Why Go If My Loved One Can’t Remember My Visit?

By Carol Combs, MSW, Oxford’s Memory Care Coordinator

When a loved one has Alzheimer’s disease, it changes the way friends and family interact with the person. Knowing what to say, or even how to act, can be challenging. The individual may not remember those who come to visit or remember prior visits.

When visiting a loved one with Alzheimer’s you may hear questions such as, “Why don’t you ever visit?” or “Who are you?” Such questions, as well as behavioral changes that accompany the disease, can make visiting difficult and uncomfortable.

However, there are some things you can do to help ease the discomfort and make your visit more pleasant for you and your loved one.

  • Focus on feelings – the content of the conversation doesn’t matter. The feelings and sense of contentment created will make a difference. Emotion lasts longer than memory. The emotion resulting from a positive visit can improve a person’s mood and influence the rest of the day.
  • Accept the person’s reality- don’t correct your loved one, just go along with it. If the person insists the grass is blue, agree. Telling the individual it’s really green can create agitation. Instead, offer reassurance and distraction.
  • Introduce yourself- avoid saying “Don’t you remember me?” because if the person doesn’t, it can be embarrassing. Introduce yourself with “Hi Mom, this is Susan.”  Save her the embarrassment or awkward moment.
  • Be respectful- don’t talk to Alzheimer’s patients like they are children. They have a lifetime of experiences, so show them the respect they deserve.
  • Bring an activity – long-term memory is often still intact. Reminiscing with pictures or photo albums can be comforting and encourage conversation. Play music or sing. Consider Music Therapy. Music can stir positive emotions, and individuals may be able to remember lyrics even though their ability to communicate has declined. Exercise improves brain circulation. Encourage movement of arms and legs, or toss a beach ball. Introduce your loved one to a GeriJoy Companion, a special tablet which provides social interaction, helps decrease loneliness and has shown remarkable success with Alzheimer’s and dementia patients.
  • Touch – hold a hand, stroke hair, hug. Touch is a powerful way to communicate when words fail. People with dementia recognize a caring touch, even in the late stages of the disease.
  • Minimize distractions – it will be more difficult to have a meaningful visit if there is too much noise or activity. Over stimulation can cause agitation. Try to find a quiet place or take a walk outside.

If you know someone with Alzheimer’s and are hesitant to visit, remember that the benefit of your visit may last long after you’ve gone.

For additional support or information, contact Oxford HealthCare. Oxford offers numerous programs that provide the help and relief you need—so you can enjoy time with your loved one and continue to provide care at home. For your peace of mind, advanced technology like Lifeline and GeriJoy helps provide added security when you can’t be with your loved one. To find out more about all Oxford has to help families, contact a Care Coordinator, today.




November is National Hospice Month and National Alzheimer’s Awareness Month

By Elizabeth Lee, RN, BA, CHPN Oxford’s Hospice and Palliative Specialist and Carol Combs, MSW Oxford’s Memory Care Program Coordinator

Hospice is a wonderful and caring option for people who are facing end of life illness. The primary goal of hospice care is to help maintain the highest quality of life in the last stages of an illness.

Hospice serves individuals with any terminal illness, including Alzheimer’s disease. The Hospice Interdisciplinary Care Team includes the physician, nurse, social worker, chaplain, aide and grief services. This team works together with the patient and family to help manage the unique needs of end stage Alzheimer’s disease and other related dementias.

Hospice focuses on comfort, support and managing pain rather than providing treatment. People with Alzheimer’s disease become more disabled over time; and with advanced dementia, individuals can no longer communicate their wants and needs. Focusing on the senses—touch, hearing and sight—can bring comfort when verbal communication cannot.

An Alzheimer’s patient could be eligible for Hospice care if they:

  • Are unable to ambulate without assistance
  • Are unable to dress or bathe without assistance
  • Are unable to swallow
  • Are unable to speak or communicate meaningfully
  • Have urinary and fecal incontinence
  • Have UTI’s (urinary tract infections), decubitus ulcers and/or aspiration pneumonia

The end of life path of hospice patients can be divided into one of three typical patterns:

  1. A short period of obvious decline at the end (typical for most cancers)
  2. Long-term disability with periodic intensification and unpredictable timing of death (typical for a patient with chronic organ system failure)
  3. Steadily declining function with a slowly dwindling course to death (typical for a patient with frailty, dementia or Alzheimer’s)

End of life decisions become more complicated if wishes have not been or cannot be expressed by the dying person. Families then have to speak for the person based on their knowledge of the individual’s values and beliefs.

What is the current quality of life, and how will the on-going treatment potentially impact quality of life?

Patients and families need to understand benefits versus burdens before treatment continues or is introduced. This requires truth telling and explanations in a language the patient and family are able to understand.

Family members caring for a dying loved one with Alzheimer’s often express relief—for the patient and themselves—when death comes. It is important to understand that these feelings are normal.

Hospice can help the patient and caregiver deal with the challenges faced in the patient’s final months, and offer grief support both before and after the loved one dies. Hospice helps ensure the highest quality of life while being treated with dignity and respect.

For more information about Oxford’s Hospice or Memory Care Programs, please contact one of our Care Coordinators, today.


Are you caring for someone with Alzheimer’s disease or dementia?

Oxford HealthCare’s Memory Care Program Presents:

Coping with Caregiving


This free event will be held Tuesday, June 9th from 10 a.m.-12 p.m. at the Library Center, 4653 S. Campbell, Springfield.

The program will focus on learning strategies for managing the challenges of caregiving, reinforcing coping skills and obtaining resources to assist in providing care at home.

Register at: memorycare@oxfordhealthcare.net by June 5, or call 417-883-7500.

Dementia affects the entire family, and there will be ongoing changes and challenges. Oxford HealthCare will be there to help. Our Memory Care program offers an innovative and compassionate approach to finding solutions to the challenges you and your loved ones face.

If you have concerns or questions, please contact our Memory Care program coordinator at 417-883-7500.


Can I Keep My Promise? A Caregiver Dilemma.

By Carol Combs, MSW, Oxford’s Memory Care Program Coordinator

If you are a caregiver of a loved one who has Alzheimer’s or a related dementia, you desperately want to keep your loved one at home and you are committed to doing so.  Most likely you made a promise, and you feel a duty to provide care.

I can’t even begin to add up the number of times I have heard people say to me, “I promised I would never place my loved one in a nursing home” OR “I promised that I would always be the one to take care of my loved one.”

The promises you made may be impossible to keep. Here are some signs and circumstances that despite your best efforts as a caregiver, a change may need to take place.

  • You or your loved one has had a serious illness, injury or hospitalization.
  • You’ve hurt your back or fallen when trying to lift or move your loved one.
  • Your loved one has progressed to the point where he/she hurts you, exhibits frequent anger or other challenging behaviors.
  • Your loved one has wandered outside and become lost.
  • Your own health is declining.
  • Your relationships are suffering.
  • You are not able to keep up with your other responsibilities.
  • Your loved one’s doctor has recommended placement.
  • Your loved one requires more care than you can provide.
  • You don’t think you can financially afford to hire the additional care needed at home.
  • Friends and family express concern for you and encourage you to consider placement.

Keep in mind, if your own physical or emotional well-being is suffering, you may soon be unable to provide the care and support needed by your loved one.

Seek information and support and look at ALL of your options before making a decision. Planning ahead to know what your options are can help you be there for your loved one as you continue to offer the love and support needed during this challenging journey.

What are your options?

A home care agency such as Oxford can provide a wide range of home care services to assist and help keep a loved one at home. An Oxford Care Coordinator can assess your situation, make recommendations, and identify sources of payment to meet your needs. They can also arrange for services if requested to do so. Oxford services such as Hospice and Private Duty can also be provided in facilities.

If home care is no longer feasible, it may be time to consider a facility placement.   Sometimes, the next appropriate step is an Assisted Living facility before a nursing home is needed.   An Assisted Living facility provides care for someone who can no longer live independently and needs some assistance in day-to-day living but does not need the more skilled level of care offered by a nursing home.

The nursing home provides 24 hour skilled nursing care for the more chronically ill. Both types of facilities will often have a designated unit for dementia care.

A stay at either type of facility can sometimes be short term for recuperation or as respite, and the person can then return home with home care.

If you have questions about the appropriate level of care your loved one may need, an Oxford Memory Care Coordinator can assist you.

If you are considering a facility placement for your loved one, the following links have helpful information.



Communicating With Someone Who Has Alzheimer’s Disease

Keep it Simple, Smile (KISS)

By Carol Combs, MSW, Oxford’s Memory Care Program Coordinator

As humans, we are communicating from the time we are born. Alzheimer’s disease and related dementias can gradually diminish the ability to communicate as the disease progresses. That person’s ability to express thoughts and comprehend what others are saying can be affected. Individuals with Alzheimer’s or dementia may forget words, invent words or use familiar words repeatedly. They may lose their train of thought and become frustrated at not being able to express themselves.

Communicating with memory-impaired individuals presents challenges, but there are some techniques that you can learn to ease understanding.

  1. KISS (Keep it Simple, Smile)A smile can communicate when words cannot. A person with Alzheimer’s or dementia understands a smile and the feeling behind it. Social skills remain intact when language fails so a handshake, greeting, pat on the back or holding hands are ways to communicate without a lot of words. Touch is the most basic form of human connection.
  2. Speak Slowly and ClearlyIt takes much longer for a person with dementia to process what has been said. Use short, simple sentences and maintain eye contact. Give them time to respond. If they do not understand, repeat with the same tone and facial expression and change key words if necessary.
  3. Tone of VoiceAs a caregiver, it is sometimes common to revert to a parental role, which can come across as condescending and disrespectful. Communicate in a pleasant, patient and unhurried manner. People with Alzheimer’s or dementia are aware of nonverbal cues such as facial expression, stance, tension or mood and may react similarly. If you are impatient, anxious, or frustrated, they are likely to become annoyed or agitated.
  4. Use One Step DirectionsBreak down tasks and instructions into clear, simple steps. Do the activity with them such as brushing teeth so they can mimic the task.
  5. Offer Praise and EncouragementFor the person who is gradually losing the ability to perform basic activities, it is important to maintain feelings of success and self-esteem. Use phrases like “You’re doing fine”, “Good job”, “You look very nice”, and ‘’Thank you”.
  6. RephraseAvoid vague words – Instead of “Here it is”, try “Here’s your hat”.
    Turn a negative into a positive – Instead of “Don’t go there” try “Let’s go here”.
    Provide the solution rather than the question – Instead of “Do you need to use the bathroom?” try “The bathroom is right here”.
    Avoid open-ended questions – Instead of “How many children do you have?” try “What was it like to raise 5 boys?”
    Ask yes/no questions – Instead or “How do you feel?” try “Are you tired?”
    Limit choices – Instead of “What do you want for lunch?” try “Would you like chicken or fish?”

Most importantly, treat them with dignity and respect, regardless of how difficult communication becomes. The person with Alzheimer’s or dementia can understand nonverbal communication and humor longer that they can understand spoken communication. Even when the person is unable to communicate, they need affection, which you can communicate through touch.

If you have questions or concerns our Memory Care Program Coordinator would be glad to assist you.  Additional information is also available through the Alzheimer’s Association.

The Stages of Alzheimer’s

By: Carol Combs, MSW, Oxford’s Memory Care Program Coordinator

Don'sBackyard_Faded_pathAlzheimer’s disease is an irreversible, progressive brain disease causing a slow decline in memory, language, reasoning, judgment, and daily functioning. It typically develops gradually and worsens over the course of several years. This progression is often referred to as stages, but not everyone will experience the same symptoms at the same rate. There are common patterns of symptom progression and a person’s abilities will change through the course of the disease.

Stages are typically referred to as early, middle and late or mild, moderate and severe. It is important to recognize these stages are a rough guide based on averages; each stage could be as brief as a year or as long as ten years. The stages can help patients and families understand what they might expect and plan accordingly.

Early stage symptoms

  • Increased forgetfulness, memory loss for recent events
  • Poor concentration
  • Repetitiveness: telling the same story over and over
  • Difficulty with word finding, expressing thoughts
  • Difficulty with decision making, problem solving or complex tasks
  • Misplacing objects or getting lost in familiar places
  • Mood or personality changes, less tolerance
  • Slower to react or learn something new
  • Needs support/supervision to continue living alone

In the early stage, most people can still live alone and carry out daily tasks, but may need assistance with finances, appointments, meal planning or cooking. This is a good time to organize and simplify daily routines and assess the home for safety. Depression and withdrawal from social activities is not uncommon in this stage and the person may try to hide the memory losses he/she is experiencing.

Middle stage symptoms

  • Increased memory loss, may not recognize family
  • Communication difficulties
  • Problems with reading, writing and numbers
  • Loss of impulse control, poor judgment
  • Difficulty with dressing, bathing, toileting
  • Aggression as a response to frustration
  • Inappropriate behaviors including resisting care, agitation, wandering
  • Delusions or hallucinations
  • Abnormal sleep/wake cycles
  • Needs full time supervision

In the middle stage, the patient may be more unpredictable and daily activities will be more challenging. Inability to perform tasks such as cooking and driving may lead to unsafe situations. At this stage, many will need full time supervision to remain in their home. Behaviors such as suspicion, wandering, resisting care, agitation and sleep disturbance may be displayed. Frustration is common because the person cannot make sense of the world around them. The behaviors are not intentional and are best dealt with by staying calm, using redirection or distraction, reminiscence and reassurance.

Late stage symptoms

  • Needs to be bathed, dressed, fed, turned
  • Loses ability to verbalize; may yell, groan or grunt
  • Loss of bodily functions, incontinent
  • Flat affect; where their faces show very little emotion
  • Unable to recognize others or themselves
  • Immobility
  • Appears apathetic, lethargic
  • Requires total care, may be appropriate for nursing home placement

With the increased cognitive losses, the patient will become calmer; less distressed by the changes happening to them and appear more apathetic.  Physical losses increase with incontinence, immobility, diminished speech and inability to perform any daily functions.  Physical wellbeing and comfort care become the primary concern. When the patient reaches this final stage additional in-home care including Hospice care may be needed to assist the caregiver.

In all stages, family and caregivers need to obtain available in-home care, seek support, utilize community resources and ensure that legal and financial affairs are in order.

If an individual has not been diagnosed with Alzheimer’s but is displaying any of these symptoms, he or she should seek a medical assessment promptly. If you have questions or concerns our Memory Care Program Coordinator would be glad to assist you.  Additional information is also available through the Alzheimer’s Association at www.alz.org.