Parkinson’s care at home

Parkinson’s medication is taken at set times, and a dose of levodopa usually works for somewhere between two and six hours before it wears off. Timing matters more here than in almost any other condition we work with. A dose taken an hour late can cost someone their afternoon.

Our caregivers remind, bring the tablets and a glass of water, and write down the time. They don’t decide doses, shift the schedule, or give injections. If the doctor or pharmacist has said the tablets work better away from a high-protein meal, we plan meals around that.

If the timing stops working, you hear about it. A caregiver who sees the same person every morning notices when a dose that used to last until lunch is fading by eleven. That is the kind of detail a neurologist needs and a short appointment rarely uncovers.

Freezing is the feeling that the feet have stuck to the floor. It usually strikes at the start of a step, in doorways, in tight spaces like a bathroom, and when a dose is wearing off. It is frightening, and it is a common way people fall.

What a caregiver does in that moment

• Never pulls on the arm. Pulling a frozen person forward is how they go down
• Gives a cue instead: counting out a rhythm, marching on the spot, or stepping over a line on the floor
• Asks for a wide turn rather than a pivot in a doorway, because tight turns are where freezing bites
• Clears the route first: rugs, cables, the dog’s bowl, the low table nobody notices
• Doesn’t rush. Hurrying is what turns a freeze into a fall
• Waits after standing up. Blood pressure can drop on standing with Parkinson’s, so a moment sitting on the edge of the bed is part of the routine

During the free consultation we walk the route from the bed to the bathroom, because that is where night falls happen, and tell you what we would change first: a light left on, a chair with arms, a grab bar, or moving the bed downstairs.

Two therapy programs come up constantly, and licensed therapists deliver both, not caregivers. LSVT BIG is physical and occupational therapy that trains people to make deliberately large movements. LSVT LOUD is speech therapy for the quiet voice, given as a run of sessions over several weeks. Ask the neurologist for a referral, because Medicare often pays for therapy a doctor orders.

What a caregiver adds is the practice in between: the exercises the therapist set, done at the time of day the person can actually do them.

The Parkinson’s Association of San Diego runs support groups, exercise classes including a mobility and stability class in Carlsbad, and the Tremble Clefs singing group, which is built around the voice. Rock Steady Boxing, a boxing-style class designed for people with Parkinson’s, runs at several places around the county, including North County and downtown San Diego. UC San Diego’s movement disorders program runs support groups as well.

A caregiver can drive your father there, stay, and bring him home. Getting to the class is the part that usually stops happening first.

• A morning visit, timed around the first dose and the shower, which is the hardest hour of the day for many people
• Twice a day, morning and evening, when the late dose and bedtime are both difficult
• Overnight, when getting to the bathroom at night has become the main risk
• Around the clock, later on, or after a fall or a hospital stay
• Respite, because the husband or wife doing this alone is usually the one who needs help first

Visits start at four hours and are billed at $40 to $48 an hour, depending on the care and the schedule. The in-home consultation is free, and care can usually start the same day.