been discussed extensively. In these cases, procedures are in place to ensure that patients can make decisions while unimpaired or can appoint persons of their choice to make these decisions if the patient cannot. Persons can execute advance-planning directives, durable powers or attorney, or living wills. Perhaps the impaired customer has already appointed a proxy decision-maker who can make the funeral plans. What should you do if you think your customer isn’t capable of independent choices, but he or she has not specifically appointed a decision maker? How can you protect the customer from others imposing their own wishes? Or, since the customer isn’t competent, does this statute even apply? Is the family the customer? Opinions vary: One could follow the wishes of the family, hoping that they choose what their loved one would have wanted, recognizing that they control the pocketbook. The legal procedure that declares someone incapacitated involves various steps: A state court probate judge will examine the person and decide as precisely as possible what the person can and cannot manage for him- or herself. The judge then appoints a guardian who has authority over the person’s affairs, financial affairs, or all affairs—depending on the extent of impairment. The judge must act according to two basic ethical directives: “First, do no harm” and “do good.” In some cases, it is difficult to communicate with the individual because he or she has aphasia—an inability to understand speaking or writing. The affected individual may also be unable to respond. Various forms of aphasia exist. It is most often caused by strokes or head injuries; in these cases, speech therapy can help. It can also result from neurological disorders, such as brain tumors or Alzheimer’s disease. There is also a rare, unrelated disorder called “primary progressive aphasia.” This condition typically begins with difficulty speaking and progresses to a near inability to speak. However, the person can still comprehend most information. Suggestions for communicating with a person with aphasia include the following: ● Be patient. Allow plenty of time to communicate. ● Be honest with the person. The provider or agent must let the person know if he or she cannot comprehend what the individual is saying. ● Allow the aphasic to try to complete his or her thoughts, to struggle with words. Avoid being too quick to guess what he or she is trying to say. ● If the customer can write, encourage him/her to do so and read it aloud. ● Use gestures or point to objects in supplying words or adding meaning. ● Use touch to aid in concentration, to establish another avenue of communication, and to offer reassurance and encouragement. For seniors with hearing trouble, aphasia, or cognitive difficulty, consider making a pictogram. Pictograms replace written language for people with limited hearing, speaking, reading, writing, or comprehending. A pictogram is a chart with pictures that represent objects or situations. Some pictograms even include symbols to indicate emotions or verbs, such as hearts for “love” or frowns for “dislike.” Pictogram developers suggest that one may use black and white only, to increase contrast. Besides symbols representing immediate needs, such as a glass for water, the pictogram could include pictures of kinds of services and events, such as open or closed casket funerals, places for a memorial services or receptions, pictures of caskets, urns, and other containers. The provider or agent can begin a sentence, such as “I need” or “I want,” and the customer need only point to the appropriate picture.
confusion, memory loss, and clumsiness. Since many seniors take a variety of pills each day, this problem is not uncommon. Switching or reducing medications, or changing when they are taken, can minimize these effects. ● Irreversible dementia : Although most people associate dementia with Alzheimer’s disease, other conditions can cause it as well. These conditions include strokes, tumors, head trauma, alcoholism, AIDS, and end-stage kidney disease. Additionally, Parkinson’s disease causes dementia in 80% of elderly Parkinson’s patients. Alzheimer’s is the most common form of irreversible dementia. The longer a person lives, the more likely he or she is to develop the condition. It is estimated to affect 30% of persons over 65 years of age and 50% of those over 80 years of age. It is estimated that 48% of those living in a nursing home suffer from Alzheimer’s. Of those, 64% of them are Medicare residents. The only way to confirm an Alzheimer’s diagnosis is by an autopsy, which reveals the nerve tangles in the brain. Alzheimer’s begins with memory loss. A person’s personality may change; a formerly gentle man, for example, may strike out at others. Alzheimer’s sufferers often have trouble hearing: This makes it even harder for them to understand information and to effectively communicate. As the disease progresses, the sufferer loses the ability to remember words, perform familiar tasks, and travel to familiar places. Eventually he or she needs help with activities of daily living, such as eating and dressing; finally, the sufferer can’t walk or speak. When communicating with persons with Alzheimer’s disease or other dementias, follow cues from family members. Ask the individual (or his or her family members) how to make things as clear as possible for the individual. ● Always approach the person from the front, or within his or her line of vision. Don’t suddenly appear. ● Speak in a normal tone; greet the person as you would anyone else. ● Face the customer when speaking to him or her. ● Be respectful of the person’s personal space and notice his or her reaction as you move closer. Maintain a distance of one- to one-and-a-half feet at first; minimize hand movements that approach the other person. ● Avoid a setting with too much sensory stimulation, such as a big room, where many people may be sitting or talking. Avoid noisy or busy areas. ● Maintain eye contact and smile. ● If a person is a pacer, walk alongside him or her as you talk. ● Use a low-pitched, slow speaking voice. ● Ask only one question at a time. ● Repeat key words if the person does not understand at first. A customer in the early stages of dementia may be able to make his or her own funeral planning decisions. Most states have laws, such as “The Colorado Disposition of Last Remains Act,” which specify that competent adults have the right and power to direct the disposition of his or her remains after death. These laws state that the competent adult should be protected from interested persons who may try to impose their wishes regarding such disposition that are contrary to the deceased’s desires. The exception to this is if a person has died, leaving an unreasonable declaration (or is inappropriate regarding finances, for example). Note that the decision maker must be competent and must be able to think rationally. If the customer cannot do so, someone else must make the decisions for him or her. When it comes to medical treatment, the issue of incapacity has
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