text stringlengths 59 1.12k |
|---|
of their independence and adulthood. It can therefore be difficult to convince them of the necessity to stop driving. But, it is too dangerous an issue not to be dealt |
with straight away. You should first try to discuss the issue of driving with the person with dementia, pointing out the possible dangers of driving, as well as the benefits |
of not having to. They may feel angry and depressed about the loss and need support during this awkward period. It might soften the blow if you were to arrange |
for other forms of transport or for other people to drive the person around. However, persuasion does not always work and some carers have tremendous difficulties trying to stop the |
person with dementia from driving. If this is the case, you might find that the person is more willing to listen to a doctor, the police or someone in authority. |
If this is also unsuccessful, you may have to try to prevent them from driving. You could, for example, hide the car keys, arrange for the car not to work |
(e.g. by removing the distributor cap) or park the car further down the street out of sight. If it is not needed, you could even sell the car and the |
money saved would help pay for other means of transport. One carer overcame this problem by leaving the car out ready to drive without the ignition key. Her husband sat |
in it and happily “drove” for hours changing gears and signalling without actually moving. Whatever you decide to do, you should inform the insurance company about the diagnosis of dementia. |
Care should be taken not to let the person with dementia smoke alone as it is a fire hazard. Also, some people with dementia might forget that they are holding |
a cigarette and it could burn their fingers. You should try to persuade the person to cut down on smoking and preferably stop. People with dementia often forget to smoke |
and then don’t miss cigarettes once the habit has been broken. However, if they continue smoking, there are a few useful precautions to take, e.g. put large ashtrays everywhere, replace |
wastepaper baskets with metal bins, buy flame resistant clothes and furniture, fit smoke alarms and keep matches out of reach. Smoking alone, particularly in bed, is the biggest risk. You |
might have more success persuading the person with dementia to restrict their smoking to times when there is company, rather than trying to prevent it altogether. It is important to |
pay particular attention not to let the person smoke if they are using nicotine patches as this greatly increases health risks. Alcoholic drinks may increase confusion in the person with |
dementia. Although the occasional social drink should not cause particular concern, it is best to ask your doctor’s advice about whether the person with dementia should have access to alcoholic |
drinks. This is particularly important if they are under medication. Even if the doctor agrees to the person having an occasional drink, you will still need to make sure that |
they do not have more. Loss of memory may result in the person with dementia forgetting that they have already had a few drinks. It is best to keep alcohol |
in a locked cupboard or hidden away. Early on in the disease, the person with dementia might be able to use public transport. But as the disease progresses they may |
start to have difficulties remembering where they are going, paying the fare, getting the right bus or train, getting out at the right place, etc. When this happens the person |
could feel embarrassed and afraid, particularly if they cannot remember where they are going or where they live. For this reason, in the later stages it would be preferable to |
try to arrange private transport. You could perhaps make a plan in advance of different people who are willing to drive the person around. Administrative formalities and personal finances The |
person with dementia might also have financial obligations or assets of little or considerable importance. It is necessary to discuss financial matters early on so that the person with dementia |
can make decisions while they are still able, appoint someone to handle their financial matters when they are no longer able and make a will. If you are handling the |
person’s finances, keep them separate from your own and keep a record of what you spend and receive in case you are asked to account for it at some stage. |
The person with dementia might forget what was decided however many times you might explain it. You might also find it necessary to help the person with dementia to deal |
with administrative formalities, e.g. collecting benefits, filling out forms, etc. There are a few possibilities for handling this such as an Enduring Power of Attorney. Your Alzheimer’s organisation will be |
able to give your more details. As the disease progresses the person with dementia will become less able to defend their own interests. It is possible to appoint a guardian |
to protect their interests and make decisions on their behalf (e.g. on where to live, health issues, etc.). This would help in situations where the person with dementia did not |
or was unable to take the decision at an earlier stage. People with dementia tend to experience difficulties handling money even fairly early on in the disease. Due to a |
loss of memory and understanding of the symbolic function of money, they may pay for something more than once, not pay at all, give money away or lose it. In |
this way problems can accumulate without you necessarily realising. In order to maintain their sense of wellbeing and self-esteem, you might be able to arrange for the person with dementia |
to carry on paying for goods and services (whilst ensuring that the risk of mistake or being taken advantage of is minimised) and ensure that they always have some money |
on them. Some carers have found that certain shopkeepers and hairdressers are willing to take cheques from the person with dementia, which are no longer valid, but which are then |
replaced by the carer. Sometimes, local shopkeepers who are understanding will let you pay later for articles which the person with dementia takes out of the shop without paying. Payment |
of regular accounts (e.g. electricity, gas telephone, etc.) can be settled by arranging direct debits with your bank. Going out alone You may be worried about the person with dementia |
going out alone for various reasons, e.g. traffic, the risk of getting lost or robbed etc. However, they might object to being accompanied everywhere, seeing this as an invasion of |
their privacy. You will therefore need to be extremely tactful in trying to keep an eye on their whereabouts. (Please see chapter on wandering). Last Updated: jeudi 06 août 2009 |
Background information about dementia and home care services In Spain, the provision of home care services is in the stage of development with about 20% of communes offering such services. However, this is not sufficient to cover demand and it is estimated that only about 1% of the elderly receive home care services pr... |
is to keep elderly people in their homes for as long as possible. The vast majority of elderly dependent people have to rely on services provided by informal carers. Care of elderly and dependent people tends to be seen as a family obligation. However, according to a survey carried out in 2001, only 24% of the populati... |
the responsibility for caring for their elderly parents in the future and the number of elderly people living alone is steadily increasing (Larizgoitia Jauregi, 2004) Legislation relating to the provision of home care services The Spanish constitution states that all citizens are entitled to “health protection”. The Ge... |
access to health services is a citizen’s right. In the Spanish Civil Code (Book 1), it is stated that the spouse and children of elderly dependent people are responsible for their maintenance and care which covers everything that is essential for sustenance, shelter, clothing and medical assistance. The extent of the m... |
needs of the dependent person. The obligation to provide maintenance comes to an end when the provider dies or when their wealth has fallen to such a level that continuing to do so would mean having to neglect their own needs or those of their family. Brothers and sisters also have an obligation to provide maintenance ... |
this obligation is limited to what is absolutely necessary Kerschen et al., 2005). Citizens’ do not have a legally established right to social services. The provision of such services is at the discretion of the Autonomous Administration. Access rights are governed by legislation at the level of the autonomous communit... |
their own environment for as long as possible. The main social services are therefore aimed at maintenance in the home. There is also a residential type network. These services generally concentrate on attending the dependent elderly who live alone. The need is also recognised to help subjects with few resources. Organ... |
autonomous communities. Each community has a Health Service and draws up a Health Plan which outlines which activities are necessary in order to meet the objectives of its own Health Service. Amongst other services provided by the health services of the autonomous communities, there is primary care which includes healt... |
free for people who are on the minimum pension. People who have an income twice as high as the minimum pension must pay for the services whereas those on an intermediary income must pay a certain amount which is calculated on the basis of their income. Health care is funded exclusively through general taxation and not ... |
financed jointly by the Ministry of Social Affairs, the regional ministries of Social Welfare and the municipalities. Home visits by general practitioners and primary care nurses are funded through the Public Health Service. In addition to government provided services, voluntary associations and not-for-profit associat... |
care services include primary care social services, social work, assistance with household tasks, meals-on-wheels and tele-alarm services. However, these services are not available in all the autonomous communities. In practice, home care services are more or less limited to household tasks (which also includes laundry... |
personal care should be carried out by the family. This opinion seems to be shared by carers who often prefer to receive formal assistance with household tasks rather than personal care (Valderrama et al., 1997 in Larizgoitia Jauregi, 2004). Meals-on-wheels is a services that is only available in the cities of Malaga a... |
October 2004 | Volume 55, Issue 5 As America goes into its fifty-fifth presidential election, we should remember that there might have been only one—if we hadn’t had the only candidate on earth who could do the job Looking back over two hundred years of the American Presidency, it seems |
safe to say that no one entered the office with more personal prestige than Washington, and only two Presidents—Abraham Lincoln and Franklin Roosevelt—faced comparable crises. The Civil War and the Great Depression, though now distant in time, remain more recent and raw in our collective memory than the American foundi... |
so we find it easier to appreciate the achievements of Lincoln and Roosevelt. Washington’s achievement must be recovered before it can be appreciated, which means that we must recognize that there was no such thing as a viable American nation when he took office as President, that the opening words |
of the Constitution (“We the people of the United States”) expressed a fervent but fragile hope rather than a social reality. The roughly four million settlers spread along the coastline and streaming over the Alleghenies felt their primary allegiance—to the extent they felt any allegiance at all —to local, state, |
and regional authorities. No republican government had ever before exercised control over a population this diffuse or a land this large, and the prevailing assumption among the best-informed European observers was that, to paraphrase Lincoln’s later formulation, a nation so conceived and so dedicated could not endure.... |
at the Executive level during the first year of Washington’s Presidency, which was exactly the way he wanted it. His official correspondence was dominated by job applications from veterans of the war, former friends, and total strangers. They all received the same republican response—namely, that merit rather than favo... |
determine federal appointments. As for the President himself, it was not clear whether he was taking the helm or merely occupying the bridge. Rumors began to circulate that he regarded his role as primarily ceremonial and symbolic, that after a mere two years he intended to step down, having launched |
the American ship of state and contributed his personal prestige as ballast on its maiden voyage. As it turned out, even ceremonial occasions raised troubling questions because no one knew how the symbolic centerpiece of a republic should behave or even what to call him. Vice President John Adams, trying |
most innocuous option available: The President of the United States should be called exactly that. Matters of social etiquette—how the President should interact with the public, where he should be accessible and where insulated—prompted multiple memorandums on the importance of what Alexander Hamilton called “a pretty ... |
short of secluding the President entirely. The solution was a weekly open house called the levee, part imperial court ceremony with choreographed bows and curtsies, part drop-in parlor social. The levee struck the proper middle note between courtly formality and republican simplicity, though at the expense of becoming ... |
boring and wholly scripted occasion. The very awkwardness of the levee fitted Washington’s temperament nicely since he possessed a nearly preternatural ability to remain silent while everyone around him was squirming under the pressure to fill that silence with conversation. (Adams later claimed that this “gift of sile... |
greatest political asset, which Adams deeply envied because he lacked it altogether.) The formal etiquette of the levee and Washington’s natural dignity (or was it aloofness?) combined to create a political atmosphere unimaginable in any modern-day national capital. In a year when the French Revolution broke out in vio... |
destined to reshape the entire political landscape of Europe, and the new Congress ratified a Bill of Rights that codified the most sweeping guarantee of individual freedoms ever enacted, no one at the levees expected Washington to comment on those events. Even matters of etiquette and symbolism, however, could have |
constitutional consequences, as Washington learned in August of 1789. The treaty-making power of the President required that he seek “the Advice and Consent of the Senate.” Washington initially interpreted the phrase to require his personal appearance in the Senate and the solicitation of senatorial opinion on specific... |
the mode of a large advisory council. But when he brought his proposals for treaties with several Southern Indian tribes to the Senate, the debate became a prolonged shouting match over questions of procedure. The longer the debate went on, the more irritated Washington became. Finally he declared, “This defeats |
every purpose of my coming here,” and abruptly stalked out. From that time on, the phrase advice and consent meant something less than direct Executive solicitation of senatorial opinion, and the role of the Senate as an equal partner in the Grafting of treaties came to be regarded as a |
violation of the separation-of-powers principle. Though he never revisited the Senate, Washington did honor his pledge to visit all the states in the Union. In the fall of 1789 he set off on a tour of New England that carried him through 60 towns and hamlets. Everywhere he went, the |
residents turned out in droves to glimpse America’s greatest hero parading past. And everywhere he went, New Englanders became Americans. Since Rhode Island had not yet ratified the Constitution, he skipped it, then made a separate trip the following summer to welcome the proudly independent latecomer into the new nati... |
During a visit to the Jewish synagogue in Newport he published an address on religious freedom that turned out to be the most uncompromising endorsement of the principle he ever made. (One must say “made” rather than “wrote” because there is considerable evidence that Thomas Jefferson wrote it.) Whatever sectional |
suspicions New Englanders might harbor toward that faraway thing called the federal government, when it appeared in their neighborhoods in the form of George Washington, they saluted, cheered, toasted, and embraced it as their own. The Southern tour was a more grueling affair, covering nearly 2,000 miles during the spr... |
of 1791. Instead of regarding it as a threat to his health, however, Washington described it as a tonic; the real risk, he believed, was the sedentary life of a deskbound President. The entourage of 11 horses included his white parade steed, Prescott, whom he mounted at the edge of |
each town in order to make an entrance that accorded with the heroic mythology already surrounding his military career. Prescott’s hooves were painted and polished before each appearance, and Washington usually brought along his favorite greyhound, mischievously named Cornwallis, to add to the dramatic effect. Like a m... |
on the campaign trail, Washington made speeches at each stop that repeated the same platitudinous themes, linking the glory of the War for Independence with the latent glory of the newly established United States. The ladies of Charleston fluttered alongside their fans when Washington took the dance floor; Prescott and |
the four carriage horses held up despite the nearly impassable or even nonexistent roads; Cornwallis, however, wore out and was buried on the banks of the Savannah River in a brick vault with a marble tombstone that local residents maintained for decades as a memorial to his master’s visit. In |
the end all the states south of the Potomac could say they had seen the palpable version of the flag, Washington himself. During the Southern tour one of the earliest editorial criticisms of Washington’s embodiment of authority appeared in the press. He was being treated at each stop like a |
canonized American saint, the editorial complained, or perhaps like a demigod “perfumed by the incense of addresses.” The complaint harked back to the primordial fear haunting all republics: “However highly we may consider the character of the Chief Magistrate of the Union, yet we cannot but think the fashionable mode |
of expressing our attachment... favors too much of Monarchy to be used by Republicans, or to be received with pleasure by the President of a Commonwealth.” Such doubts were rarely uttered publicly during the initial years of Washington’s Presidency. But they lurked in the background, exposing how double-edged the polit... |
imperatives of the American Revolution had become. To secure the revolutionary legacy on the national level required a person who embodied national authority more visibly than any collective body like Congress could convey. Washington had committed himself to playing that role by accepting the Presidency. But at the co... |
the Revolutionary legacy lay a deep suspicion of any potent projection of political power by a “singular figure.” And since the very idea of a republican Chief Executive was a novelty, there was no vocabulary for characterizing such a creature except the verbal tradition surrounding European courts and kings. By |
playing the part he believed history required, Washington made himself vulnerable to the most virulent apprehensions about monarchical power. He could credibly claim to be the only person who had earned the right to be trusted with power. He could also argue, as he did to several friends throughout his |
first term, that no man was more eager for retirement, that he sincerely resented the obligations of his office as it spread a lengthening shadow of public responsibility over his dwindling days on earth. If critics wished to whisper behind his back that he looked too regal riding a white |
stallion with a leopard-skin cloth and gold-rimmed saddle, so be it. He knew he would rather be at Mount Vernon. In the meantime he would play his assigned role as America’s presiding presence: as so many toasts in his honor put it, “the man who unites all hearts.” Exercising Executive |
authority called for completely different talents than symbolizing it. Washington’s administrative style had evolved through decades of experience as master of Mount Vernon and commander of the Continental Army. (In fact, he had fewer subordinates to supervise as President than he had had in those earlier jobs.) The Ca... |
he installed represented a civilian adaptation of his military staff, with Executive sessions of the Cabinet resembling the councils of war that had provided collective wisdom during crises. As Thomas Jefferson later described it, Washington made himself “the hub of the wheel,” with routine business delegated to the de... |
at the rim. It was a system that maximized Executive control while also creating essential distance from details. Its successful operation depended upon two skills that Washington had developed over his lengthy career: first, identifying and recruiting talented and ambitious young men, usually possessing formal educati... |
then trusting them with considerable responsibility and treating them as surrogate sons in his official family; second, knowing when to remain the hedgehog who keeps his distance and when to become the fox who dives into the details. On the first score, as a judge of talent, Washington surrounded himself |
with the most intellectually sophisticated collection of statesmen in American history. His first recruit, James Madison, became his most trusted consultant on judicial and Executive appointments and his unofficial liaison with Congress. The precocious Virginian was then at the peak of his powers, having just completed... |
triumphs as the dominant force behind the nationalist agenda at the Constitutional Convention and the Virginia ratifying convention, as well as being co-author of The Federalist Papers . From his position in the House of Representatives he drafted the address welcoming Washington to the Presidency, then drafted Washing... |
it, making him a one-man shadow government. Soon after the inaugural ceremony he showed Washington his draft of 12 amendments to the Constitution, subsequently reduced to 10 and immortalized as the Bill of Rights. Washington approved the historic proposal without changing a word and trusted Madison to usher it through |
Congress with his customary proficiency. One of Madison’s early assignments was to persuade his reluctant friend from Monticello to serve as Secretary of State. Thomas Jefferson combined nearly spotless Revolutionary credentials with five years of diplomatic experience in Paris, all buoyed by a lyrical way with words a... |
famously displayed in his draft of the Declaration of Independence. Alexander Hamilton was the third member of this talented trinity and probably the brightest of the lot. While Madison and Jefferson had come up through the Virginia school of politics, which put a premium on an understated style that emphasized |
indirection and stealth, Hamilton had come out of nowhere (actually, impoverished origins in the Caribbean) to display a dashing, out-of-my-way style that imposed itself ostentatiously. As Washington’s aide-de-camp during the war, he had occasionally shown himself to be a headstrong surrogate son, always searching for ... |
shadow. But his loyalty to his mentor was unquestioned, and his affinity for the way he thought was unequaled. Moreover, throughout the 1780s Hamilton had been the chief advocate for fiscal reform as the essential prerequisite for an energetic national government, making him the obvious choice as Secretary of Treasury |
once Robert Morris had declined. The inner circle was rounded out by three appointments of slightly lesser luster. Gen. Henry Knox, appointed Secretary of War, had served alongside Washington from Boston to Yorktown and had long since learned to subsume his own personality so thoroughly within his chief’s that disagree... |
became virtually impossible. More than just a cipher, as some critics of Washington’s policies later claimed, Knox joined Vice President Adams as a seasoned New England voice within the councils of power. John Jay, the new Chief Justice, added New York’s most distinguished legal and political mind to the mix, |
and also extensive foreign policy experience. As the first Attorney General, Edmund Randolph lacked Jay’s gravitas and Knox’s experience, but his reputation for endless vacillation was offset by solid political connections within the Tidewater elite, reinforced by an impeccable bloodline. Washington’s judgment of the a... |
myself supported by able co-adjutors,” he observed in June of 1790, “who harmonize extremely well together.” In three significant areas of domestic policy, each loaded with explosive political and constitutional implications, Washington chose to delegate nearly complete control to his “co-adjutors.” Although his reason... |
in each case, they all reflected his recognition that Executive power still lived under a monarchical cloud of suspicion and could be exercised only selectively. Much like his Fabian role during the war, when he learned to avoid an all-or-nothing battle with the British, choosing when to avoid conflict struck |
him as the essence of effective Executive leadership. The first battle he evaded focused on the shape and powers of the federal courts. The Constitution offered even less guidance on the judiciary than it did on the Executive branch. Once again the studied ambiguity reflected apprehension about any projection of |
federal power that upset the compromise between state and federal sovereignty. Washington personally preferred a unified body of national law, regarding it as a crucial step in creating what the Constitution called “a more perfect union.” In nominating Jay to head the Supreme Court, he argued that the federal judiciary |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.