Reaching out can ease burden of Alzheimer's

Q: My mother has Alzheimer's, and my dad does his best to care for her, but he's struggling. Why does she ask the same questions over and over? Why can't she remember things they just talked about? Why does she go ballistic over nothing? Are there books — or better still, classes — available to help him learn about this terrible disease?

A: Nothing in life prepares us to care for someone with Alzheimer's disease (or any other dementia). "It's like dealing with a large toddler who's drunk," a caregiver who specializes in dementia once told me.

Take the headstrong contrariness of a 2-year-old, mix in wildly poor judgment and inexplicable anger, then add liquor — there's an apt description. Yet, because the person still looks the same, it's difficult to understand that the brain is changing — thereby changing the way he or she thinks, reacts and behaves. The person is no longer the same one he or she was for 75 or 80 years, because the disease comes like a thief in the night, erasing the personality. Slowly robbed of intelligence, the person does goofy, dangerous things.

And always there is the repetitiveness, asking the same questions continually. In time, he or she stops being able to talk, walk or control going to the bathroom. Death can take 10 to 15 years. Not only is Alzheimer's the most expensive chronic illness on earth, but it's one of the cruelest. My mother died of it almost two years ago today.

There are three things you should do if someone you love has Alzheimer's or another dementing illness:

• First, learn everything you can about it. Because dementia is so unlike anything you will ever experience and lasts so many years, the quality of your care — and your sanity — will be enormously improved if you know what you're doing.

• Second, don't do it alone. Get help from other family members, friends, paid caregivers, experts.

• Third, make sure the people you hire to provide care at home — or in a facility your loved one moves to — have dementia training. Good care requires understanding how to deal with difficult behaviors that people with dementia present. It doesn't come to us naturally; we have to learn it.

A terrific place to go for all three is the Alzheimer's Association. Serving Western and Central Washington, the office in Seattle is a "one-stop shop," providing pamphlets and articles, a newsletter, videos, support groups, book recommendations, social workers and a 24-hour-a-day help line.

"We also offer a free two-part educational series about Alzheimer's for families and people who work in the field," says Sue Schepp, RN, the education director.

The first class, "Introduction to Alzheimer's and Dementia," lays the groundwork. The second, "Tips for Communication & Behaviors," teaches skills to deal with problem behaviors. The classes are held in many different locations. For information, call 206-363-5500 or 800-848-7097, or go to www.alzwa.org.

Q: My folks live part of the year in New York, part of the year in Florida. My mother has many health issues, including dementia, and my dad wants us to bring her to Seattle if he dies first, to be near family. Will one durable power of attorney for finances and health care work for all states, or do we have to somehow get one in every state she might end up in?

A: The answer to this increasingly common dilemma is, "maybe — but probably not." Durable powers of attorney (DPOA) for health and finances are two of the most important documents every adult (not just older ones) needs, enabling someone you trust to pay your bills and make health choices for you if you become mentally incapacitated.

Unfortunately, each state has its own rules.

"The best plan," says Allison Feher, legal director of King County's Senior Rights Assistance Program, "is to prepare these documents according to the state or states you think you will be living in."

While there are no guarantees, planning documents that are executed according to the laws of one state will usually be honored in another.

As an extra precaution, you can have them witnessed and notarized.

But, says Feher, the issue might be a molehill, not a mountain. "We're not hearing from families that the planning documents they signed elsewhere aren't being honored here."

For copies of DPOAs suitable in Washington, call Senior Rights Assistance at 206-448-5720 in Seattle. You can also find them online at www.seniorservices.org, then go to "Senior Rights Assistance."

Liz Taylor, a specialist on aging and long-term care, counsels individuals and teaches workshops on how to plan for one's aging — and aging parents. E-mail growingolder@seattletimes.com or write to P.O. Box 11601, Bainbridge Island, WA 98110.