There is a technique called validation. This process allows caregivers or family members to approach their relative with memory loss without the argumentative struggles.

Q: My mother has dementia. As her memory loss progresses she is becoming more argumentative and what I call stubborn. She won't listen to reason and I find myself more frustrated talking to her and unable to redirect her when she is focused on a topic. Is there anything I can do so I do not feel so frustrated and end up feeling like I am in battle with my mother?


A: There is a technique called validation. This process allows caregivers or family members to approach their relative with memory loss without the argumentative struggles.


For example, if your mother refuses to get dressed, you may want to say to your mother, "It is OK if you do not want to get dressed." Then show her a shirt and let her know that the color of that shirt highlights her skin tone and makes her look younger. If you approach your mother and tell her the shirt she is wearing is dirty or she has worn it for two days, she will disagree with you and you will lose the argument.


Your mother sees herself as competent and able to dress herself and keep herself clean. She sees your comments as negative and it brings up negative emotions.


With validation therapy it is best to show support and understanding. Try not to get caught up if something does not make sense, but remember that emotions are valid and driving all comments made by your mother. It is not easy to change habits and your approach. Pick and choose your battles; some are not worth fighting. Approach is very important with your mother. You can find more on validation therapy if you do a Web search on the words "validation therapy in dementia."


Q: My father was in the hospital for two days and then transferred to a rehab setting. I was told that my father's Medicare insurance would cover his stay at the rehab. Once at the rehab the social worker informed me that my father does not have insurance coverage because he did not spend three nights in the hospital. I immediately took my father home. Did the hospital caseworker or physician know about the three-night rule? I am very upset my father was transferred to a rehabilitation setting and then returned home. It was a nightmare for all of us.


A: Yes, the caseworker did know about the three-night rule. In the Medicare booklets it states that Medicare will cover rehabilitation if the senior had a three-night hospital stay. The rule is three midnights in the hospital with an order for "admission." The emergency room does not count as a night in the hospital toward the three-night rule. Also, some seniors are not "admitted" but put instead in an "observation unit."


If your father was initially under "observation" for the first night then it would not count as a night in the hospital. The night of observation has different billing rates. Medicare does not count a night in the hospital under "observation" as one of the three nights needed to put the Medicare benefit in effect for rehabilitation.


Next time your father is in the hospital and there is a discussion of him being admitted, ask the caseworker if the physician wrote "admitted" or "observation" in the orders. If the physician writes "admitted," then the first midnight is counted toward the three qualifying days in the hospital.


ElderCare Resource Services is a partnership of geriatric nurses and social workers that helps families to investigate, assess and recommend medical and non-medical care and resources for seniors. Send questions to SeniorSavvy@ElderCareResourceServices.com or ElderCare Resources Inc., 29 Gano Road, Marlborough, MA 01752, or call them at 508-879-7008.