. He was hands down the most spirited, loyal, fun-loving resident I’ve had the pleasure of serving, and he adored his wife. No matter the circumstance, he’d support her blindly. They’d dance to any song and, if separated, he was beside himself. During a brief stint in the hospital (for her), he sat in the lobby from morning until night awaiting her return. Literally, he didn’t move (except to yell into my office every hour for an update).

My “boyfriend” was also extremely headstrong, and he and his beautiful wife both lived with dementia. When she had an idea in her head, she’d rile him up and they would fixate on it. Dementia is so f’ing weird – they’d forget that they ate breakfast but despite my prayers and redirection, they’d remember every detail of these delusions. I’m cracking up at the thought and at the memory of them standing in my office, him raising his voice (& sometimes his middle finger) and her egging him on.

One of my favorite stories of Mr. & Mrs. M came to be fondly referred to as “Operation Green Sheets”. One morning, they came to alert me of a probable theft: their daughter-in-law had bought them a set of green sheets, which were now missing. Thankfully, I had a great relationship with their two sons, who were insanely understanding and supportive. I know it’s horrible to say (but I always say it anyway) – I’ve seen a lot of amazing, involved daughters, but those really good, patient, helpful sons.. they’re a dime a dozen (sorry, boys). These two are exceptional. A quick text confirmed there was not, in fact, a green sheets delivery. We laughed it off, reassured them that they were in the laundry, and hoped they’d be forgotten by morning.

To our disappointment, these were the most memorable made-up sheets in the history of fake bedding. A few days passed with constant calls, visits, and middle fingers. I was out of excuses and there was no appeasing them. I sent the boys two shades of green and by the grace of God, they picked the right color – they arrived via Amazon Prime the next morning and when delivered, my loves shouted in unison, “That’s them!”. Crisis averted, and this time without the help of the police (I’ll save that story for another post 😉).

I was only lucky enough to spend a brief time with Mr. M. However, I don’t need to have known him forever to be certain the world will be a duller place without him. I will be always grateful for his lessons, laughs, love, and even middle fingers. May he rest in the sweetest peace. ❤

Face Value

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When caring for a loved one with dementia, you’re often faced with situations that don’t seem logical; they’re far from “normal” and can be downright confusing. In fact, most lack “common sense” altogether… at least at face value. Working in the field, one of the most important lessons I’ve learned is that nothing is as it seems. Today, for the millionth time, it was reiterated by one of my favorite nonnos.

In the senior living world, the word investigation is part of our everyday vocabulary. Unusual behaviors? Investigate the unmet need. Frequent falls? Investigate environment, meds, and other risk factors. As time consuming as they can be, investigations are also super practical, especially when faced with puzzling scenarios. There’s a level of formality we associate with them that isn’t always necessary or applicable. Sometimes an open mind, creative thought, and a little digging are all you need.

There have been some concerns about the hygiene of the nonno I mentioned. Other residents have been complaining that he stinks and he always looks unkempt. Though in the earlier stages of dementia, he is fiercely independent and doesn’t let us help him with anything; we can’t so much as lay out his outfits in the morning without a fight. Oddly enough, when by the grace of God he lets us do routine skin checks, everything looks good. His hair and beard aren’t oily, either, but the odor he emits is pungent. He swears he showers regularly, but how could that be?!

Cue investigation mode. I thankfully have a good rapport with my sarcastic, headstrong love, so I felt comfortable being honest with our concerns (in an extremely kind, empathetic way, obviously). It was immediately apparent that his clothes were filthy. He admitted to keeping them on for a few days and thinking nothing of it, which is not uncommon with dementia. When I affectionately offered to pick out a fresh outfit for dinner, though, I discovered the most pressing issue: he has nothing to wear. Aside from a pair of cargo shorts and a ripped, medium-sized t-shirt in his closet (he’s an XXL), there was next to nothing to choose from. In his mind, however, that didn’t matter – he had clothes on his back and, thankfully for him, a poor sense of smell & self-awareness.

A pep talk, some hand-me-downs, and a phone call to his POA later, I left him with the agreement that he’d continue bathing regularly and change his clothes every day. I held my breath for the rest of the afternoon until I heard him roll out of the elevator. To my most pleasant surprise, he changed for dinner! Had we continued to take this situation at face value, I’m confident that it would’ve gone an entirely different route.

The fact that this nonno never mentioned his dilemma makes no sense, but with dementia, nothing does. Whether he was too embarrassed to bring it up or just flat out unbothered is irrelevant; what’s important is that we gave him the benefit of the doubt and dug deeper. We nixed face value and investigated, and I can confidently say we’re all better off for it.

Is It Physical or Mental?

Contrary to what my social media may portray, working in assisted living is not all bus outings and puppy kisses. A decent amount of my time is spent not with my residents, but communicating with their loved ones, whether in person, over the phone, or via email. While I really enjoy that part of my role, too, it can sometimes be extremely challenging. I held a family meeting yesterday with one of my favorite nonna’s son and daughter-in-law. She’s currently rehabbing at our post acute care and will likely end up staying there long term. When conveying our nursing home recommendation to her family, my coworkers and I were met with sadness and confusion. “Is it physical?” her son asked. “Is that why she has to stay here? Or is it mental?” The short (but complicated) answer: it’s kind of both.

This particular nonna, who I’ll call M, is physically in pretty good shape. Granted, she’s in a wheelchair, but she can self-propel and get around on her own. She can bear her own weight and really just needs someone on stand-by when she does things like shower and get ready in the morning. Cognitively, she’s in the earlier stages of dementia and is pleasantly confused. She knows exactly who we are and has no problem telling us how she feels (read: she can be super cranky). Her reality orientation is a bit off and we have to remind her when it’s time for lunch, but she has more good days than bad ones. Doesn’t sound like M’s necessarily nursing home appropriate, right? Here’s where that confusion and the “kind of” come into play.

M is both prideful and forgetful. She not only wants to do things on her own, she forgets that she can’t. If she tries and fails, she’s not sure how to call for help; though she has an emergency pendant and pull cords throughout her apartment, they’re essentially useless as she won’t remember how to use them. Assisted living, in her case, is a recipe for disaster; despite the fact that she’s not too clinically or mentally compromised, she has very poor safety awareness and, as a result, falls constantly. It’s no secret that one bad spill can be incredibly dangerous for someone elderly and in her condition.

Dementia affects various parts of the brain differently. The frontal lobe, which is responsible for things like judgment, impulse control, and spontaneity, can be a game changer if impaired. There’s no reasoning with someone who lacks judgment, either. I wish with my entire heart that I could convince M it’s not safe to try to walk, to shower by herself, or to keep her door locked. I want her to stay with me for so many reasons, and I know her family does too. Safety is always top priority, however, no matter how or why it’s compromised (physically, mentally, or kind of both).

HTWF&IP

Full disclosure: I have an embarrassingly impressively large collection of leadership books. When I was offered my current job at the end of last year, to say I was nervous would be an understatement. Since no “Executive Director for Dummies” book exists, I figured those on personal growth would be the next best thing. While some have been cheesy, most have actually proven to be helpful, with my favorite being How to Win Friends & Influence People by Dale Carnegie.

Despite being one of the most successful books in American history, I had not heard of Carnegie’s bestseller until recently. With millions of copies sold worldwide, numerous accolades, and over 7,000 Amazon reviews, I anticipated that I would learn a great deal in regards to professional relationships and communicating with employees. I did not, however, anticipate finding so much to be relevant to working with dementia patients.

HTWF&IP features 29 principles (outlined here), but the below hit closest to home. Note that they are in no particular order and that some have been combined:

  • Smile – it’s a simple way to make a good first impression. Remember that a person’s name is to that person the sweetest and most important sound in any language.”

Unfortunately, your nonna may not realize at first glance that she knows you. Even if she does, she may not understand how or in what context. Smiling and greeting her with her name not only indicates that you’re familiar with one another, but also elicits comfort and relief.

  • “Don’t criticize, condemn, or complain. The only way to get the best of an argument is to avoid it.”

See previous post for specifics on arguing and how detrimental it can be. As Carnegie reiterates, it’s essential to distrust our first instinctive impression; our natural reaction in a disagreeable situation is to be defensive. If your nonno accuses you of misplacing his keys, you’ll understandably want to assure him you have not. Conversely, make it a point to listen and apologize; it will help disarm him. Show respect for his opinions and never say he’s wrong.

  • “Make the other person feel important – and do it sincerely. Throw down a challenge. That is what every successful person loves: the game. The chance for self-expression. The chance to prove his or her worth, to excel, to win. That is what makes footraces and hog-calling and pie-eating contests. The desire to excel. The desire for a feeling of importance.”

Regardless of age or cognition, we as human beings crave a sense of purpose. We need to feel as though we matter. Last month, one of my favorite residents was visibly agitated and I overheard staff having a difficult time redirecting him. Upon entering his room, I exclaimed that he was just the man I was looking for; I had to hang up flyers for an impromptu ice cream outing we’d take that afternoon. I solicited his help and together we completed a seemingly trivial task. He even agreed to join us at Dairy Queen following some shameless pleading on my end – I needed a man’s coaching and direction while driving our huge van!

  • “Let the other person save face. Even if we are right and the other person is definitely wrong, we only destroy ego by causing someone to lose face.

One of my biggest pet peeves is hearing someone point out the fact that a nonno or nonna has wet themselves, regardless of whether or not others are present. I’m cringing at the thought. The legendary French aviation pioneer and author Antoinne de Saint-Exupery wrote: “I have no right to say or do anything that diminishes a man in his own eyes. What matters is not what I think of him, but what he thinks of himself. Hurting a man in his dignity is a crime.” No matter the situation, preserving dignity is essential. In my opinion, this is non-negotiable.

Truth be told, all 29 principles in How to Win Friends & Influence People are applicable, but why shouldn’t they be? After all, individuals living with dementia are just that: people.

Little Mamma

As if it wasn’t already evident from previous posts (and my Instagram bio), I am a huge dog lover. I worked through undergrad and grad school at the most incredible kennel, and I grew up with Shepherds and Labs. I’ve always hoped to somehow combine my love for dogs and seniors – to do meaningful work that involves both. This weekend, I took the first step toward doing just that: I rescued a three-month-old puppy. I know, I know…I work 65+ hours a week, I’m never home, and to say I travel often would be an understatement. I promise there is a method to my madness.

It’s no secret that the effects dogs have on people of all ages are immense. Within an instant, they can make us feel happy, loved, and safe – simultaneously excited and calm. Physically, they keep us active and in turn help our hearts. Dogs reduce stress (except during the housebreaking stages perhaps) and teach us lessons. For seniors especially, they can be pivotal in decreasing loneliness and improving mood; dogs live in the here and now. They don’t worry about tomorrow, and according to Dr. Jay Granat, tomorrow can be very scary for someone who is elderly:

“Having a pet helps the senior focus on something other than physical problems and negative preoccupations about loss or aging.”

And focus on them they do. That goes for both physical impairments and cognitive ones. Individuals with dementia (particularly in earlier stages) tend to be extremely stressed, and understandably so; they recognize that something’s wrong but can’t necessarily distinguish it from what is right. They’re not only confused, but also frightened and embarrassed. Here’s where my little mamma comes in:

“I sort of think that anybody with Alzheimer’s could benefit by a friendly little dog. Somebody they can play with and talk to – it’s kinda nice to talk to a dog that you know is not going to talk back. And you can’t make a mistake that way. … My dog knows things about me before I know them myself. … The one thing I know is that the dog is with me, and when she’s with me I at least have some solace, even if I don’t know the way.”

– Cary Henderson, Partial View

Rosie, that’s your cue. Introducing the newest member of our team and family:

 

The impact this little girl has had on our residents in three short days is immeasurable. I’m completely blown away. I have no doubt she will continue to amaze me. She is, after all, a dog ❤ one of the only beings that will ever love us without condition or complication. Mamma, we are so thankful for you already.

Is Honesty Really the Best Policy?

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Last week, I sat beside a client in the hospital and reminisced of days gone by. Though her short-term memory is shot, she’s able to recite stories from the past as though they took place yesterday. She shared one in particular that’s stuck with me for a few reasons: 1) it was hilarious and 2) it hit really close to home. This nonna (who I’ll call Lo) and daughter (D) recalled one summer at their country home, where they took in a baby raccoon that had been abandoned by its mommy. Four-year-old D affectionately named him Rakki and they bonded instantly; she dressed him in tiny outfits and turned a bottom drawer into a bedroom.

September approached and so did the inevitable: it was time to part with Rakki. Obviously D was heartbroken, but in true mom fashion Lo stepped in and made it better. Uncle Eddie lived on a farm full-time in Pennsylvania and was happy to adopt his furry nephew. Perfetto! The story doesn’t end there, though. Lo and D outlined the rest of Rakki’s thrilling life, including marriage, kids, and a subsequent (yet civil) divorce. Lo got a kick out of filling me in, especially when she revealed that they did not, in fact, ship Rakki to PA – he went right back where he came from (the back yard). We could not stop laughing.

The Rakki tale hit close to home because my parents told a similar lie to me: after finding that an egg had fallen from its nest and opened prematurely, I was panicked. We were on our way out, but my mom assured me that if I scooped the baby up and put him by the Virgin Mary, my dad would rush him to the vet when he got home from work. As far as I knew (until my mid-f’ing-twenties), he did just that: Dr. Wilson patched him up and sent my tiny bird to live on a farm in Pennsylvania. Was the PA farm anecdote a Jersey parent thing?! Was it so that we wouldn’t ask to visit? Regardless, the elaborate fibs our parents told were not simply for their own amusement, nor were they to hurt us. On the contrary, they were for our own best interests – to protect our little hearts.

D didn’t find out the truth about Rakki until adulthood, just as I was kept in the dark about the bird. It makes sense considering as kids we’re taught that lying is both awful and unfair. On top of that, we learn to never lie to our parents or to people that we love. Being dishonest with someone with dementia, then, logically sounds appalling. In reality, it can be essential:

“Those with dementia often struggle with logic, rational thought, sequencing, and emotional control. Therapeutic fibbing may be may be appropriate when telling the truth would cause pain, anxiety, or confusion, or when the person with dementia is experiencing life in a different “time zone”.”

Sometimes, a fib may be the kindest thing you can say to your loved one with dementia, though it’s easier said than done:

“To varying degrees, many of us as adults still feel that our parents are parents and that we, the children, are less assured, less capable, and less “grown up.” [We feel guilty for being untruthful.] The trouble with guilt is that it can keep you from making clear-headed decisions and doing what is right for [your parent] and the rest of the family.”

The 36-Hour Day

Remember that the fibs you tell are not intended to hurt your parents, just as theirs were not to you. Shake the guilt and be creative; adaptation is the key to success. There’s no one-size-fits-all when it comes to this stuff. Accept the illogical and embrace absurdities. If your nonna insists her car’s outside and she’s got somewhere to be, remind her that “it’s in the shop.” Show her it’s not out front and offer her a ride. Validate her feelings. If nonno needs an aide post-fall but is too prideful (and too cheap), confirm that it’s just temporary and covered by insurance. Empathize with him: a guest at home is not ideal but the doctor wants him stronger (plus it doesn’t cost a thing!). Think outside the box and go with it. After all, they did the same for you.

Commendable or Crazy?

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Picture this: it’s 9:57AM and you’re just waking up, super late for work. Groggy and in a little pain, you immediately reach for your phone – why the f didn’t your alarm go off?! Wait, why is your phone not plugged in on your nightstand? Where is your nightstand? You don’t know where you are, but it definitely isn’t home. Perhaps more frightening, you’re not alone. You ask for – no, you demand answers. You had to have been kidnapped (possibly even drugged) and, rightfully so, you’re not going down without a fight.

Under most circumstances in the above situation, we’d praise the fighter; we would commend them for their bravery and validate their panic. At the very least, we’d empathize with their hysteria. In the case of dementia sufferers, however, our reactions differ. When a nonno whose reality orientation is off by 50 years insists on getting to work, we scoff. When a nonna swears she has to get her kids from school, we try to snap her out of it. Even worse, when emotions escalate, we dish out labels like “behaviors” or “agitation” and over medicate for good measure. Suddenly, the above scenario reads paranoia and delusion.

Dementia is so much more than memory loss. It has a lot of positive symptoms, too, or ones that manifest themselves as a result of some condition. Hallucinations, delusions, illusions, and paranoia are examples, to name a few.

  • Hallucinations are the perception of an object or event in any of the five senses in the absence of an actual external stimulus. They can be visual, auditory, etc.
  • Delusions are false beliefs that are based on incorrect inferences about real external stimuli. So a person isn’t necessarily seeing or hearing things, they’re believing in something that simply isn’t true and that has evidence against its validity. They could assert that they don’t live in their own home and truly believe it, even though it’s evident that not only do they reside there now, they’ve been there for nearly 30 years.
  • Illusions involve distortions of the senses or how one interprets sensory information. Someone may hear a violent show on TV and interpret the scenes to be happening in real life, for instance.
  • Paranoia is heavily influenced by fear, often to the point of irrationality. Paranoid thinking, then, usually involves anxiety-inducing beliefs about some perceived threat.

As unnatural as it may feel and difficult as it can be, it is so important to put yourself in your loved one’s shoes. Instead of trying to bring your nonna back down to earth and convince her she’s mistaken, think outside the box: what’s triggering her perception? Consider her environment and any changes that may be beneficial: provide adequate lighting, avoid sensory overloads, and make detailed observations. Something as trivial as rustling bushes could trigger the perception of an outside intruder. Most importantly, reassure her and validate her feelings. Lock the deadbolt on her front door and alert the authorities of suspicious behavior (wink wink). Tomorrow, address her overgrown shrubs.

An old friend recently shared a story about her mom that serves as the perfect example of how to act in such situations. Her mother, who is believed to be suffering from frontotemporal dementia, is convinced there is a snake in her bedroom. The fear became so debilitating that she could no longer sleep in her own bed. Her compassionate (and smart!) first born nixed the reality orientating game and stepped into her mom’s world: every evening, she screens the room alone then lovingly (and convincingly) assures her mother that she’s thrown the snake out the window. On particularly rough days, she calls for backup and “exterminators fumigate the house.” Unnatural? Maybe. Insanely comforting, thoughtful, and commendable? Absolutely.

What’s Your Sign?

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Full disclosure: I know close to nothing about astrology. I have no idea how planets retrograde or what it means for all the signs. I do, however, follow Thought Catalog religiously, and find its zodiac posts to be alarmingly accurate. The above assertion fits me to a T: I don’t stress easily, but try to control me and I’m instantly claustrophobic. Not physically, of course, but emotionally – down to my core, I feel suffocated.

Horoscopes are vague. They’re intended to be broad enough to apply to everyone yet specific enough to strike a cord. At the very least, they get you thinking. Conforming, being told what to do, and meeting deadlines aren’t just anxiety-inducing to us Sagittarians; we as human beings crave autonomy. We inherently desire the ability to make choices consistent with our own free will.

According to the self-determination theory, human aspiration relies on three core psychological needs: autonomy, competency, and relatedness/the need for social connection and intimacy. In other words, we need to feel that we are free to make our own decisions, that we’re capable and thriving, and that we’re connected to other people. Satisfy all three, they say, and find your bliss. Restrict them, however, and you’ll experience more than just claustrophobia.

Constraints on our autonomy can both destroy our sense of happiness and spark retaliation. Throw incompetence and isolation into the mix and you’ve got the perfect storm. Interestingly (and sadly) enough, that is exactly what one experiences when they have dementia. Luckily, we can do something about it.

For whatever God forsaken reason, it seems as though our instinctual reaction when a loved one starts deteriorating is to completely take over. Are they drinking enough water? Have they gotten enough sleep? What about their diet – are there three square meals a day? Coffee’s out of the question, as are sugars and red meats. Che cazzo?! Innocently and with the best intentions, we as caregivers assume total control. What we don’t realize, however, is that our authority may do more harm than good.

Research shows that the desire for and assertion of power are sometimes misconstrued; its appeal is not, in fact, to control things but rather to control oneself:

“Power as autonomy allows one person to ignore and resist the influence of others and thus to shape one’s own destiny. … Generally, when people say they want power, what they really want is autonomy. And when they get that autonomy, they tend to stop wanting power.”

The Atlantic: People Want Power Because They Want Autonomy

When it comes to dementia, we so naively take the reins and are confused by the reaction. We use tough love to set new standards and enforce rules with no real bearing. Could nonna benefit from cutting ice cream out of her diet? To some degree, I’m sure. Would nonno nap less after breakfast if he skipped the nightly news? Yes, most likely. Odds are he’d also fight your bedtime.

Put yourself in their shoes. Try to think objectively of what is necessary and practice patience and acceptance. When your influence is required, be mindful of its implications. After all, wouldn’t you be pissed if someone messed with your routine? Sagittarius or not, I bet you would.

How To Drive Yourself Crazy Caring for Your Loved One with Dementia in 5 Easy Steps

Books, open forums, support groups, blogs: there are numerous platforms that offer advice on what to do when your loved one has dementia. A simple Google search alone yields over 1.5 million results in half a second. While often helpful and insightful, I’ve come to find that there’s a benefit to learning what not to do, as well, especially when given relatable examples that might just sound familiar. As promised, below are five easy steps to drive yourself crazy when caring for your loved one with dementia:

  1. Orient them to reality: Due to the nature of her disease, your nonna may revert back to another period of time in her life that she now believes to be the present. It’s possible that you’ll find her worrying about her parents who reside nearby, not in Heaven, or a job she’s still committed to, not retired from. When such situations arise and anxiety and confusion persist, comfort her by bringing her back to reality. Firmly remind her that it’s 2017, she’s 96 years old, and obviously completely losing it.
  2. Argue: On a similar note, once you’ve explained to your nonna that she does not, in fact, have to catch the 5:00 bus, listen to her rebuttal. Consider the points she’s made and quickly call attention to their absurdity. Laugh at the ridiculousness and respond accordingly, reminding her that she hasn’t lived in Hoboken in 35 years and her place of employment is now a parking garage. Oh, and the mom and dad she’s worried about? They’re dead. Duh!
  3. Repeat yourself: When brought back to the present, it’s not uncommon for your nonno to voice concerns. After all, he’s living in a totally different reality than that which was just described to him. He’ll have some questions, surely, and your answers are important. If and when he’s still perplexed, simply repeat yourself: seriously, say the exact same thing you just stated as if he didn’t hear you. Works every time!
  4. Rush them: Patience is to be practiced on naive children, not seniors who should know better. If your nonno seems to be having a difficult time following through with trivial, everyday tasks like getting dressed, try a tough-love approach. Put some pressure on him: set time limits and outline strict consequences. Stress can be a motivator, too!
  5. Expect them to be who they’ve always been (and take it personally when they’re not): In the same breath, keep in mind that older people are set in their ways. Not only does your nonna know what she’s doing, she’s also got a motive behind her actions. Know the games she plays and don’t feed into them; make it clear you’re not down for nonsense and encourage her to get it together or else (nursing home, anyone?!).

Seriously, I cringed just typing the above. Unless you simultaneously hate your nonno and love self-harm, please don’t practice anything on this list. In fact, do the opposite. My examples may read humorous and even a bit extreme, but it’s not uncommon for caregivers to find themselves in similar, equally frustrating situations. Always keep in mind that what you’re now experiencing is the disease, not the loved one you once knew. Be patient and be kind. To keep yourself from truly going crazy, just go with the flow; dementia’s demons foster arguments you will never win and changes you cannot control. The only one whose outlook can be altered is your own.