Mar 14, 2010

Living Alone with Dementia

Yesterday was a difficult day. My agency was called to provide care for an elderly woman living alone with Alzheimer’s.

By Angil Tarach-Ritchey
Alzheimer's Reading Room

Forget Me Not

Prior to going out to meet her, I was told Adult Protective Services had already been involved, but no one would be there at her home with her when I was scheduled to visit.

This is never a good idea.

We always want someone in the meeting that can witness what took place.

The son who called us said he couldn't make the meeting. Because I know and trust myself, and already had concern for a lady living alone with dementia, I went to her home.

I expected to find her home alone in a terrible situation, and was fearful of what I might find. I was pleasantly surprised to find her home health nurse there, so at least someone was able to witness my visit, and was involved in her care.

I met a beautiful 88 year old woman who I was happy to see was clean, groomed well, and lived in a clean environment. Not what I expected. We all base expectations on our past experiences, and I have seen some really bad situations. She was very friendly, talkative and from outward appearances appeared healthy, physically and mentally.

The nurse filled me in on her recent hospitalizations, and family situation. This is when the scenario took a turn for the worse. This lady had been driving and caring for herself until her church family noticed something was very wrong. A wonderful woman from the church family took it upon herself to help. Mind you this patient has adult children.

Her recent hospitalizations were a blessing because that is when the home health agency was called to provide medical monitoring in her home.

To make this story much shorter than it was I am just going to say this patient has no one in charge of her medical decisions or finances. She is in dire need of someone to help her. What is most concerning is her inability to obtain groceries, eat appropriate meals, drink enough fluids (she was hospitalized both times for dehydration), obtain and take her medications appropriately and handle her finances. Thank goodness she hasn’t fallen, or left home being too confused to find her way back home. As we all know Alzheimer’s is progressive, and this is an issue in the future.

She has already been taken advantage of financially by one family member, and showed me her feelings about a particular incident that she wrote at the time. Very painful to read I must say.

The other family member has been repeatedly contacted by several parties to get involved but fails to show much concern other than for himself.

This leaves her with no one but agency nurses, a social worker, and her lady friend from church to try and figure out how to protect her and keep her safe. This is just one of many vulnerable elderly patients I have wanted to take home. The nurse from the home health agency feels the same way. We even laughed saying we’d have to fight over her!

As nurses we have very little options other than to get Adult Protective Services (APS) involved. My experience with them hasn’t been the best. In this case I believe they were called, made a visit, contacted the family with options and recommendations before there is more action taken. This is where the problem lies. The family tells APS what they want to hear, APS believes it, case closed.

As I said earlier the family was the one that called us to start care. I called the family after my visit and was saddened and angered by their lack of concern or commitment to help. The conversation did not go well and shortly after I reported to the home health nurse what the outcome of that conversation was; the family called and terminated our involvement.

At this point there will be a meeting, APS will be called again, and the professional staff involved will be recommending the patient be appointed a guardian through the court.

This is not the outcome I wanted to see, and I am really sad that this very wonderful woman will be attended to by a stranger that may or may not care, rather than being loved and cared for by her family. The truth is someone has to be responsible for her health and welfare so she is not out there alone and confused.

There are probably more people out there on their own with dementia than anyone will ever know. We only know when someone accidentally comes across their path and realizes the vulnerable situation they’re in and does something, or something tragic happens.

We have been called by neighbors, and concerned individuals in these type of cases. They notice something is very wrong with the person that lives next door, or in this case goes to their church. What happens when the neighbor doesn’t pay attention or the individual doesn’t want to get involved? I hate to even think about all those undiscovered persons living alone with dementia.

I can see how this may happen when there is no family and a person stops socializing, but how tragic and sad is it when the family doesn’t care?

Can’t we do a better job at protecting and caring for our elders? Why doesn’t APS do more? As it stands now, it’s up to us as citizens to look out for the elderly. We need to pay attention and get involved. We need to put pressure on Adult Protective Services to do more, to follow up on complaints, to follow up on promises by family members. To place people immediately when there is no alternative to keep them safe and cared for.

Just imagine for a moment being alone and confused. Wouldn’t you hope someone would help you? Let’s be the someone.

Angil Tarach-Ritchey(RN GCM) has over 30 years of experience, and is a nationally known expert in senior care and advocacy. Angil is also the owner of Visiting Angels in Ann Arbor, Michigan.

Original content Angil Tarach-Ritchey, the Alzheimer's Reading Room