Making the decision to place your loved one in a Nursing Home can be very stressful. You may feel guilty about the decision, but you may also feel like you have no other choice. For persons suffering from difficult diseases which require 24-hour care, it can be necessary. There is no shame in making this decision if it is your best or only option for your loved one.
In the Caribbean, Nursing Homes are a recent trend. With the increase of older persons across the region, they have been popping up to fill the need for elder care. However, it's happened very quickly and Caribbean governments have not yet implemented policies to govern nursing homes. This means that they are widely unregulated and unfortunately, many are not appropriate or well-run.
For example. in Trinidad, there is no legal requirement for homes to provide a certain number of staff to patients. There is also no legal requirement that Nursing Home Staff have adequate qualifications. It is therefore very important to do your own research when choosing a home. The guidelines below are meant to help you make the best decision available to you and have been adapted from a UK organisation, Unforgettable.org.
But bear in mind that the Caribbean still has a long way to go in providing formal, holsitic care for older persons. You are unlikely to find an ideal, affordable care home but you can find a home that is appropriate and well suited to your loved one.
'...they are widely unregulated and unfortunately, many are not appropriate or well-run. It is therefore very important to do your own research when choosing a home'
Visit more than one home
Treat each visit as if you’re shopping around for a new house and choosing a good school for your children – at the same time. You're not only looking for a sturdy, safe building and convenient location, but for warm, qualified, caring staff to look after someone you love and who may, in many respects, be as vulnerable as a child.
Questions to ask the manager/staff:
'If the manager hesitates, is unable to provide first and last names, or clear roles for staff, this is a sign of a home with an inadequate care team...'
Before making a decision:
• If possible, take the person, especially if thay have dementia, to see the home before hand. Ask any other friends or relatives, whose opinion you’d value, to visit, too.
• Drop in again – this time unannounced and at a different time of day if possible. Staff should still welcome you if they have nothing to hide.
After making your decision:
Understand that moving your loved one to a care home can be a difficult transition at first. They will need time to adjust and settle in. Once you choose a home, try to work with staff to ensure that your loved one is comfortable as far as possible. Your job as a loving caregiver to your relative does not end when you place them in a home. Instead, you are now part of a bigger team to help care for your ageing relative.
As a psychiatrist, I get questioned about the medications I prescribe all the time. People often Google and research the medication I give them. What they find might really worry them.
First of all, doing your research and asking questions about your medication is an excellent practice, once you use a reputable website such as www.mayoclinic.org or www.alzheimers.co.uk. It is important to know what a drug is being prescribed for, what the side effects are, if there are any risks, and how long you should take the medication for.
It's easy to think that drugs prescribed by a psychiatrist that effect your brain can be more dangerous than drugs perscribed by another specialist or GP. But this is not true. Some GP's prescribe psychiatric drugs. Other doctors might not properly explain what they are prescribing or why. It is up to you to make sure that you ask the right questions before you leave their office. Taking too many medications at the same time can be dangerous, unnecessary and expensive. So make sure that you and your doctor agree that each and every medication prescribed is absolutely necessary.
It is important to know what a drug is being prescribed for, what the side effects are, if there are any risks, and how long you should take the medication for.
But just because a medication is necesary does not mean that it will be perfect. So you need to look at the benefits over the risks and understand that it might be the best decision for you or your loved one, despite what you might find in your research,
For example, Antipsychotics have been shown to increase the risk of many things in people with Dementia including stroke, pneumonia, falls, sedation and death in extreme cases. Sounds terrifying, I know. But as a psychiatrist, it is my job to find the best and safest antipsychotic to treat extreme agitation and agression in persons with Dementia. In many cases I choose a drug named Risperdal because it works well and is specifically santctioned to help people with dementia.
Whenever I have Dementia patients with aggression or agitation, I recommend other tactics first, such as paying attention to any physical health problems that may be causing their agitation. Apart from this, the person's environment should be calm, peaceful, comfortable and cool. Most importantly, they should be receiving good nursing care. This is a real challenge in the Caribbean because many of the nurses or caregivers have very limited experience or training with Dementia patients. But in my opinion, when it comes to Dementia, having an excellent nurse is far better than any medication.
Whenever I have Dementia patients with aggression or agitation, I recommend other tactics first, such as paying attention to any physical health problems that may be causing their agitation...and the person's environment.
But the reality is that often I get calls from families saying that they simply cannot cope. Often times, local Nursing Homes threaten to throw Dementia patients out if their aggressive behaviour cannot be controlled. This is not pleasant, but this is what happens. So when the agitation is severe enough, I take on the risk of prescribing low doses of Risperdal (0.5mg to 1 mg daily) which in my experience helps with aggression and agitation, but are unlikely to cause harm at such a low dose. (The maximum dose of Risperdal is 16mg, or 32 times the dose I prescribe).
So in the end, sometimes antipsychotics, although dangerous in large doses, can be safely given to persons with Dementia who absolutely need it. But first, be sure to talk to your doctor, try to improve your loved one's behaviour by attending to their physical needs and environment and ask your doctor for the lowest possible dose to start off with in order to decrease the risks of the medication.
Remember- these guidelines apply to any medication for any condition- not just dementia. For our T&T clients, Age Caribbean will be hosting a seminar on Medication Management in January 2017. Check our Seminars page to learn more and keep educating yourself about elder care.
Christmas time is here again. Treat yourself or your loved one with a gift that will make ageing a bit easier. If you know someone who is struggling with daily tasks because of reduced mobility or athritis, then one of these 5 items can really make their life, and the life of their family members, much easier.
Scroll to the bottom of the page to complete the order form for any of these 5 items via our partners at Care Safety Solutions Ltd.
(All prices provided are inclusive of VAT and shipping.)
#1.- Self-Standing Cane with Light - from SteadyCane ($385.00 TTD)
I hurt my foot recently and used crutches for a while. It's extra dangerous to walk into a dark room if you have a walking stick or crutches. Not to mention, it can be hard to find somewhere to lean them up when you're not using them. This walking stick: stands up by itself, is foldable for easy transport, has a wrist strap to help you hold it easily, is height adjustable for short people like me and has a bright LED Light to help you see where you're going.
#2- Automatic One Finger Can Opener ($400.00 TTD)
If you have athritis, a shoulder injury or if you are just fedup of struggling with big, heavy can openers, this one is for you. Just place the Automatic Can Opener on top of the can, press the button and the can will be open in seconds. A little extra help in the kitchen is always useful.
#3- Car Caddie- to help you get in and out of the car easily ($485.00TTD)
Seniors who may not move as briskly as they used to might need a little extra support to get in and out of a vehicle. The Car Caddie is a sturdy and easy to reach device to help get you to a standing or sitting position. It can help reduce the likelihood of pain and falls when entering or leaving the car.
#4- Portable Fall Alert for Cane, Walker or Wheelchair ($750.00TTD)
Falls are serious business. They can lead to head injuries, broken bones and a decrease in somebody's confidence. Help prevent falls with an alert which attaches to a walker, wheelchair or cane. If the walker, cane or wheelchair tips past a 30 degree angle, the alarm sounds. This can also be used as a PANIC alert system that is in easy reach if someone is in danger.
#5- Door knob Gripper (pack of 2) ($350.00TTD)
Only when we get older do we realise how difficult little things like opening a door can be. But for people with limited dexterity or mobility, turning a smooth, round door knob can be very frustrating. The door knob grip cover gives you something to hold on to and makes it easier to use slippery doorknobs. It's also quick and easy to install and even easier to use.
So there you go. 5 gift ideas for mom or dad, granny or grandpa, or even just for you. Remember, there are many useful gadgets specially designed to make getting older safer, easier and more enjoyable.
Follow Age Caribbean for more updates and advice on age-friendly services.
Dr James Bratt, Lead Consultant at Age Caribbean and Geriatric Psychicatrist.