At what stage of dementia would you want to begin to speak with caregivers about safety with IADL performance (i.e. driving and money management)?
Answer
The answer would be as soon as possible. If you notice that somebody is having difficulty even at stage 2, you would want to begin to engage them and their caregivers in conversation about the problems that they have been having. For example, I might say, "I am starting to notice that you are having some trouble with this. Would you like to bring in your family in so we can talk about some of the things we are doing to make you as independent as possible?" Unfortunately, at the earlier stages, they may still be living independently and making their own decisions so you cannot go over their head and talk to their family. You have to walk a fine line because they are worried about losing control and that they are losing their independence. Again, the earlier you can begin to engage in this process the better as it can be a difficult topic for the patient to discuss.
Michelle Hediger, M.S., OTR/L
Michelle is an Occupational Therapist who currently is responsible for clinical program development and special projects for a large contract rehab provider. Prior to this role, she has held regional operations positions providing management oversight for post-acute rehab and assisted living settings. She has nearly 15 years experience as an Occupational Therapist across a variety of settings including skilled nursing, assisted and independent living, mental health and school based therapy. Her clinical areas of expertise include management and leadership, long term care programming and wellness program design and implementation. She spent four years as an Assistant Professor and Academic Fieldwork Coordinator at Suffolk County Community College, New York. She is an experienced program developer who has produced and presented training courses for healthcare professionals with a variety of backgrounds, including therapists, nurses, social work and long term care administrators. Her expertise in Geriatric management and education has led her to expand rehab teams and build innovative therapy programs across the geriatric care continuum.
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