Mom's little boy
Mom is getting worse quickly.  She slips in and out of time/place recognition.  She asked me the other day where her little boy was; he should be around here someplace.  I'm her little boy.  Yet, now I'm more like her father.

Alzheimer's turns the table on relationships.  The nurturer gets nurtured.  The parent gets parented.  The child takes charge.  The thing that doesn't change is the love that is exchanged.  Indeed, that aspect of the relationship is actually enhanced.  This is a cherished time, a time for service without conditions, a time to give to the one person who gave so much to me. 

This terrible disease changes everything.  It changes relationships and responsibilities and time commitments.  it will also change the heart.  Whether that heart change is bitter or blessed is up to each individual. 

Dinner is a challenge
We took dinner to mom and dad tonight.  They are so appreciative.  They always rave about the food.  I like that part of it.

Tonight, mom finished before dad.  She said that she was stuffed and couldn't eat another bite.  She said she couldn't finish her salad and asked that I put it in the fridge for later.  I cleared her plate and she went to sit on the couch.  After dinner, dad asked for a slice of homemade apple pie, which he always asks for kind of as a joke, because he knows there isn't any apple pie.  I suggested a bowl of ice cream, which he took.  I asked mom if she wanted some and she said that she was too full to eat another bite.  As dad ate his ice cream, I cleared the table and put the salad bowl and strawberries, which we had put in the green salad, on the coffee table near the door. 

Mom saw the strawberries and asked why she didn't get any.  I said they were in her salad.  She said that she ate her salad and didn't get any strawberries.  Janice asked if she would like some strawberries on ice cream.  Yes, that sounds great.  I got her ice cream.  She ate about half of it and said she was stuffed, she just couldn't eat any more.  She asked me to take her ice cream and put it in the freezer for later.  I was doing the dishes, so I just got rid of the remaining little bit (it wouldn't keep long anyway).  A few minutes later she asked where her ice cream was.  She wanted strawberries and ice cream.  I got her another bowl, a small portion, with strawberries.  She thanked me, took a few bites and said, "I'm stuffed, I just can't eat another bite."

We just keep smiling and laughing, that's all we can do.

Pathways to Memory
Pathways to Memory is a cognitive enhancement program for those suffering from Alzheimer's disease or any other memory-impairing condition.  Because Alzheimer's disease affects people differently, Pathways targets specific deficiencies.  This is a great program because it works.  It slows the progression of the disease and helps those suffering deal with it and interact with family and friends.  It gives people back a little bit of their pre-disease lives.

One of my first Pathways clients was my mom.  The difference with her was dramatic.  In December of 2007 she and dad came to Sunday dinner and sat on the couch.  When dinner was on the table, they came and ate.  Mom spent much of her time sleeping on the couch.  She didn't interact with other very much.  About six weeks into the Pathways program, I noticed a difference on Sunday.  Mom was up and asking what she could do to help.  She washed potatoes, set the table, cleared the table.  She interacted with family. 

After the full 12 week program ended, we took a break.  Mom then had a heart attack and spent about a week in the hospital.  When she next came to dinner, there she was on the couch, not offering to help. 

Within a couple of weeks, we started up Pathways again.  This time it only took a couple of weeks to get mom back up and helping with Sunday dinner.  It was a dramatic change.

I believe in the Pathways to Memory program.  In fact, we had offered it to clients as an additional premium service.  I decided it was too important not to have everyone possible take part.  Last August 2008, I changed our policy to give it free to any client who wants it.  I don't offer it as a stand-alone program. 

Actually, that may change.  We may offer it at assisted living facilities.  Check out my next post.  

Pathways study
On March 23, 2009, we started a Pathways to Memory program at Sunrise Assisted Living, Sandy Utah with the support of the Alzheimer’s Association of Utah.  The study lasted six weeks.  It involved residents living in the Reminiscence Unit (Rem), which is the Alzheimer’s lock down unit, and in Assisted Living (AL).  On April 16, 2009 (about four weeks into the study) we had a meeting with some of the family members and staff of Sunrise to discuss how things were going.  Following are the comments made by family members, staff at Sunrise who are working with the residents on a daily basis and our Pathways Partners:

Barbara D. (80, AL)
Barbara has been more calm and cooperative at 3:00 socials; her social interaction has improved.  Barbara came to get her nails done for the 1st time ever.  – Staff.

Betty G. (77, Rem)
1. Major – my mother is now cooperative in bathing.  2. My mother is more cooperative over all.  3. My mother is usually very uncooperative when I take her to the doctor.  She was much better today. 4.  Anxiety has gone down.  5.  Seems more content. – Son.  (The son also told me that he feels less guilty about not spending more time with his mother because he knows she is now so much happier and more involved in the community.)

Less hostile situations – very pleasant attitude majority of time.  Responds well with direct answers and being cognitive.  – Staff.

Beverly T. (78, Rem)
Participating more; anxiety is maybe a bit less; memory, no clear picture of improvement. – Husband.

Beverly is more independent using the restroom.  – Staff.

Beverly has been more calm and a lot less timid.  She isn’t so afraid to use the bathroom with verbal cues.  She is remembering other residents’ names and interacting more with them.  She has been joking with them and very engaged both one on one and in a group. – Staff.

Jean and Bev get along very well.  They talked for a good hour or hour and a half.  They helped each other out with lunch. – Staff.  (These two residents had not interacted previously.)

Beverly H. (81, AL)
Housekeeper mentioned that she is much easier to work with.  Doesn’t complain as much and is more pleasant.  Used to complain constantly.  – Pathways Partner.

Floyd H. (85, Rem)
More outgoing.  Talkative and physical “conditioning.”  - Son (The son talked about Floyd walking without his walker and being more stable on his feet.)  

He is a lot more talkative and more alert.  He is happier.  Deb (the Reminiscence Unit manager) said he did “Karaoke” and got everyone up and going.  Not so anxious. – Daughter.

Floyd has really blossomed.  He is more involved in activities where before he isolated himself in his room.  Floyd and I had a 30 minute conversation which was completely coherent.  I believe Floyd is more engaged and involved all the time.  When I invite Floyd to activities, he is happy to join us.  – Staff.

George K. (91, AL)
Wants to keep the program going.  Asks caregiver if she will continue with him after the study is done. – Staff.

Jack D. (92, Rem)
Jack has been seeking more interaction, he comes out of his room ready to talk and participate in activities.  – Staff.

Very cognitive with one on one situations.  – Staff.

Cooperative showering.  – Staff.

Jean A (81, Rem)
The people involved in Pathways recognize each other, sit together and have a sense of community.  For example, Jean was having a rough day, and Nelson, Wayne and Ron all sat beside her and comforted her.  She told them how much she appreciated their support. – Staff.

Beverly and Jean get along very well.  They enjoy talking to each other and helping each other out with meals. – Staff.

Nelson L. (82, Rem)
Cognitive abilities, especially one on one, are much better.  Can answer and respond to questions and situations while understanding and being focused.  – Staff.

Ronald P. (85, Rem)
Refused to participate directly in Pathways, but will engage in the common room as Barbara works with others.  Is more social now.  He now interacts with the other Pathways clients.  He is going on outings now.  Prior to starting Pathways, he spent most of the time in his room.  – Pathways Partner.

Ruth F. (84, AL)
Ruth has been less agitated at dinner time – before she would refuse all menu items.  Ruth has been calmer and more cooperative. – Staff.

Viola K. (86, AL)
Viola is more talkative and responsive – usually she is quiet.  She is now able to refuse items on the menu that she does not want, which she did not do before.  Viola has overall been more vocal about her needs.  Viola has been more assertive in telling care managers she wants to attend activities – even if her husband disagrees. – Staff.

Wayne R. (85, Rem)
I’ve seen some improvement in my Dad’s ability to carry on a conversation.  He is very aware of what is happening.  Problem solving seems improved.  –Daughter

Wayne has been very compassionate and reaching out to other residents in the community.  He seems more happy and less anxious.  – Staff.

My Dad
By the way, I took dad to the doctor last week.  He was diagnosed with Alzheimer's as well.  I'm having a hard time adjusting to this.  It took a while, a long while, to train myself how to respond to mom's incessant questions.  Now I have to have that same patience and understanding with dad.