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Dealing with dementia poses challenges for Alabama family

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DECATUR, Alabama — Nita Lawrence always wore clean, freshly pressed clothes.

"She never would've worn clothes with a stain," said her daughter, Kim Lemmond.

About four years ago — 10 years after her husband, B.J. Lawrence, died — Lawrence started to forget her clothes were dirty. Sometimes she would take three showers a day because she didn't remember the previous one.

"She says, 'Her forgetter is the best thing working for her,' " Lemmond said.

Lawrence, 84, has dementia, a general term for a group of cognitive disorders usually associated with memory impairment.

The most common cause of dementia — Alzheimer's disease — affects more than 5 million Americans each year. Of the 5 million Alzheimer's sufferers age 65 and older in the United States, 3.2 million are women and 1.8 million are men.

Doctors say dementia is a disease that cannot be prevented or cured. The challenge for family members is to find or provide proper care.

Lemmond, of Hartselle, and her three siblings have been caring for their mother the past four years. They moved Lawrence into Westminster Assisted Living's memory care unit in Decatur in February. Each stage of their mother's dementia has presented different obstacles for the family.

One of the most challenging things for Lemmond, 53, was becoming a caregiver.

"When you have to question them, you become the parent," Lemmond said. "The roles reverse."

In Lawrence's early stages of dementia, she would become frustrated, and so did the family.

"I would get so agitated because I didn't understand what she was going through," Lemmond said.

Lemmond said her mother tried to hide her dementia and would give answers to avoid saying, "I don't remember," or "I don't know."

Decatur Morgan Hospital Medical Director Nikki Brannon said sometimes trickery is the only way to get someone with suspected dementia symptoms to see a doctor.

"Sometimes you can get them to go to the doctor for another reason," Brannon said. "Call ahead of time and let the physician know you have these concerns, and the family member thinks they're going for a regular checkup."

Otherwise, Brannon said, there's not another way unless the person is willing to go to the doctor. If they're a danger to themselves or others, guardianship can be requested.

Sue Brantley, executive director of the Mental Health Association in Morgan County, said many people tell her that symptoms experienced in the early stages of dementia are often overlooked. Brantley said family members might see the forgetfulness as simply part of the aging process.

"As it progresses and they get to a medical diagnosis, they'll say this has been going on for several years," Brantley said.

The stigma of dementia and Alzheimer's can be upsetting for patients. Brantley said some doctors and families refer to it as a "memory disorder" to avoid the negative context with patients.

Lemmond soon learned tricks to make it easier on both her mother and the family. She said safety precautions, such as unplugging the oven and hiring a night sitter, became a priority.

"Redirecting her, or sometimes turning things around to where it seems like it's their idea helps," Lemmond said.

Lemmond and her siblings allowed their mother to drive for about six months after they first noticed her symptoms.

PHOTO: In this Aug. 8, 2014 photo, Kim Lemmond helps her mother, Nita Lawrence, 84, get up out of a chair in her room in Westminster Assisted Living, in Decatur, Ala. Lawrence battles dementia and her family helps her face the challenges of aging. (AP Photo/The Decatur Daily, Gary Cosby Jr.)
In this Aug. 8, 2014 photo, Kim Lemmond helps her mother, Nita Lawrence, 84, get up out of a chair in her room in Westminster Assisted Living, in Decatur, Ala. Lawrence battles dementia and her family helps her face the challenges of aging. (AP Photo/The Decatur Daily, Gary Cosby Jr.)

"We installed a GPS on her car that allows you to set up fences of where she's allowed to go," Lemmond said. "If she went past it, then we would be alerted."

When they would go somewhere, Lemmond would let her mother drive, so she could determine whether she was driving safely. One day, Lawrence asked if she could turn left on red. She knew then it was time to take her mother's keys.

"That's one of the most difficult things — approaching the mental state of the driving issue of taking keys away — that's very difficult," Brantley said. "It's taking their last piece of independence. We have stories of people going and buying another car."

Lawrence's children never told her she could not drive. They let Lawrence's doctor tell her it was not safe, to soften the blow.

"She would call about her keys, and we would say, 'We'll find them,' or 'Don't worry about it,' and she would forget about them," Lemmond said.

Lemmond knew it was time to move her mother into an assisted living home when a neighbor called one day and said, "She's OK, but the fire department has been there."

Something had ignited in the microwave. Until then, her children let her use the microwave, which had sticky notes pointing to the buttons she was to use.

Although Lawrence was defensive in early stages of her dementia, Lemmond said, she now is happy and more accepting of being in an assisted living home.

Lemmond stressed the importance of "getting things in order" before the illness progresses.

"I had been doing their bills since before Daddy died," Lemmond said. "So I knew their business, and that was helpful to not have to go through that."

If a family waits until the dementia progresses, Brantley said, it can make important things, such as going to the doctor, difficult. When a family member goes with the patient to the doctor, the family member cannot go into the examination room unless the patient allows it.

While they are still competent, Brantley suggested getting the "legal house" in order and signing documents such as a durable power of attorney, durable health care power of attorney and a HIPPA release form.

Once a person is no longer capable of making sound decisions, they must be declared incompetent by a probate judge. Morgan County Probate Judge Greg Cain said it has to be determined if the person is incapacitated.

"Alabama law speaks to what are called limited guardianships," Cain said. "What we look for in a hearing is how to allow the person to have as much freedom as they can, but having someone there to make decisions on their behalf to the degree they need to be made."

Cain said the court appoints an attorney as a protective person to represent the incapacitated person's best interest.

If a person is making decisions over health care and the person, he or she is considered a guardian. If a person is making monetary decisions for an incapacitated person, that is called a conservator.

Cain said it's a full-blown court process. The patient has to be evaluated by a court-appointed examiner. Once the paperwork is filed, the process takes 45 to 60 days. A provision in the law allows for emergency guardianships, which last 15 days, until a hearing.

"A lot of times it's very difficult on families," Cain said. "The family has to get to a point to where they believe their parent needs some sort of intervention and getting to the place of making decisions. A lot of times people with dementia, with my experience, are very paranoid. 'Are they trying to take advantage of me?'

"It's a lot of things that are going on and places the family at some difficult crossroads."

With tears in her eyes, Lemmond said the illness has challenged her in many ways. It's hard on a family, she said, but the hardest part has been watching the active mother she knew decline.

"I would much rather my heart, or anything go than my memory," Lemmond said with her voice shaking. "And she had, too."


Information from: The Decatur Daily, http://www.decaturdaily.com/decaturdaily/index.shtml

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