Surprised by no therapist / counselor in AL / MC

SEM_BOS

My mom's recently become aware enough of what's going on that she knows shes in MC, and she knows she's confused/sick and having memory problems.  So now she's getting depressed and scared.

I'm really surprised there are no therapists or social workers on staff at these places.      I've spoken to some of the nurses with industry experience and they pretty much agreed with me. 

I know we could find a therapist to bring her to, or possibly one who'd visit her, but someone who could see her daily interactions would probably be a lot more helpful.  Plus, I already take her to so many medical appointments that we're both sick of those trips.

So I'm not expecting a real solution here, but curious if any AL's have therapists?  And if not why? Is  it just a budget thing?

SM

Stuck in the middle

I don't think many people with severe memory loss could benefit from therapy.  Antidepressant meds can be a blessing, though.

Iris L.

Seventy per cent of PWDs have anosognosia, so traditional therapy won't help them.  For those who are aware of losing their cognition and memory and independence, IMO, what they need is not available.  They have a terminal illness.  No one helps with that. 

I am responding as a person with cognitive impairment who fell into a deep depression in the beginning when I was confronting the possibility of having Alzheimer's Disease.  I consulted a psychologist who works only with seniors over sixty years.  I told her the only thing I was depressed about was having Alzheimer's Disease.  She discounted my fears!  She told me I couldn't have AD because I was too aware!  She did absolutely nothing constructive to ease my distress and depression, although I saw her weekly for over a year.  The only relief I gained was from reading the posts here on these message boards.  In those days, there were more patients posting.  I gained confidence and acceptance from reading caregiver posts, also from personal communication with certain caregivers.

My suggestion, is that along with whatever medication you try, work to assure your LO that you are there for her, and that she won't be abandoned or mistreated.  Learn a new way of communication and adjust as she changes.  That's all I can think of now.

Iris

GothicGremlin

I'm also of the mind that a therapist wouldn't be able to help, particularly with someone who is in memory care.

Your mom sounds like my sister, Peggy. She knows she's in memory care, she knows she needs to be there, she even knows she has early onset Alzheimer's. What she doesn't know anymore is just how compromised she is at this point. If we brought in a therapist, two minutes after the session ended she'd forget who the therapist is, why he/she was there, and even what they talked about. I think this is probably the norm.

What we did do though - Peggy also told me that she's scared. She said she was afraid all the time, so afraid that she couldn't do anything. She couldn't tell me what she was so afraid of - it's all just part of the Alzheimer's, but I didn't say that to her. I discussed this with her doctor who prescribed an anti-depressant. So far the anti-depressant is working.

And I agree with Iris -- "...work to assure your LO that you are there for her, and that she won't be abandoned or mistreated.  Learn a new way of communication and adjust as she changes."  Yes, yes, yes.  I always let Peggy know that I'm there for her and I won't abandon her. I also remind her that she has wonderful devoted friends (very true) who also visit her often and care very much. This all goes a long way.

harshedbuzz

SM-

I am absolutely gobsmacked that you know nurses with industry experience who believe there should be therapists working with people who have dementia. 

As Iris pointed out, many PWD have anosognosia which is a condition in which a person is unable to appreciate that they've had a cognitive shift. This would make it difficult to understand their condition and take active steps to identify when to implement new ways of thinking. And as SITM said, given their short-term memory issues, it would be difficult for them to learn the strategies in the first place. Additionally, the tendency of some PWD to conflate situations would make it difficult for them to take the kind of ownership needed to see one's role in a situation and make changes. 

That said, many good hospitality-model CCRC do have a social worker on staff who might be able to work with a person who is in the MCI/earliest stages of dementia. Many MC communities have an affiliated geriatric psychiatrist who can address depression pharmacologically. Carefully tweaked psycho active medication improved the quality of dad's life tremendously.

Dad was able to see a geriatric psych in-house; prior to that we took him to see a geripsych as part of his routine care. IMO, the geripsych was the most important member of dad's medical team-- we continued visits with him long after we'd moved to a more palliative approach and ceased most of his specialist-care.

One thing to consider if your mom is in early stages in an AL that is not high acuity memory care is that she probably can't "keep up" with other residents in the facility and that could be making the situation worse. My aunt was placed in an AL when she was a better candidate for MC. She had trouble with their planned activities and keeping up conversationally with the other ladies who began to shun her. 

Another thought would be increasing the visits your mom gets. A number of the residents at dad's MCF had a few visits a week from the HHA who assisted them before they went into MC. These were more social visits in nature and were often arranged by families who couldn't visit as much as they might have wished.

HB

Rescue mom

My mom was in MC for years, in two states, I’m now looking again (more facilities here, now) for my DH with Alzheimer’s. None had or have a therapist on staff, and I cannot see how it would help much at all.

 Unless they are in very early stages, most residents don’t have the functioning abilities to benefit from counseling. They forget what was said; cannot put “two and two together” or draw conclusions/outcomes of various behaviors. 

Nor understand how doing one thing can help (or hurt) something in the future. They don’t understand two-step, cause-and-effect and effect.  They have simply lost the ability to think that way. To expect them to think/reason  like that now is like giving a newly blind person a book and thinking they can read it because they used to read.

Some facilities do have social workers who encourage residents to socialize or do activities, or provide some companionship, (many private aides do the same, more dependably) or help the families deal. 

Many residents benefit from meds such as anti-depressants and anti-anxiety. I took my DH to a Geriatric Psychiatrist to get an Rx for Seroquel; the psych. asked some questions that were more about assessing DHs state of mind.  The geriatric psych. use was to prescribe the more serious drugs, not for any sort of “talk therapy.”

Like someone said, I’m curious about the “nurses” experience/backgrounds who seemed to agree with you about therapy…sometimes it’s seemed to me, some staff also may overstep to try to seem agreeable with family.

Quilting brings calm

At this point, most ALs are struggling to keep an LPN weekdays to manage the medications, coordinate with residents’ doctors etc.    There is usually an executive director, office manager, activities person, housekeeping,maintenance, cook, and a few resident  assistants there  24/7.  More during the day to help serve meals, etc- Fewer at night and weekends.   That costs $5200 monthly for my parents( lower than most ).  Where would they get a counselor, and how much would it raise the residents’ rent?  

My mom ( mild dementia) was struggling last fall with issues between her and  my step-dad ( undiagnosed, and also just not a nice person). Their doctor ordered home health for a few weeks. That got her an evaluation, a weekly nurse visit, physical and speech therapy and a social worker visit.  None of that really helped because she forgot about it by the end of the day.  It did however give her a warm body  to talk to temporarily. 

What I want more than anything is for Medicare to require the doctor to assign  a social worker/ case manager upon diagnosis to be there to support and advise the family.  to help determine level of care needed, help find that care and help  with the applications for financing that care( VA,  long term care policies, Medicaid, etc).  

MN Chickadee

Neither of our two facilities had therapists, one had a social worker but she did more logistical stuff than counseling. The chaplain did some work with people but it was more just visiting and reminiscing. None of the residents would have benefited from traditional therapy. Usually pharmacological interventions are more successful with dementia, and interventions that are more "in the moment" than therapy. Validating their feelings, redirecting, encouraging participation in activities, reassuring you are there for them and will take care of whatever they are worried about. Of course with memory issues this is a loop and you are repeating it constantly. If your LO is depressed and scared I would consult her doctor, that is no way to live. If it's persistent or difficult to treat bring in a geriatric psychiatrist. The facility may have one they work with. Many times the right meds can be found to feel good, make care more possible, and have a higher quality of life.