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The Media and How It Influences Care Choices

Although the Media has finally discovered Alzheimer's Disease as a subject worthy of exploration, how they traditionally represent this illness leaves a great deal to be desired.  

  • The thrust is about institutionalizing our people .

  • There is a general lack of information about the illness and so symptoms are misrepresented .

  • There is yet to exist a program that portrays home care as a viable or preferred way to care for our people.  

  • The public gets a very skewed version of this disease, one that probably pleases the nursing home industry but one that does very little for those of us who strive to keep our people home.  

  • The universal message is that home care can't be done.........when it is in fact doable and for a large percentage of us, the preferred choice.

Rarely, if ever, is the Alzheimer’s person ever portrayed as having any worth

Everyone has something to say about the care of our people.

I haven’t seen one network talk show on Alzheimer’s Disease, in the last 10 years that ever had a late-stage home caregiver on the panel of caregivers.

And when home-care is mentioned, too often, the example they give is someone like Jay Rockefeller who’s family spent $300,000 a year to maintain his mother in her home as the standard.

For the most part the media, and by media, I mean every avenue of information available to the public that functions as a reporting venue, has consistently portrayed this disease on a level that does not reflect the actual symptoms of the disease or the reality of the caregiving that is being done. 

Rarely, if ever, is the Alzheimer’s person ever portrayed as having any worth. The focus is always on how difficult it is for the caregiver and never is the basic humanity of the person with the disease ever raised. People with this disease are always spoken of as having lost their dignity, as being a burden, as their care being a needless sacrifice, because to lose your cognitive function is to lose your worth as a human being in this society. Our people become "Something to take care of," instead of "Someone to care about." 

As a result, those of us who care at home for our people are treated as if we are candidates for a psychiatric classification because we continue in spite of the fact that they can’t identify us properly. After all, how can it matter where or who does the care to someone with this disease when they don’t even know where they are or who their caregivers are? And when they die the caregiver isn’t given their due even then. We aren’t even allowed to grieve. Instead we are expected to get on with our lives because the ‘burden’ is finally over. 

These negative attitudes about this particular disease and the people who get it, permeate every aspect of society from those who are mandated to help those of us dealing with this illness to strangers in the parking lot of the local supermarket. Everyone has something to say about the care of our people. This is nothing less than bias, a bias so accepted it isn’t even recognized as bias and it affects how our people feel about themselves and it affects the moral of their caregivers. As examples of the prevailing attitudes and how they are translated by the media, I offer the following:


TALK SHOWS

  • I haven’t seen one network talk show on Alzheimer’s Disease, in the last 10 years that ever had a late-stage home caregiver on the panel of caregivers. The panel members were people who already had their family members in nursing homes or people who would be sending their family member to a nursing home. This is not reflective of the true picture of the caregiving that is being done and it sends a faulty message to those watching these programs. The message is that all Alzheimer’s people are eventually placed in institutions which simply isn’t true. Those of us facing home care needs are literally left out in the cold to fend for ourselves. Home care continues to be the best-kept secret in the country. The Alzheimer’s Association states that over 75% of the care is done in the home. Home-caregivers face different issues than caregivers who have opted for the nursing home choice. The home care issues aren’t even raised, let alone represented.

  • I have yet to hear home-care even offered as an option in care, or the problems inherent in finding adequate home-care services discussed on any television show. There are millions of viewers facing this illness and millions who will be facing the illness, and yet they aren’t even being made aware that over 75% of the care is being done at home. Its no wonder we home-caregivers feel isolated. We don’t even get the feed back that home-care is even being done. That does little to bring the plight of the millions still dealing with the care at home to the attention of those serving this population.

  • All the talk about the cost of late stage care has traditionally centered about the cost of nursing home care. In fact, when long-term care costs are mentioned the general assumption is that the reference is to nursing home costs. And yet there is a growing industry of home-health care and day-care that is going largely ignored, untapped, underdeveloped and unregulated. While quality of care in nursing homes is an important issue in the seminars and workshops I regularly attend, I have yet to hear the same issues discussed with regards to the industry that services the home-care population in any real depth. 

And when home-care is mentioned, too often, the example they give is someone like Jay Rockefeller who’s family spent $300,000 a year to maintain his mother in her home as the standard. The message here is just another way of saying home-care can’t be done unless you’re a Rockefeller. My costs were half of what a nursing home would have cost and I paid for 30 hours a week for a home-health aide, and frankly I could have survived with less hours. I was one of the millions who couldn’t afford the nursing-home option. 


TELEVISION MOVIES

Television movies that have been made about this illness have ended in nursing home placement as the only option, with the usual downward spiral of doom and gloom focusing on loss of memory and the inability to recognize the caregiver. The focus has always been one of justifying separation. There has yet to be a movie made for television that speaks to the positive connection that can exist between family and the family member with this illness and no one in which the behaviors were dealt with positively and creatively. There simply are no positive role models at all for families facing this disease. This is not so for any other disease group portrayed on the little screen or the big screen.

Do You Remember Love, Joanne Woodward, Richard Kiley, 1985. Joanne portrayed a professor who began exhibiting symptoms of dementia. The writers were effective in showing the drama of her initial awareness of her deficits and progresses into the mid-stages of the illness. The lead character was placed in a nursing home at the end of the movie and I understand it is based on a true story. Although the acting was wonderful, this movie set the standard, the formula, if you will, for all movies about this disease that would follow.  Never are practical ways for the spouse and other family members to deal with the problems given the message being that the ‘problems’ are always too difficult.

In this particular case the ill spouse herself ‘made the choice’ to go into a nursing home because she didn’t want to be a burden on her family.  Ah! That Permission Thing.  

I talk in more depth about ‘this permission thing,’ that everyone grasps at, in my book. Tom gave me permission as well. At some point they all give ‘permission.’  Our reality is that ...

  • we didn’t have the money even if I wanted to place him in the nursing home without going bankrupt, and 

  • I decided that he was better off in his own home, and, 

  • by the time most people go into nursing home placement I realized I had already been through the worst of it. 

The last stage of care was actually the easiest and the most rewarding in terms of our relationship because all the behaviors were behind us. We were then able to get back to the loving and caring and there were still moments to cling to and treasure, moments I would have missed had he not been home.

The reason most of us keep them home is because we ignore the ‘permission’ and do what we have to do in order to get ourselves through this disease. We don’t see commitment, sacrifice, or unconditional love as bad things and believe it or not, the majority of us come out of this illness strengthened in ways that others simply cannot understand. This is an aspect of care that has yet to be dramatized in any movie dealing with this illness. There have been a number of television movies made about this disease and I wouldn’t recommend any of them to anyone starting out on this journey of care. However, there is a television movie that was made in 1991 that is about aging and this I do recommend.

Fire in the Dark, Olympia Dukakis, Lindsay Wagner, 1991. This movie follows the Dukakis character as she faces the death of her spouse and the problems of living independently as an aging woman. We gradually see the family dynamic unfold as one sibling is unable to take on the challenge of the mother’s increasing needs and the other sibling, the daughter who finds herself assuming more and more of the tasks. What is so unique about this film is the accurate portrayal of the daughter’s initial reluctance, her frustration at being divided between her own family and her mother’s needs and her mother’s intense desire to remain independent. We are allowed to see her transformation from daughter to caregiver and we get to see this family make the journey with her, not without pitfalls but ultimately with a degree of grace and an awakening to the concept of what unconditional love is.

This is both the dilemma and the goal of families facing Alzheimer’s. How do we enter their space without demeaning them? How do we alter our lifestyle to accommodate someone who can no longer do it on their own without losing something ourselves? This movie shows the transitions with such awareness and sensitivity that I feel it is a map for all families facing the chronic needs of aging parents. There is one poignant moment when Ms. Dukakis, as the mother, utters the following to her daughter: "You know, it isn’t death that I fear, it’s what happens to me before I die that scares me." I think that statement should be branded on the foreheads of anyone who has the gall to speak of our people in less than human terms because they have lost their cognitive abilities. The assumption is that our people aren’t capable of feeling these fears when the reality is they feel little else for as long as this disease permits them to feel. Instead of being assured they will be loved in spite of what this illness does to them they are subjected over and over to the belief that they are nothing but a drain on society, a drain on their families, a drain period. Why censor what you say in front of them when everyone knows they don’t know what’s going on anyway? Is it possible to imagine the horror they feel?

This is a movie about living the human drama instead of running away from it. I highly recommend it.


THEATER MOVIES

There have been some positive theater movies about caring for the elderly, but not one on Alzheimer’s Disease that hasn’t used euthanasia as a solution for the long-term care needs of the Alzheimer’s character.

"Folks," Tom Selleck, Don Ameche, Anne Jackson, 1992. The Don Ameche character had Alzheimer’s and spent most of the film trying to commit suicide in order to not be a burden to his family. The family spent many slapstick moments helping him achieve this goal. A real madcap group of self-centered cartoon characters that reflected no caregiver and no person with Alzheimer’s Disease that I ever met. The Alzheimer’s character remained charmingly cute through the end of the movie. Apparently, standing in a closet with a dumb look on the face was considered high comedy by the writers. In the end this character was kept home but again, the portrayal was of a cute but ditzy person who’s behavior had little to do with this disease. If this disease was that cute there wouldn’t’ be any need for nursing homes. We’d all be able to keep them home. They’d be no trouble. It is of interest that Leonard Maltin’s review of this film had the following quote: "…blame this one on the writer and the director."

"DAD," Jack Lemmon, Ted Dansen, 1989 showed the growth of a caregiver as Mr. Lemmon’s character succumbed to the effects of his illness and growing ancillary confusion. This was a movie about relationships and the development of a caregiver in warm glowing terms. It was not a movie about Alzheimer’s Disease. However, the fears this man felt and his response to the acceptance of his son of his disability is not unlike the process that happens to our caregivers.  For that reason I recommend this movie.

"Nothing In Common," Jackie Gleason, Tom Hanks, Eva Marie Saint, 1986. A film about relationships and the development of a caregiver. The Gleason character does not have Alzheimer’s, but he does have a wounded relationship with his son and a critical illness. The movie centers about the changes that occur as the son steps in to take over his father’s care. While we are dealing with someone who still has their cognitive abilities in this movie, the process for caregivers facing Alzheimer’s care is not that different. The bond that develops for Alzheimer's caregivers follows much the same course as the one that develops in this movie. If nothing else it is as least a positive role model that doesn’t denigrate concepts such as obligation, sacrifice, unconditional love and all those other stalwart ideals that have fallen into disrepute in recent decades. In today’s world, to be a caregiver of someone with Alzheimer’s is to be: co-dependent, unrealistic, a martyr, controlling, symbiotic, or a saint, none of which reflects the true act of giving care which is more about unconditional love and less about a psychiatric classification.

"Iris," As sensitive and as well written and acted as this production was, even this woman was institutionalized in the end.

 


TELEVISION DRAMA

Television drama, for the most part, portrays our people as better off dead. They either blow them away, put them in nursing homes or have them commit suicide because ‘they’ would never want to live ‘that way.’ Never have they offered the public the opportunity to see these people cared for, lovingly, at home with the real issues of care and connection explored. Apparently the writers of these programs subscribe to the ‘They’re better off dead’ approach to long-term care for persons with Alzheimer’s disease. And why? Can it be that they don’t see any value in those who can’t speak for themselves? I think its because they have no idea what this disease is about and they are too lazy to find out. And besides, killing them off boosts ratings.

"L. A. Law,’ had a character who exhibited an uncontrollable urge to dress up like Ralph Kramden spouting verbatim dialogue from the ‘Honeymooner’s’ when his "Alzheimer’s kicked in." He ended up in a nursing home and died a death that conveniently terminated his character and tied up the story line, but which had no relationship to Alzheimer’s.

Picket Fences,’ and ‘Sisters,’ both blew their character away and then had a trial justifying the homicides. In both of these dramas the writers spoke about the loss of dignity and how painful it was for their family member to watch them deteriorate. I wonder, is it easier for a family to watch a child die of leukemia, a subject that is always treated with respect and empathy? And there is the fact that euthanasia isn’t really an option in the real world of caregiving. The final episode using this character had their mayor, Howard, running around in an American Indian costume, wearing an adult diaper in place of the requisite ‘loincloth,’ blithely reminding the cast they he was now incontinent. He then excused himself in order to change is own diaper. Seems to me they got to insult two groups on that one.

‘Sisters,’ had real potential until the Alzheimer’s character was given an overdose of sleeping pills. I actually thought for a moment that this character was going to make it through to the end of the disease. The care techniques were in place, the writers had done some research into the disease, the acting was superb, and then it was over with the requisite trial exonerating euthanasia. To go so far and then miss the opportunity to share in this character’s dying in his own home with a sense of completion with the other characters in the story line was a real shame.

"Any Day Now," had their character commit suicide. Keep in mind this character was so confused she had her bowel movement in bed, a scene most graphically portrayed for the audience. She couldn’t recognize the need to relive herself, but, she was able to figure out a plan and follow it through. This involved finding paper and pen, writing a letter of good bye waxing profoundly to her granddaughter with no apparent problems with spelling or syntax. She then somehow got downstairs without help, (She was unable to walk without assistance) find her gun, load her gun and aim her gun. I’m sorry, but Alzheimer’s just doesn’t work that way. And of course the cast spent the remaining minutes of the episode talking about how Grandma went out on her own terms. I was too tired to write another letter.

 

On the flip side…..

"Homicide, Life on the Streets," and "ER," do get my applause for portraying Alzheimer’s characters realistically, although I admit it would be difficult to blow Rosemary Clooney away while she sang so sweetly in the halls of the ER. Both programs dealt with realistic situations in care and brought up ethical issues that need to be explored in more depth, such as the rights of the individual with the disease, the misconceptions that surround elder abuse, and the challenge of reworking old relationships into new ones. Obviously someone on both programs had first hand experience with Alzheimer’s, someone who was able to glean something positive and life giving in that experience.

"Homicide, Life of the Streets," called up the issue of caregiving to someone who was physically abusive to the caregiver as a child. It dealt honestly with the issue of how this caregiver faced the dilemma of caring for a man who was hated. And yet, the character found a sense of peace, of having the opportunity to see his tormentor in a different light, of seeing his role in their history from a different place because he allowed himself that luxury. Their relationship wasn’t developed in the series past the one episode, but it was clear that this character was making decisions for his uncle based on something other than hatred. If you think that all caregivers enter in the caregiving role because of a deep abiding love of the person with Alzheimer’s then you are greatly mistaken. We are all reluctant caregivers at best. 

I know a woman, as just one example, who was sexually abused by her father, as were other members of her family. She had every reason to walk away from his care, but she ended up being the only one in the family to take on the challenge. She actually put her career on hold, moved into the family home, took him out of the nursing home and cared for him until he died. Did she ever get what she needed from him in terms of a verbal admission of the damage he had done to her, to the entire family? Was she ever thanked by him for her sacrifice? The answer to both of those questions is "NO." But after he died, she did walk away with a deeper sense of herself, a feeling of completion, an ability to put the horror behind her and finally get on with her life. There is value in that.

"ER," in 1999, added a surgeon character who exhibited symptoms of the disease through several episodes. The transition was done with taste, obvious research, dignity and sensitivity. The character expressed his fears of his future, a future in a nursing home, unable to take care of his own hygiene, unable to express his basic needs. That, unfortunately is the reality for people facing this diagnosis. The fear that fills them has to be beyond mere words and what do they get in response to these fears? As a rule, they get to hear from the world at large that they will be a burden to their caregiver, if they have one, they won’t know what planet they are on let alone who their caregivers are, and they will hear their caregiver being told over and over that they belong in nursing home care. What they don’t hear is that they will be loved in spite of what this illness does to them. ER made an attempt to do that in these episodes and I applaud them for it.

Another episode of ER dealt with the too quick judgment of family abuse because the patient was elderly, suffering from dementia, emaciated and suffering with bed sores upon admittance to the ER. The initial assumption was that he had been neglected by his family. Social Services was called, the man was separated from his family and placed in a nursing home. Unfortunately, the attending doctor revised his opinion of what had happened as he began to get a clearer picture of the dynamics of the family and the desire of the elder to remain in his home with his family. 

The writers didn’t shrink from the reality of how the initial assumptions affected this family unit.  The beauty of this episode is that it showed how quickly those on the outside, the parameters of the chronic care needs of someone with Alzheimer’s are so ready to point the finger at the family when problems develop. 

The reality is that few family members are coached in terms of how quickly a pressure point can turn into a deep bed sore if not treated immediately. Bruises are common in the late stages because of poor circulation, lowered skin quality, a depressed immune system and a myriad of other problems. Just moving someone from bed to wheelchair can cause bruising. The emaciation happens in the late stages because the body no longer gleans nutrients from the food they ingest no matter how much they eat or how carefully prepared the food is. These are things qualified personnel know. Those who operate on the fringes of this disease see only what they want to see, a family taking their frustrations out on the victim. They rarely if ever see the family as the advocate who needs tools, resources, training, support, encouragement. It is so much easier to jump to the other conclusion and the hurt that is done when an accusation isn’t warranted is beyond measure. The scars last for years, and long after the person dies of this disease.


DOCUMENTARIES

Documentaries have fared somewhat better showing some home care in the late stages, but the general viewing public probably doesn’t watch them with the same devotion or interest as they give to a show like Pickett Fences or Sisters.  It isn't a pretty picture even though those of us who see it through get past the picture part and relate to the person with the disease on human terms that transcend the images others see.


NEWS SHOWS

News shows tend to couch information on research studies in terms of how long nursing home placement can be staved off, as in: "Vitamin E can stave off nursing home placement for 6 months. Good news for families facing Alzheimer’s Disease." One wonders just what population these studies canvas given the fact that you can wait 6 months to get your person placed in a nursing home even when you’ve already made the decision. And for what its worth, since at least 75% of the caregiving is done in the home I guess one might rightly surmise that whatever the new ‘study’ shows, it results in staving off nursing home placement indefinitely for at least 75% of those with Alzheimer’s Disease.

One local show touted a three day series. "Crossword Puzzles and mazes can stave off Alzheimer’s." The story was about the recently released Snowdon Study regarding the nuns who had donated their brains for Alzheimer’s study after death. Snowdons’ study revealed the same approximate breakdown of healthy nuns and those nuns exhibiting Alzheimer’s like symptoms as exists in the general population. The well nuns were video taped answering the same questions put to the nuns exhibiting Alzheimer’s symptoms. There were obvious marked differences in the responses of the well nuns from the ailing nuns over a period of time. However, upon researching the brain tissue of well nuns after death in order to compare differences with the brain tissue of those who died with Alzheimer’s, it was discovered that at least one of the well nun’s brain tissue showed that she had Alzheimer’s but had not shown any symptomology of the disease while she was alive. She died of a cause unrelated to dementia.

The question then arose what made the difference in the nun who had the disease but not only maintained her abilities but actually showed some improvement in her cognitive skills and the nuns who obviously developed the symptoms to the point where they were diagnosed with the disease before their death. The assumption made is that something caused one to not develop the progressive symptoms the others experienced. The only differences between them is that the nun who didn’t develop the symptoms had not experienced a trauma, had remained physically and mentally active, had a deeper sense of self and operated on a fairly high cognitive scale of intelligence. There was no way of assessing if she too might have developed symptoms had she not died of other causes. In short, once symptoms became noticed in the other nuns their disease ran the predictable course of anyone else diagnosed with Alzheimer’s. The study did not prove that mental exercises would stop the progression of the disease once symptoms developed to the point of diagnosis under present diagnostic procedures.   

The newscasters completely missed the point of the study gleaning a comment about the need for us to remain active, to use our abilities to continue to learn new things and exercise our brains as a way of stopping the progression of Alzheimer’s before the symptoms become obvious


BOOKS AND PUBLICATIONS

Books and publications written by practitioners in the service providers and medical field state, either as fact or innuendo, the inevitability of nursing home placement for Alzheimer’s people. I have listed those books I found helpful in the Resources Section as well as reservations I have about most books that are presently on the shelves.   Books I found most helpful.

I refer you to "It's Just Poop People," which demonstrates the differences with how long term care is portrayed

Alzheimer’s care is no more difficult in the last stages than is the care of someone with Parkinson’s, MS, ALS, or stroke. The only difference is that most of these people keep their cognitive function whereas Alzheimer’s people don’t. The fact that they cannot communicate does not automatically make their care more difficult. It makes it more solitary and that is the only difference.


STATISTICS AND TRAINING TOOLS

 

Even the graphs that show the downward progression of this disease show this bias. While the Early and Mid Stages of this illness are always described in terms of function, such as confusion, forgetfulness, loss of motor control, etc., etc., the description listed by the Last Stage will often end in the words: Nursing Home Placement, instead of a more reflective description of the care that is needed, i.e.: Patient becomes totally incapacitated and needs help with all aspects of care. I attended the Annual Public Policy Meeting in Washington several years in a row. My last visit was marked by a seminar led by one of the great researchers in our country. This is a man who knows the vast majority of care is going on the homes and yet the graph he put up list nursing home placement as the final stage of care. I spoke to the president of the association after that talk and he agreed that was not a true reflection of how care is administered in this country and that the speaker, himself did not believe that it was. The only explanation is that he too is a victim of having swallowed the jargon. Hear it enough and it becomes truth whether its true or not.


THE PUBLIC

  • You can’t make fun of the deaf, the blind, cancer or the insane, because that is considered reprehensible, but stand-up comics as well as the public at large seem to feel Alzheimer’s Disease is open territory for ridicule. Someone misplaces something at work and someone else will invariably accuse him or her of having Alzheimer’s Disease. And people laugh. And while it might be considered gallows humor,§ it nevertheless creates an aura of complacency and misconception that goes largely unchallenged. A caregiver I know once challenged her co-workers after one of them made a joke about Alzheimer’s. She was accused of being the Politically Correct Police and that she had no sense of humor. "Just because you’re crazy keeping your mother home, doesn’t mean everyone else is," was the statement one of her co-workers threw at her.

  • A support group leader I once knew announced at a meeting that she was utterly amazed when she learned how much home-care was being done. She had been working with Alzheimer’s families for years at that point.


THE ALZHEIMER'S ASSOCIATION

  • The most recent commercials on Alzheimer’s Disease still only mention memory loss and how sad it is for caregivers when they aren’t recognized anymore. 

Firstly, there is a large portion of us who aren’t so shallow that we can’t care about someone even if they can’t identify us properly. 

Secondly, my husband was curled into the fetal position and weighed under 100 lbs. as a result of this disease when he died. There is more to it than just memory loss and if the public had any notion of how horrifying this disease really is, there would be a hue and cry across the planet demanding that this illness be eradicated. And our Congress would be leading the charge in allocating money for research if for no other reason than to preserve their own chance to function as they age. As it is, why worry about a bunch of people with ‘Old-Timers Disease,’ who walk around forgetting who their relatives are and who have outlived their children’s ability to take care of them?

  • The Alzheimer’s Association sponsors a Public Policy Forum which takes place every year in Washington. The conclave is there to address members of Congress about the needs of people with this disease and the needs of their caregivers. The highlight is when the Senate Aging Committee hears from actual family members. I have yet to see a caregiver who still has their person home during the last stage of this disease speak. I quote from the "Public Policy Up Date, dated May 1999 and published by the Alzheimer’s Association Public Policy Division in Washington.

"(name deleted) who was diagnosed with early onset Alzheimer’s at age 56, spoke about his experiences with the disease. Accompanied by his wife, he told the Aging Committee about their life since the diagnosis and how they are planning for the future. "All of the necessary legal and financial plans have been put into place. As I require more assistance, we will hire a live-in caretaker to help when my wife is at work. Naturally, I want to remain independent as long as possible but when the time comes, we anticipate that a nursing home will be necessary." The emotional and financial burdens this will place on the family are painfully obvious to all of you sitting here today."

It is a shame that this family can’t even fathom the possibility of keeping this man home until he dies. If they can afford live-in help now they can probably afford it later and his care really won’t require a 24 hour-a-day nurse. If anything, his care needs will actually get easier in the last stage of this illness. There is also adult-day-care, volunteers, family involvement, private home-health aids, to help in the daily care as well as hospice to aid in the final care. Obviously, this family isn’t getting information about alternative choices. And isn’t it a shame that this man already sees his care needs as a burden. What a burden for him to carry through what remains of his thinking life.


So how can we blame our service providers or the public at large for that matter, for their inexperience and misconceptions about this disease. 

There are 4,000,000 people with Alzheimer’s Disease in this country, and according to the statistics, 75%, roughly 3,000,000 are being cared for at home by one other person, usually a family member. In reality, the numbers at home exceed the 75% figure with the addition of paid home health care, adult day care, supported living arrangements and family, volunteer, and hospice involvement.

With the numbers of those with this disease increasing as our population ages, that is a whole lot of people being left out of the publicity loop in my opinion.