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I leave my sister notes to help her remember things.


I know she can still read.


Twice a week I put up notes before I leave to remind her that her shower day is the next day saying, "Do not wash up. Stay in your robe. Today is shower day."


Most of the time she complies.


She likes her showers, and thanks me for helping her take them, as her fear of falling has prevented her from taking them independently for years.


However, more frequently lately, she started ignoring my notes, and is washed and dressed when I arrive.


So, I made more and bigger notes, putting a very large note, in very black marker, covering her towel and washcloth in the bathroom, put 3 large (8 × 10) notes in her clothes closet, and another 8 x 10 note in her underwear drawer. Also, I have been arriving 30 minutes earlier than usual on shower day, on the off change she gets up earlier, so she does have to sit and wait for me too long.


Today, despite my best efforts, I arrive to find her already washed and almost dressed. I asked if she saw my notes. She claims, "they just didn't register in her mind." It is difficult to believe this isn't deliberate, but I having trouble imagining her reason.


What is going on here? Visual abnormality, manipulation or what?


Any insight appreciated!

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It has to do with how the brain processes things - she sees, she reads but there is a glitch in comprehension and applying the information. Maybe start calling her in the morning on her shower days.
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1. it’s very kind of you to help your sister so much. what an amazing sister you are :).

2. there’s no visual abnormality. it’s either intentional (because she wants to try to take the showers on her own)…or unintentional (the note - really - didn’t register in her mind. maybe her memory is so bad, she forgot what she read, 2 seconds later).

3. your sister shouldn’t live alone. there’ll be more and more problems, danger. i hope she can hire caregivers.
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If she has dementia, she likely can't understand what the notes are telling her.

Dementia didn't rob my mother of her ability to read -- just her ability to comprehend and retain what she read.
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I can’t imagine how frustrating this is for you.

Obviously, your sister isn’t able to function by herself any longer.

I realize that you are sincerely trying to assist her by leaving notes. They aren’t helping her in any way because she can’t understand what they mean.

Help her by finding a suitable facility for her to live in, then oversee her care.
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NeedHelpWithMom Jun 2023
Thanks, I’ll read it.
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She may or may not read them.
She may or may not understand them.
She may or may not comply with them.
Her short term memory loss may be so acute at some point that it is there one second, gone the next.
I would assume she isn't retaining the information and cannot coordinate now to comply with the directions.
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In spite of leaving huge poster notes in moms room at her memory care AL, she wasn't able to comprehend the words on them. Which is why she stopped reading books, then her favorite People magazines also.

Dementia destroys the brain, yet we still find it hard to believe our loved ones aren't deliberately conning us or that they've got any "reasoning" power left? It's hard to believe a once normally functioning person is now unable to even read a large note that's left for them, I know.

Difficulty with language and communication that goes along with dementia and strokes is known as aphasia.

A person with aphasia may:

Speak in short or incomplete sentences
Speak in sentences that don't make sense
Substitute one word for another or one sound for another
Speak unrecognizable words
Have difficulty finding words
Not understand other people's conversation
Not understand what they read
Write sentences that don't make sense

As her dementia progresses, you'll likely see the aphasia worsen too. I saw it in my mother with her inability to process what I was saying. I first thought she couldn't hear me for her saying "what?" constantly, until I realized it was the words she didn't understand, not the volume.

I'm sorry you're learning about aphasia in addition to the dreadful condition known as dementia. Wishing you the best of luck with all of this.
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AlvaDeer Jun 2023
My "OLD Nurse's AWARD" for the best catch of the day goes to Lea. Lea, I would bet you are spot on!!!!
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Seriously, you guys...?
You think this is an indication she needs to be in a facility?
She is not wandering.
She can still use the microwave.
She manages on her own without supervision 6, sometimes 10, hours a day without incident.
She is still so f***ing grateful she is still living in her apartment.
Just seems like such a leap, ya know?...from not reading a note to putting her in MC.
Really?
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MJ1929 Jun 2023
People here have experience -- lots of it.

What you're describing is in hindsight a red flag. It's just a little warning that if this is a problem, there are probably 10 more problems you haven't picked up on yet.

No, she might not need a facility yet, but she's heading that way. She can't comprehend a note, which means she isn't processing language properly, which means she has an issue with cognition, which means she might not remember how to use that microwave tomorrow or would turn on the stove and walk away, or who knows what.

It's just something to be aware of, because it's a change in her cognitive ability and much more than simply "ignoring" a note.
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just testing
something

Regards
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There does come a point when someone with dementia no longer can read and even if they can they loose their ability to comprehend.
It sounds like that is where your sister is at in her dementia journey, so be kind and gentle with her as she is not manipulating you or being "deliberate" in ignoring the notes.
And sadly as this happens she will require more care, and won't be as safe at home as she once was. So it may be time to be looking into hiring more help(with her money of course)to come in and assist her in her daily activities, since it sounds like you prefer to keep her in her own home.
There may come a day though when she will have to be placed to keep her safe, so I hope and pray that you won't be in denial about that fact, as dementia only gets worse, never better.
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I believe it is as CWillie said. The ability to read and even tell you what she read may still be there but the ability to follow directions seems to be an entirely different proposition. MY DH Aunt, needed to take her thyroid meds before she had coffee. A nephew volunteered to come by in the morning and help her take the meds before coffee. He already had a routine of coming twice a week for coffee. She seemed to remember he was coming so would get up early, make the coffee to be ready for him and be enjoying her first cup when he came in. Back to the drawing board. We tried many things and finally landing on hiding the sugar until the aide got there. She was willing to try whatever we came up with in the moment but would not remember later. “ it is difficult to believe this isn't delberat, but I having trouble imagining her reason.”Exactly, you are not truly understanding dementia since you expect her to remember and to be able to “reason”. It takes awhile. You will get there. To truly drive you around the bend, there will be times her reasoning will seem superior to your own. Not unusual to see posts where a caregiver wonders if they are being manipulated by their LO and that they don’t really have dementia although they have been diagnosed and can’t find there own way to the dinner table without help. ‘’Meet her where she is” is a note you might write for yourself. This is a stage. She will progress in her decline and this issue will be replaced by another. In some ways she is already back to an earlier time when it never occurred to her that she needed help to bath. I too think you are an amazing sis. Try watching a few Teepa Snow videos on YouTube. They are helpful
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Tiredsister......the question is, when will she put the microwave on for 60 minutes instead of 60 seconds and not realize the food is exploding in there?

Living alone with dementia is a dangerous thing bc you just don't know when a step down is going to occur. If she does decide to wander, then what? Being grateful to live in her apartment doesn't make it a wise idea if she mixes ammonia together w bleach one day to clean.

Their reasoning power is gone, their logic is gone, along w short term memory which is what keeps us functioning with how to do things every day. The steps involved in boiling an egg, for instance, are many. A person w dementia will forget them halfway thru and leave an empty pot on the stove on high heat and walk away. This is how accidents happen.

You can hire in home help for her before placement becomes necessary. Someone to be a companion and helper and to keep an eye on her behaviors.

Speaking of "leaps".....I'm sure you weren't expecting your sister to forget how to comprehend words from one day to the next, either, but such is the nature of dementia sometimes. They're fine one day, step down the next, and everything changes.

Keep all this in mind for when you need Plan B.

In the meantime, I suggest you read this 33 page booklet online about managing dementia and what to expect with an elder who's been diagnosed with it. Lots of Do's and Don't tips for dealing with dementia sufferers are suggested in the booklet.

Understanding the Dementia Experience, by Jennifer Ghent-Fuller 

https://www.smashwords.com/books/view/210580

Jennifer is a nurse who worked for many years as an educator and counsellor for people with dementia and their families, as well as others in caring roles. She addresses the emotional and grief issues in the contexts in which they arise for families living with dementia.

The reviews for her books are phenomenal b/c they are written in plain English & very easy to read/understand. Her writings have been VERY helpful for me.

The full copy of her book is available here:

https://www.amazon.com/Thoughtful-Dementia-Care-Understanding-Experience/dp/B09WN439CC/ref=sr_1_2?crid=2E7WWE9X5UFXR&keywords=jennifer+ghent+fuller+books&qid=1657468364&sprefix=jennifer+ghent%2Caps%2C631&sr=8-2


Educate yourself about what lies ahead as dementia progresses before you decide what steps to take. Knowledge is power.

Best of luck to you. 
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AlvaDeer Jun 2023
Yes. My brother ignored symptoms until there was a serious accident that injured (luckily) only him, quite badly.

Things tend to be ignored until we cannot do so anymore.
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I understand that you want your sister to have as much independence as she possibly can.

Here’s the thing though, when you are doing all that you possibly can to assist your sister and it’s still not working, then don’t you think that it’s time for a change?

Wouldn’t you rather plan ahead and be prepared, rather than wait for something drastic to happen and then be sorry because you could have prevented it by finding suitable alternatives for your sister?

I realize that you are trying very hard to help your sister. I know how hard it is to be a caregiver. I helped care for my brother and I cared for my parents. I empathize with you.

I think it’s important to acknowledge to yourself that you have done all that you can do. Step aside and let others help now.

Your sister is struggling to cope with everyday life. She needs additional support.

Best wishes to you and your family.
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NeedHelpWithMom Jun 2023
MD,

I get what you’re saying but she has absolutely no control over what her sister’s children do or don’t do.

I am aware that she cares about her sister. Still, she isn’t helping her with notes or anything else because her sister isn’t able to respond the same way that a person without dementia would respond.

So, now the only thing that she can do is step aside. Hopefully, her children will take over. They will not make any attempts to help if their aunt is doing everything to help.

The only other thing that she can do is to report her sister as a vulnerable adult without sufficient resources to live safely.
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Yes, she can no longer read. My Mom could read the word "Stop" on a sign but not be able to string a series of words together and comphrehend the meaning. Like your "Don't wash up" She may read each word but her mind cannot put them together where she comprehends the meaning of the sentence.

Your sister's brain is literally dying. And as each part of the brain is effected, that ability dies. And yes, there comes a time when your sister will not be able to be left alone. Dementia is very unpredictable. You never know whats going to happen next. No ryhmn or reason. My nephew came home to find Mom had left a pot boiling. Another time to her crying because the phone had been ringing and she didn't know how to answer it.
We wondered if she had forgotten how to use her remote. Shortly after this she came to live with me.

Things can happen overnight. I worked for Nurses and they called it an episode. Something happens why they are sleeping and next day there is a decline.
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I feel kind of shocked by all of your insights...and by my lack of perspective.
I just really believed I would "know"...see clearly as her abilities diminished, and be able to deal with it less emotionally than I'm feeling right now.

I sincerely appreciate all of your responses...your many years of collective experience, and your willingness to share that wisdom and knowledge with me.

Caring for other people's brothers, sisters, mothers, fathers, grandparents in assisted living, as I did for many years, really does not prepare you for caring for a close loved one with dementia.
The emotional connection is what trips you up, and yes-blinds you-everytime...
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AlvaDeer Jun 2023
You are so right.
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Only one of my sister's 4 sons has regular contact with her. I will ask for a meeting with him this week to explain we need to prepare ourselves for her to go to memory care because she' no longer safe living on her own.

Everyone who pointed out that my sister has turned a corner...taken a leap into aphasia, is correct, of course. I'm feeling grief stricken at the realization, and completely bewildered by how easily a caregiver (me) can lose perspective when so caught up in the daily challenges of trying to manage the unmanageable.
I do understand my sister and I are at the point where my helping is no longer helping.

Thank you, all of you, for helping me understand this. I have to do the next right thing for my sister, and myself. I see that clearly now.
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lealonnie1 Jun 2023
Sending you a big hug. Dementia is the worst. I hate it. It robs us of our loved ones and leaves a shell of who they once were in their place. It took my mother's life and AD her sisters life.
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