How do I handle it if my parent is refusing aged care? 4 things to consider
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It’s a shock when we realise our parents aren’t managing well at home.
Perhaps the house and garden are looking more chaotic, and Mum or Dad are relying more on snacks than nutritious meals. Maybe their grooming or hygiene has declined markedly, they are socially isolated or not doing the things they used to enjoy. They may be losing weight, have had a fall, aren’t managing their medications correctly, and are at risk of getting scammed.
You’re worried and you want them to be safe and healthy. You’ve tried to talk to them about aged care but been met with swift refusal and an indignant declaration “I don’t need help – everything is fine!” Now what?
Here are four things to consider.
1. Start with more help at home
Getting help and support at home can help keep Mum or Dad well and comfortable without them needing to move.
Consider drawing up a roster of family and friends visiting to help with shopping, cleaning and outings. You can also use home aged care services – or a combination of both.
Government subsidised home care services provide from one to 13 hours of care a week. You can get more help if you are a veteran or are able to pay privately. You can take advantage of things like rehabilitation, fall risk-reduction programs, personal alarms, stove automatic switch-offs and other technology aimed at increasing safety.
Call My Aged Care to discuss your options.
Nadino/Shutterstock
2. Be prepared for multiple conversations
Getting Mum or Dad to accept paid help can be tricky. Many families often have multiple conversations around aged care before a decision is made.
Ideally, the older person feels supported rather than attacked during these conversations.
Some families have a meeting, so everyone is coming together to help. In other families, certain family members or friends might be better placed to have these conversations – perhaps the daughter with the health background, or the auntie or GP who Mum trusts more to provide good advice.
Mum or Dad’s main emotional support person should try to maintain their relationship. It’s OK to get someone else (like the GP, the hospital or an adult child) to play “bad cop”, while a different person (such as the older person’s spouse, or a different adult child) plays “good cop”.
3. Understand the options when help at home isn’t enough
If you have maximised home support and it’s not enough, or if the hospital won’t discharge Mum or Dad without extensive supports, then you may be considering a nursing home (also known as residential aged care in Australia).
Every person has a legal right to choose where we live (unless they have lost capacity to make that decision).
This means families can’t put Mum or Dad into residential aged care against their will. Every person also has the right to choose to take risks. People can choose to continue to live at home, even if it means they might not get help immediately if they fall, or eat poorly. We should respect Mum or Dad’s decisions, even if we disagree with them. Researchers call this “dignity of risk”.
It’s important to understand Mum or Dad’s point of view. Listen to them. Try to figure out what they are feeling, and what they are worried might happen (which might not be rational).
Try to understand what’s really important to their quality of life. Is it the dog, having privacy in their safe space, seeing grandchildren and friends, or something else?
Older people are often understandably concerned about losing independence, losing control, and having strangers in their personal space.
Sometimes families prioritise physical health over psychological wellbeing. But we need to consider both when considering nursing home admission.
Research suggests going into a nursing home temporarily increases loneliness, risk of depression and anxiety, and sense of losing control.
Mum and Dad should be involved in the decision-making process about where they live, and when they might move.
Some families start looking “just in case” as it often takes some time to find the right nursing home and there can be a wait.
After you have your top two or three choices, take Mum or Dad to visit them. If this is not possible, take pictures of the rooms, the public areas in the nursing home, the menu and the activities schedule.
We should give Mum or Dad information about their options and risks so they can make informed (and hopefully better) decisions.
For instance, if they visit a nursing home and the manager says they can go on outings whenever they want, this might dispel a belief they are “locked up”.
Having one or two weeks “respite” in a home may let them try it out before making the big decision about staying permanently. And if they find the place unacceptable, they can try another nursing home instead.
CGN089/Shutterstock
4. Understand the options if a parent has lost capacity to make decisions
If Mum or Dad have lost capacity to choose where they live, family may be able to make that decision in their best interests.
If it’s not clear whether a person has capacity to make a particular decision, a medical practitioner can assess for that capacity.
Mum or Dad may have appointed an enduring guardian to make decisions about their health and lifestyle decisions when they are not able to.
An enduring guardian can make the decision that the person should live in residential aged care, if the person no longer has the capacity to make that decision themselves.
If Mum or Dad didn’t appoint an enduring guardian, and have lost capacity, then a court or tribunal can appoint that person a private guardian (usually a family member, close friend or unpaid carer).
If no such person is available to act as private guardian, a public official may be appointed as public guardian.
Deal with your own feelings
Families often feel guilt and grief during the decision-making and transition process.
Families need to act in the best interest of Mum or Dad, but also balance other caring responsibilities, financial priorities and their own wellbeing.
Lee-Fay Low, Professor in Ageing and Health, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Remember – by Dr. Lisa Genova
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Memory is often viewed as one thing—either you have a good memory, or you don’t. At best, a lot of people have a vague idea of selective memory. But, the reality is much more complex—and much more interesting.
Dr. Genova lays out clearly and simply the various different kinds of memory, how they work, and how they fail. Some of these kinds of memory operate on completely different principles than others, and/or in different parts of the brain. And, it’s not just “a memory for faces” or a “memory for names”, nor even “short term vs long term”. There’s working memory, explicit and implicit memory, semantic memory, episodic memory, muscle memory, and more.
However, this is not just an interesting book—it’s also a useful one. Dr. Genova also looks at how we can guard against failing memory in later years, and how we can expand and grow the kinds of memory that are most important to us.
The style of the book is very conversational, and not at all textbook-like. It’s certainly very accessible, and pleasant to read too.
Bottom line: memory is a weird and wonderful thing, and this book shines a clear light on many aspects of it—including how to improve the various different kinds of memory.
Click here to check out Remember (we recommend to do it now before you forget!
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Gut Health for Women – by Aurora Bloom
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First things first: though the title says “For Women”, almost all of it applies to men too—and the things that don’t apply, don’t cause a problem. So if you’re cooking for your family that contains one or more men, this is still great.
Bloom gives us a good, simple, practical introduction to gut health. Her overview also covers gut-related ailments beyond the obvious “tummy hurts”. On which note:
A very valuable section of this book covers dealing with any stomach-upsets that do occur… without harming your trillions of tiny friends (friendly gut microbiota). This alone can make a big difference!
The book does of course also cover the things you’d most expect: things to eat or avoid. But it goes beyond that, looking at optimizing and maintaining your gut health. It’s not just dietary advice here, because the gut affects—and is affected by—other lifestyle factors too. Ranges from mindful eating, to a synchronous sleep schedule, to what kinds of exercise are best to keep your gut ticking over nicely.
There’s also a two-week meal plan, and an extensive appendix of resources, not to mention a lengthy bibliography for sourcing health claims (and suggesting further reading).
In short, a fine and well-written guide to optimizing your gut health and enjoying the benefits.
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The Brain-Skin Doctor
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Of Brains And Breakouts
This is Dr. Claudia Aguirre. She’s a molecular neuroscientist, and today she’s going to be educating us about skin.
What? Why?
When we say “neuroscience”, we generally think of the brain. And indeed, that’s a very important part of it.
We might think about eyes, which are basically an extension of the brain.
We don’t usually think about skin, which (just like our eyes) is constantly feeding us a lot of information about our surroundings, via a little under three million nerve endings. Guess where the other ends of those nerves lead!
There’s a constant two-way communication going on between our brain and our skin.
What does she want us to know?
Psychodermatology
The brain and the skin talk to each other, and maladies of one can impact the other:
- Directly, e.g. stress prompting skin breakouts (actually this is a several-step process physiologically, but for the sake of brevity we’ll call this direct)
- Indirectly, e.g. nervous disorders that result in people scratching or picking at their skin, which prompts a whole vicious cycle of one thing making the other worse
Read more: Psychodermatology: The Brain-Skin Connection
To address both kinds of problems, clearly something beyond moisturizer is needed!
Mindfulness (meditation and beyond)
Mindfulness is a well-evidenced healthful practice for many reasons, and Dr. Aguirra argues the case for it being good for our skin too.
As she points out,
❝Cultural stress and anxiety can trigger or aggravate many skin conditions—from acne to eczema to herpes, psoriasis, and rosacea.
Conversely, a disfiguring skin condition can trigger stress, anxiety, depression, and even suicide.
Chronic, generalized anxiety can create chronic inflammation and exacerbate inflammatory skin conditions, such as those I mentioned previously.
Chronic stress can result in chronic anxiety, hypervigilance, poor sleep, and a whole cascade of effects resulting in a constant breakdown of tissues and organs, including the skin.❞
So, she recommends mindfulness-based stress reduction (MBSR), for the above reasons, along with others!
Read more: Mind Matters
How to do it: No-Frills, Evidence-Based Mindfulness
And as for “and beyond?”
Do you remember in the beginning of the pandemic, when people were briefly much more consciously trying to avoid touching their faces so much? That, too, is mindfulness. It may have been a stressed and anxious mindfulness for many*, but mindfulness nonetheless.
*which is why “mindfulness-based stress reduction” is not a redundant tautology repeated more than once unnecessarily, one time after another 😉
So: do try to keep aware of what you are doing to your skin, and so far as is reasonably practicable, only do the things that are good for it!
The skin as an endocrine organ
Nerves are not the only messengers in the body; hormones do a lot of our body’s internal communication too. And not just the ones everyone remembers are hormones (e.g. estrogen, testosterone, although yes, they do both have a big impact on skin too), but also many more, including some made in the skin itself!
Dr. Aguirra gives us a rundown of common conditions, the hormones behind them, and what we can do if we don’t want them:
Read more: Rethinking The Skin As An Endocrine Organ
Take-away advice:
For healthy skin, we need to do more than just hydrate, get good sleep, have good nutrition, and get a little sun (but not too much).
- We should also practice mindfulness-based stress reduction, and seek help for more serious mental health issues.
- We should also remember the part our hormones play in our skin, and not just the obvious ones.
Did you know that vitamin D is also a hormone, by the way? It’s not the only hormone at play in your skin by a long way, but it is an important one:
Society for Endocrinology | Vitamin D
Want to know more?
You might like this interview with Dr. Aguirre:
The Brain in Our Skin: An Interview with Dr. Claudia Aguirre
Take care!
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What I Wish People Knew About Dementia – by Dr. Wendy Mitchell
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We hear a lot from doctors who work with dementia patients; sometimes we hear from carers too. In this case, the author spent 20 years working for the NHS, before being diagnosed with young-onset dementia, at the age of 58. Like many health industry workers who got a life-changing diagnosis, she quickly found it wasn’t fun being on the other side of things, and vowed to spend her time researching, and raising awareness about, dementia.
Many people assume that once a person has dementia, they’re basically “gone before they’re gone”, which can rapidly become a self-fulfilling prophecy as that person finds themself isolated and—though this word isn’t usually used—objectified. Talked over, viewed (and treated) more as a problem than a person. Cared for hopefully, but again, often more as a patient than a person. If doctors struggle to find the time for the human side of things with most patients most of the time, this is only accentuated when someone needs more time and patience than average.
Instead, Dr. Mitchell—an honorary doctorate, by the way, awarded for her research—writes about what it’s actually like to be a human with dementia. Everything from her senses, how she eats, the experience of eating in care homes, the process of boiling an egg… To relationships, how care changes them, to the challenges of living alone. And communication, confusion, criticism, the language used by professionals, or how things are misrepresented in popular media. She also talks about the shifting sense of self, and brings it all together with gritty optimism.
The style is deeply personal, yet lucid and clear. While dementia is most strongly associated with memory loss and communication problems, this hasn’t affected her ability to write well (7 years into her diagnosis, in case you were wondering).
Bottom line: if you’d like to read a first-person view of dementia, then this is an excellent opportunity to understand it from the view of, as the subtitle goes, someone who knows.
Click here to check out What I Wish People Knew About Dementia, and then know those things!
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The Obesity Code – by Dr. Jason Fung
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Firstly, if you have already read Dr. Fung’s other book, The Diabetes Code, which we reviewed a little while ago, you can probably skip this one. It has mostly the same information, presented with a different focus.
While The Diabetes Code assumes you are diabetic, or prediabetic, or concerned about avoiding/reversing those conditions, The Obesity Code assumes you are obese, or heading in that direction, or otherwise are concerned about avoiding/reversing obesity.
What it’s not, though, is a weight loss book. Will it help if you want to lose weight? Yes, absolutely. But there is no talk here of weight loss goals, nor any motivational coaching, nor week-by-week plans, etc.
Instead, it’s more an informative textbook. With exactly the sort of philosophy we like here at 10almonds: putting information into people’s hands, so everyone can make the best decisions for themselves, rather than blindly following someone else’s program.
Dr. Fung explains why various dieting approaches don’t work, and how we can work around such things as our genetics, as well as most external factors except for poverty. He also talks us through how to change our body’s insulin response, and get our body working more like a lean machine and less like a larder for hard times.
Bottom line: this is a no-frills explanation of why your body does what it does when it comes to fat storage, and how to make it behave differently about that.
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Meningitis Outbreak
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Don’t Let Your Guard Down
In the US, meningitis is currently enjoying a 10-year high, with its highest levels of infection since 2014.
This is a big deal, given the 10–15% fatality rate of meningitis, even with appropriate medical treatment.
But of course, not everyone gets appropriate medical treatment, especially because symptoms can become life-threatening in a matter of hours.
Most recent stats gave an 18% fatality rate for the cases with known outcomes in the last year:
CDC Emergency | Increase in Invasive Serogroup Y Meningococcal Disease in the United States
The quick facts:
❝Meningococcal disease most often presents as meningitis, with symptoms that may include fever, headache, stiff neck, nausea, vomiting, photophobia, or altered mental status.
[It can also present] as meningococcal bloodstream infection, with symptoms that may include fever and chills, fatigue, vomiting, cold hands and feet, severe aches and pains, rapid breathing, diarrhea, or, in later stages, a dark purple rash.
While initial symptoms of meningococcal disease can at first be non-specific, they worsen rapidly, and the disease can become life-threatening within hours. Immediate antibiotic treatment for meningococcal disease is critical.
Survivors may experience long-term effects such as deafness or amputations of the extremities.❞
~ Ibid.
The good news (but still don’t let your guard down)
Meningococcal bacteria are, happily, not spread as easily as cold and flu viruses.
The greatest risks come from:
- Close and enduring proximity (e.g. living together)
- Oral, or close-to-oral, contact (e.g. kissing, or coughing nearby)
Read more:
CDC | Meningococcal Disease: Causes & How It Spreads
Is there a vaccine?
There is, but it’s usually only offered to those most at risk, which is usually:
- Children
- Immunocompromised people, especially if HIV+
- People taking certain medications (e.g. Solaris or Ultomiris)
Read more:
CDC | Meningococcal Vaccine Recommendations
Will taking immune-boosting supplements help?
Honestly, probably not, but they won’t harm either. The most important thing is: don’t rely on them—too many people pop a vitamin C supplement and then assume they are immune to everything, and it doesn’t work like that.
On a tangential note, for more general immune health, you might also want to check out:
Beyond Supplements: The Real Immune-Boosters!
The short version:
If you or someone you know experiences the above-mentioned symptoms, even if it does not seem too bad, get thee/them to a doctor, and quickly, because the (very short) clock may be ticking already.
Better safe than sorry.
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