10 May 2009
Dear Readers,
I recently had the opportunity to hear the renowned educator and advocate, Dr. Bill Thomas, speak. Dr. Thomas is the innovator for models of alternative nursing home care called the Eden Alternative and the Greenhouse Project. He had a timely message for caregivers that I’d like to pass along.
He stressed that in this climate of economic turmoil, it is important to take the time to reassure our elders that they are not the cause of our worry. Many either fear being a burden or feel they are burdens to their families and, especially now, their fears and feeling are magnified. So, let’s make it a habit each day to spend time telling them how much they mean to us.
Dear Mary,
After reading your article in the April 12th edition of the Sunday Capital, I felt it might be of interest to know that my wife has a doctor who comes to our home. He has a great bedside manner and takes the anxiety out of having to wait in a doctor’s office.
As always, I will continue to read your column.
Dear Reader,
Thank you for this valuable information. Yes, there are physicians in the county who make house calls. When calling to set up an appointment, ask if they bill Medicare, or any other insurance you have, directly. If they don’t, you will be asked to pay upfront and get reimbursed. It’s a good idea to contact your insurance carrier in advance to see if indeed they will reimburse you. Readers can call the Maryland Access Point (MAP) at 410-222-4257 for a list of physicians and more information.
Dear Mary,
Last week I noticed my father was holding his arm close to his body and, upon looking, I found a large bruise on his elbow. When I touched it he winced but couldn’t tell me how badly it hurt or when it happened. He has Alzheimer’s disease and doesn’t communicate verbally any more. What signs should I look for to know he’s in pain.
Dear Reader,
The inability to verbally communicate coupled with the normal diminished pain sensitivity that occurs with aging puts someone with dementia at risk for serious injury.
Pay attention to facial expressions, change in behavior, and body language - such as your father exhibited with guarding his arm.
I’ve had several experiences with this kind of scenario and one that really stands out is a gentleman I saw a few years ago. Upon physical exam I discovered he had a very bruised and swollen big toe. According to his daughter, he had not “voiced” any discomfort; however, she did notice he wasn’t walking as much, something she accepted with relief since he was a wanderer. An x-ray revealed he had broken it. This person’s change in usual behavior was the clue that something was not right.
Grimacing or furrowed brow is an indication of pain or worry and the caregiver has to play detective to determine which it is. You certainly should ask the person if he is in pain and then tell him to “show me where it hurts”. If he is worried, observe the environment and think about what might have precipitated it.
As caregivers of severely disabled loved ones they depend on us to be their eyes, ears, and mouths. It is important to pay attention to subtle cues and watch for change in, or development of new, behavior patterns.
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