Occasionally when a person appears to have a sudden change in memory loss or behaviors, it may be a reversible dementia. Some common reversible dementia's are hypothermia, hyperthermia, dehydration, nutritional deficits, depression, sensory problems and environmental situations. When I was working on a unit we admitted a woman who in her mid 70's. When she came to the office with her family the nurse evaluated her and felt she could benefit from placement on the unit. When she first came on the unit she was very confused and lethargic. After about two weeks and many tests she was doing exceptionally well. One day she came into my office and was able to have a comprehensive and coherent conversation. She could recall all events in the past week and she asked me if she could leave because she wasn't like everyone around her. After talking with her doctors and having the staff and family involved, we looked into her environment prior to coming to the unit. She was living alone, her home was condemned and she had not been to the doctor in over 20 years. She was not taking care of herself and she was suffering from dehydration, nutritional deficits and a poor environmental situation. She had restored her health and made lifestyle changes that enabled her to live an independent healthy lifestyle at home.

When I went through a training course for Alzheimer's the instructor did one of the most eye opening exercises. We all sat in a room and had to close our eyes. We relaxed and cleared our heads. The instructor began talking ... It's a hot day and you just packed your bags. You are traveling and on your way to the airport. When you land you look around and see signs, however you cannot read them. You look around and ask for help, people do not understand you. They just look at you as if something is wrong. After traveling for 8 hours, you are exhausted, tired and hungry. You stand in line to get food, but your money does not work. You continue to look around for something, anything and then you see it. You see a gentleman who is holding a sign with your name on it. You walk over to him and he greets you. You are relived that someone knows you and they can help.

This is why having memory boxes outside of the residents rooms in Alzheimer's Units are so important. Having their name on the door and being able to see their belongings gives them a sense of peace.

Staff members who work in a true Alzheimer's Unit have extensive training related to caring for someone with this disease. One of the most common approaches that are taught is the wellness approach. This approach focuses on someones strengths and capabilities, not their negative behaviors or forgetfulness of actions. If you look at a glass of milk that is filled half way, most people would consider it a half empty glass of milk, where staff who have been trained on the wellness approach look at it as a half full glass of milk. This approach is used throughout the day during programming and even activities of daily living. Take for instance someone who is trying to get dressed, help encourage them to get dressed, do not just take over and dress them.

One day I was working very late on the Alzheimer's Unit, almost till midnight. I noticed we had one resident who was still up and looked like they had just started their day. It was unusual because this resident was overall a good sleeper in the evening and was always up bright and early. The staff began to tell me that for the past 3 nights she has been awake all night and sleeping during the day. Hmm... After reviewing the medical record, I read in the social history that she was a night nurse for 28 years. When she was awake I observed her going to each room and writing down the room number and name on her clipboard. When I asked her what she was doing she told me she was getting her charts done. She was reliving her nursing years. One of the most important things about Alzheimer's Disease is to let the resident believe, within reason, she was still that person. So instead of trying to 'redirect' her to bed, we went with it and even got her a nursing cap and her very own clipboard.

As a social worker and health professional who has worked with Alzheimer's, I appreciate that this is a personal decision. You know your family the best. As a granddaughter of someone with Alzheimer's I can look back and say I wish I knew, but would I have understood it? I was in my early teens when my grandfather passed away. He was never actually diagnosed with Alzheimer's, but he did have memory problems. I am not sure how common it was back then. He would sit in our house in his favorite chair every day and watch I Love Lucy. He would always say, "Beverly come here," calling me, even though my name is not Beverly. He thought I was his daughter, my Mom. I remember him calling for his wife, my grandmother, even though she passed away years before. We are so fortunate now because there are books that help you tell your children, books that tell kids why Grandpa and Grandma don't remember. Support groups can be found in your local area, where they focus on helping grandchildren. If you have talked with your children about Alzheimer's, please share your story. If you have read a great book for kids please let us know.

Being a caregiver is one of the hardest yet most rewarding things to do. My Mom cared for both of her parents while teaching full time and raising her family. Looking back and knowing what I know now I realize how amazing she was. When my grandma passed away my grandfather moved in with us. My Mom gave up teaching to stay home and care for her father. She did have siblings in the local area and they did help out, but to be the primary caretaker, nobody quite understands until you become yourself. Someone always had to be home and with two teenagers who wanted no part of staying home it wasn't easy. My Mom was tired and yes cranky. She had every right to be. I remember her saying, "I can't put him in a home." Working in the healthcare industry and talking with Mom, nobody was there to help, to tell her it was OK to have a companion come in and care for her Dad while she took some time with her family or just for herself. If you don't take care of yourself, who is going to take care of your loved one? You need to make time for yourself every day!

Private duty homecare (also referred to as companion services and Non-Medical Home Care) and an Adult Day Care center are great options. If you have tried either of these services or have more ideas, please share them so we can all learn.

When working in the Alzheimer's Unit, many people felt that shower days were the hardest. Often showers are small, dark and uninviting so the residents would fight and try very hard to not be 'put' into the shower. You cannot force anyone into a shower so one of the most talked about topics at a staff meeting would be, "How I helped Ms. Smith shower." We had a resident who was new and hadn't showered in over 1 year. Her daughter tried her best and would sponge bath her as thoroughly as she could. The staff members tried day after day to convince her to shower. Finally one day we came to her and said, it is your lucky day! You won the "Pamper me for the day contest!" We gave her a crown to wear, a plush robe and slippers and had a little pink caddy with shampoos, lotions and beauty supplies. She beamed from ear to ear and said, "Wow I won!" We were fortunate to have a beautiful shower area with warm soft colors and a relaxing environment thanks to our dedicated families. So once we walked her into the shower room we had her sit on the bench and pick out her shampoos and lotions. She was so excited. She showered that day. Every other day the staff would come to her with the exact same approach and every other day she was showered.

I have heard many stories from families and other professionals with successful strategies for working with residents. We invite you to share yours!

One thing we did when working in Alzheimer's Communities is evaluate each resident to see if they were a right fit for the unit. I visited a home one day where the husband was suffering from mid stage Alzheimer's. He knew his name, recognized some of his family but thought he was still in his 20's. He did not remember having children. During the evaluation his son came in and he began reminding his Dad that he was his son. This went on for about 15 minutes until his Dad began yelling and telling this 'stranger' to leave. His son was very hurt and felt that he needed to remind his father and bring him 'into reality.' He was admitted to the unit about 1 week later. We invited his son to come to a programming day so he can see how the staff interacted with his Dad. During that time his Dad went up to him and called him Roger, and introduced him as his best friend. His son's name was not Roger, however his son saw the importance of living in the moment and not telling his Dad the reality.

How might this work with someone in your life who has memory problems? Do you think it is ok to tell them the truth or it is ok to allow them to live in that moment, whether past or present?

One of the benefits of a support group is sharing your feelings and experiences with others who understand what you are going through because they face similar challenges. Individuals in a support group have a special compassion for your situation and can share strategies that have worked for them. Sometimes it just helps to vent and know someone is listening and cares because you have a unique emotional bond.

Working on a special care unit is eventful. Each moment is different and you really have to be trained to work in this environment. Every morning I would walk on the unit wearing my clunky high heel shoes that made a loud thump. I was going to stop wearing them until one of my residents changed my mind. She would stand outside her room every morning with her gold slippers on and she would say, "I have been waiting for you, let's go," and she would give me a big huge kiss and hug. So I would walk her to my office where she sat side by side with me. After about 10 minutes, she would thank me and give me another big huge kiss and hug and go back to her room to get ready for the day. She thought I was her daughter, mom, sister and even her best friend from childhood. Her daughter was very involved and would come at least 3 times a week. Her daughter would cry in my office every visit feeling she did something 'horrible' to her mom by moving her out of her home. The next day I told her daughter to come at 7:30 am if she could. She was at the end of the hall and she was able to watch her mom at a distance. Her mom truly believed this was her home, where she had lived her entire life. We decorated it with details from her childhood memories to resemble her home. Her daughter thanked the entire staff that day and was finally able to go on a week long vacation with her husband knowing her mom was ok.

What exactly is an Alzheimer's Community, also commonly referred to as special care units and dementia units? I have worked as a social worker in Alzheimer's Units for many years and truly feel it is the best kept secret. Walking on a true Alzheimer's Unit is like entering someone's home. The environment does not look clinical. It is inviting and the way of life on a 'special care unit' is very different. Thought went into each detail from the color of the walls to the daily activity plan to ensure it is the best overall environment for someone who has Alzheimer's Disease. If you have ever had your family in this type of setting or you work in one, please share your stories about how you found one, what you looked for and the struggles you encountered during the adjustment phase. This will help others to learn and provide a strong support network for those who have families who reside in special care units.