The holiday season is a time of renewal and of fresh opportunities. At this time, when the extended family comes together and elaborate, festive meals take place with many participants, serious difficulties may arise for those caring for a patient with Alzheimer’s.
The following are a number of tips that can help you deal successfully with the complex challenges:
• First of all, there is no point in posing “riddles” and asking the ill parent/spouse orientation questions regarding the various family members, the laws of the holiday, etc. At the early stages of the illness, the sick person’s still has high self-awareness. He is very sensitive to comments and interrogations about his condition and is easily angered and offended. An inability to answer simple questions causes feelings of embarrassment and frustration in people with Alzheimer’s. Instead, help him out with the information from your side. Instead of asking, “Dad, do you remember who this is?” preempt the question by saying out loud, “Look who’s here – Moshe, Ephraim’s son.”
• It is a good idea to come to the home of the Alzheimer’s patient with a basket of items connected to the holiday (honey, apple, pomegranate, etc.) and say to him: “I brought you a small gift for Rosh Hashanah, which is coming up this week. May you have a good, sweet life!” In order to rouse memories of the family Yom Tov table, you can try cautiously asking about a favorite recipe you can recreate and/or sing songs and excerpts of the prayers along with him. The goal is to stimulate the patient to get involved in the holiday in an experiential way, founded on a pleasant connection to family members, not in a way that will rouse anger or suspicion.
• If the parent is being hosted in your home, or if you are a guest in his home, it is advisable to involve him in the hubbub of preparations. The parent wants to feel like a parent, in spite of his illness, and therefore, he needs to sense that he has a valuable role to play, that the other family members need him. At times, we want so much to honor a parent and make things easy for him that we end up sitting him on the sidelines, so as not to trouble him. But sometimes, it is important to “trouble” him! “Doing” gives a person a feeling of value. You can request the parent’s help in setting the table, serving, choosing a song to sing at the holiday table, letting him dip the apple in the honey for all the guests, praising a beloved recipe that is a traditional part of the family repertoire. You can initiate a round of berachot for the New Year by the grandchildren and great-grandchildren or a round in which the patient blesses the family members.
• Some patients may have delivered Torah classes over the years, spoken in public, or served as chazzan for the Rosh Hashanah prayers. It is important to take time to think whether the patient is perhaps still capable of doing so, or if it might pose an overly complex challenge for him that may end up causing him dishonor. The decision is a difficult one and demands great sensitivity, both on the part of the gabbai, the shul authority, as well as the family members. If the conclusion is that the job is too much for the parent, it is best to speak with the gabbai and brainstorm together how best to conclude the parent’s tenure in an honorable manner.
• Take into consideration that the holiday prayers may be too lengthy for the patients and they may have difficulty following. It is important to escort them outside from time to time, if necessary, to give them a break, and to be prepared for the possibility that they may want to go home early.
• At times, the parent is unable to verbally express how he feels, but his actions speak for him – restlessness, getting up from the table, pacing back and forth in the room, crying. These behaviors may indicate a need that he has trouble expressing, such as the need for a quiet respite from the children’s noise, the need to use the bathroom, hunger or thirst, fatigue, a flood of memories – good or painful. It is important to be alert to changes in conduct and to try to “read” and properly “translate” the body language. It is a good idea to appoint one person who will escort the patient throughout the holiday, sit next to him at the table and be attuned to his various needs (leaving the table occasionally, using the facilities, resting, appropriate nutrition, etc.).
In conclusion, a few words for you, the primary caregivers: Coping with Alzheimer’s is a long, drawn-out challenge. Be forgiving of yourselves. Split the heavy responsibility on your shoulders with other family members. Take a break a moment before you feel that the difficulty is too much for you. Remember that it is hard to give attention at every given moment. It is hard to deal with questions that are repeated again and again. You are allowed to make mistakes. It is permissible – and recommended – to take small breaks to rally strength. Tension, fatigue, despondency, anger, and impatience will have a deleterious effect on your health, on your bond with the patient, and on his mood. Try to do whatever you are able to with patience, peace with the situation, and a focus on what there is, not what there isn’t.
Wishing you a happy New Year, a year of good news, a year of success and an easy time coping. We will conclude with the words of the Rambam (from the Physician’s Prayer): “Please, compassionate, merciful G-d, strengthen me physically and emotionally and implant in me a whole spirit.”
Ketivah v’chatimah tovah,
The Tzipora Fried Center
This service is given as a part of the Geriatric Services Department of Ezer Mizion, which also provides Caregiver Services for the Elderly