Category: Benefits of Home Care

The role of depression and diabetes in the development of dementias in older adults

What are the symptoms of depression for older adults?  Does depression increase the risk of developing a dementia?  What is the impact of other chronic conditions such as diabetes?

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We mitigate the risk and continuation of depression. It is important to engage older adults in meaningful activities, not only to fight  depression, but also the development of other more serious conditions.

It is important for us to recognize these signs of depression in our older relatives and friends (“Depression in Older Adults”).   

  • Loose of interest socializing or in hobbies
  • Worries about being a burden, feelings of worthlessness
  • Slowed movement or speech
  • Neglect of personal care such as skipping meals, forgetting meds, neglecting hygiene
  • Lack of motivation and energy
  • Weight loss or general loss of appetite
  • Sadness or feelings of despair
  • Sleep disturbances, issues falling asleep, staying asleep, or beginning to sleep at different times

It is important to incorporate meaningful activities and interactions into the lives of older adults.  NursePartners has two company divisions dedicated to offering individualized companion and care services to older adults living in Philadelphia, Montgomery, Chester, and Delaware counties.  By involving your loved ones in meaningful activities early, you may stave off a development of a dementia, especially if the older adults are already dealing with chronic conditions such as diabetes.

In a population-based study of 2.4 million adults in Denmark, depression and diabetes were independently associated with greater dementia risk.  The combined association of the two disorders had a higher association with the risk of developing a dementia than the aggregate effects of the two dependent variables individually.

Covariates included martial status and its possible effect on depression and general health.

According to the study, “during the first year after depression, the associated hazard of all-cause dementia was elevated by nearly seven-fold”.  Additional periods of depression decreased the risk of developing a dementia in comparison to the first year but left the overall hazard ratio dementia risk rate about twice as high as those without depression (See Figure 1).  

This is a link to the full study, “Impact of Depression and Diabetes on Risk of Dementia In a National Population-Based Cohort”.

Other studies have focused on the singular impact of depression on dementia.  To learn more, consult the authors’ reference list in the study cited above.

 

Early Alzheimer’s disease diagnosis: Building Your Care Team

An early diagnosis of Alzheimer’s disease or another dementia can lead to a range of extreme emotions such as anxiety, depression, anger, or relief.  Although there is no cure for this progressive disease, with enough time the person living with dementia can prepare for the future.  The diagnosed person can establish the details of their own care before they are determined by others.

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        Effective caregiving requires a team and a plan.

If you are a family caregiver, you must also prepare yourself for the future instead of reacting to changes as they occur.  It is not possible for one person to attend to all the emotional and physiological needs of another adult in the face of a progressive and terminal disease.  Often intergenerational lines are blurred, and the caregiver assumes multiple roles.

The person living with dementia will increasingly depend on their caregivers.  If you are the only one, they will depend exclusively on you to make sense of the world as they experience changes to their vision, sight, coordination, and speech.  Their memory will be impaired as tangles and plaques increase, neurological connectivity is disrupted, and brain tissue atrophies and is removed from the body.

Often, we make the comparison between raising a child and caring for an older adult.  However, unlike a child, older adults have collected a lifetime of experiences, even if they are no longer able to communicate them.  These experiences give older adults a sense of pride and expectations for how they are to be treated.  Even if they are unable to articulate their wants, they have established a sense of pride.  Eventually they will depend exclusively on their caregivers for assistance.  This means if you are the only caregiver, they will depend on you for 100% of their needs.  When building a relationship, it is important to incorporate the client into their own plan of care.  This is done easiest earlier in the disease progression.  If you wait too long to incorporate other caregivers into your team, the care recipient may be unwilling to accept care from anyone but you.

Even if the caregiver thinks they are physically able to provide care on their own, this care is ineffective.  Extreme stress inhibits our ability to perform our best.  Family caregivers often suppress their own needs and wants to attend to those of the person living with dementia.  Family caregivers find that they are completing the tasks, but without connecting to the care recipient and making mistakes that often lead to confrontation with the care recipient.

If you find yourself frustrated when providing care, consider evaluating yourself for signs of stress.  Click here to complete the assessment.

Qualified professionals are available to help you with the stresses associated with caregiving.  The Lutheran Settlement House offers a free Caregivers Reducing Stress program that creates an individualized program for you in the comfort of your own home.  This program is available for those living within Philadelphia County.  If interested, please visit their website here.

Have you built an effective care team?  Even if your stress levels are tolerable now, you will eventually need help.  Acting now prevents inadequate care and stress in the future.  It allows us to learn the stories of your loved one in time, so we can incorporate them to effectively connect while providing care.

Let us form part of your care team, call 610-323-9800 or complete this form.

 

NursePartners’ coordinates grocery services for our clients

Grocery shopping is not just a chore, it’s essential.  Older adults are especially susceptible to malnutrition (World Health Organization).  It is important that they receive enough nutrition for their bodies to operate well.  Although they may need less calories than younger people, older adults still need to consume the same nutrients.

This population is at increased risk for malnutrition if they have a few of the following risk factors, as identified by Frank W. Jackson, M.D.,

  • in general poor health
  • poor eating habits
  • sudden and unexpected weight changes
  • taking multiple medications
  • poor dental health, especially dental deterioration
  • economic difficulties, causing the older adult to not spend money for their own nourishment
  • loneliness and lack of social contacts; eating is a social activity
  • cognitive impairments that no longer allow the older adult to care for themselves

Remember that the senses are also changing for older adults.  If a food no longer tastes good, it becomes less desirable.  Try using new seasonings and pepper to revive old favorite foods (Elder One Stop).

It is important not only to buy and consume the groceries, but to discard those that have already expired.  Eating an expired food item puts you at risk for food poisoning.  Common symptoms include diarrhea, vomiting, fever, nausea, and dizziness, among others (Health: One How To).

 

NursePartners coordinates grocery orders for clients.  We want to ensure that they are eating a well-balanced diet, consuming enough calories, and avoiding expired items.  Carepartners record what the client eats for each meal.  They do a weekly inventory all items in the refrigerator and cabinets and gives a report to our Administrative Assistant, Tarika Kirkley.  Tarika purchases the groceries online and coordinates the delivery.  A carepartner will be present to confirm the items received and place them away.

As you involve us in the process, it frees you time to enjoy the older adults in your life doing other activities.  To learn more about this and other services, call 610-323-9800.

 

Overview of the GEM levels

NursePartners practices the GEMTM level approach to connect with our clients living with dementia.  One of the first things we teach carepartners is to find new ways to say hello.  Depending on a client’s GEMTM stage, we need to communicate through engaging other senses.

Each of our clients receives an activity basket and customized plan of care.  Carepartners help engage older adults in meaningful projects and activities of daily living.  A nurse visits clients biweekly to ensure the success of our approaches and address signs of progression.

NursePartners admin have all completed the GEMTM training and include dementia coaches and practitioners.  We are committed to honoring our clients and assisting their families.

 

Tips for the Holidays – a collaborative piece from the National Aging in Place Council

NursePartners is proud to be a co-founder of the National Aging in Place Council of Philadelphia.  Monthly we meet with other vetted service providers to determine how we can best support older adults as they age in place.

National Aging in Place Councils from across the country have collaborated to prioritize five tips we can offer families during the holiday season.  The original post below has been supplemented by additional tips from NursePartners.

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Tips for the Holidays from NAIPC

      As the holiday season approaches, NAIPC members would like to offer seniors, caregivers and family members some health and safety tips for enjoying the holidays with loved ones.NAIPC members compiled a list of the five most common things that normally concern seniors, caregivers and their families.  We recommend that all stakeholders remain vigilant to minimize the risks and effects of the issues below:

  1. Isolation

  2. Safety

  3. Nutrition/Health

  4. Finances

  5. Transportation

      1. Isolation. Many older adults who have raised families, or been a central figure in their community, are now at a place where those roles are no longer part of everyday life. This leaves them searching for where they fit in the bigger picture and this is especially true during the holidays. It’s important for them to feel their participation is valuable and meaningful. Here are some ways you can mitigate isolationism:

  • Social visits include busy and quiet environments.  If your loved one is living with dementia, consider minimizing excessive noise and chaotic environments.  Try driving around your neighborhood to look at the holiday lights.
  • In they are unable to stand in the kitchen, have them sit and decorate cookies. You are involving them in the process, but also preventing the activity from being exhausting or overwhelming.
  • Reduce lengthy travel for older adults during the holidays.  Try suggesting that younger family members reunite in the home of the older adult.  If not, plan a virtual visit.
  • Older adults have rich stories of past holidays; incorporate these into your traditions and watch how they feel honored and valued.
  • Decorate as an intergenerational affair. From the youngest to the oldest, memories will be built when everyone can participate.

      2. Safety is a big concern, whether it be safety from the elements or safety from the unknown.

      For those aging in place, whether living alone or with the assistance of a caregiver, winter weather can be treacherous. It’s important to ensure that walkways and driveways are cleared of snow and ice before venturing out.  Hire someone to shovel pathways and salt sidewalks. Additionally, it is wise to keep a supply of candles, matches, food, extra blankets and medications at the ready.  If the older adult is living with dementia, consider having someone stay with them during snow storms.  Arrange for a groceries to be delivered before the storm, either online or by a relative or friend.
      Only use flame-resistant decorations and keep power cords away from heavily trafficked areas. Do not leave lights unattended and always assist the older adult while they are decorating.

      3. Nutrition/Health. It is always important to manage a sensible diet, but especially over the holiday season with the rich foods and drinks, that could potentially be detrimental to anyone with a risk of diabetes, heart disease or worse. Encourage those at risk to limit consumption, by taking smaller portions and balancing their diet, or avoid holiday treats altogether.

      4. Finances. We all cope with the financial pressures that our society imposes on us as we approach the holiday season.  We need presents, trees, decorations, festive meals, and constant entertainment.  This can certainly deplete the funds for someone living on a budget.

  • Consider going to another relative’s house rather than cooking a meal yourself.  If this is not an option, consider ordering a meal from somewhere like Boston Market.
  • Minimize holiday decorations by purchasing a table top tree.  This would be more manageable and easier to dispose.  Use holiday decorations that you already own.
  • Shop online for the best holiday deals to save on gifts for family members.  Assist an older adult with this process!
      Beware of charitable fraud.  Checking the IRS website for legitimate charities could be a lifesaver.

      5. Transportation. Whether it be local or long-distance travel, transportation becomes a larger issue around the holidays. Either it’s the inaccessibility of running errands or it’s waiting in long lines, navigating airports and security, claiming baggage and meeting up with relatives.  Don’t subject an older adult to these inconveniences.   Instead, celebrate your holidays by traveling to them.

The holidays are supposed to be full of joy, love and family. So, keep your family safe and happy this year.

      HAPPY HOLIDAYS from all of us at NAIPC!

Visual Cues and Decluttering for Those Living with Dementia

On Monday, November 13 at 12:30pm the National Aging in Place Council of Philadelphia will present on dementia and the importance of decluttering.  The program is titled “Visual Cues and Decluttering for Those Living with Dementia”.  It will be hosted at the Presbyterian Church of Chestnut Hill.

The goal of the seminar is to educate participants as to how dementia changes our senses and our responses towards external stimuli. Understanding the disease progression is crucial for being able to successfully adapt and to begin the dialogue of decluttering. 

Older adults thrive in an organizes and simplified environment.  By reducing clutter, older adults will be able to find the items they need and minimize the risk of falls.  However, even given the risks, the actual tasks of organizing and decluttering needs to be handled in a sensitive way.  The disposal of an item does not imply that we are forgetting experiences. 

We will also discuss the physical removal of items from the home.  This step must be done in a sensitive way too, understanding that each individual values items differently.  The removal is done in a responsible manner, always considering the possibility for donation, resale, and recycle.   

The presenters are founding members of the National Aging in Place Council (“NAIPC”) of Philadelphia.  Together the NAIPC serves as a consortium of industry leaders who hold themselves to ethical standards in their commitment to helping older adults age in place. 

If you would like to join us next Monday , please email philadelphia@ageinplace.com

Our presenters include:

  • Bode Hennegan, Life Managers & Associates
  • Bill Read, JDog Junk Removal & Hauling
  • Peter Abraldes, NursePartners, Inc.

 

Understanding Behaviors and Adapting Approaches in Dementia Care

Your role as caregiver, family member, or friend evolves with the progression of dementia.  Even faced with challenging behaviors, you can still connect with your loved one and fill their day with meaningful activities.  NursePartners is here to support you while your relationship evolves with the person living with dementia.

 

What is their behavior telling you?

We are constantly learning more about the brain’s ability to comprehend messages.  This includes messages that are delivered through speech versus writing, in a crowded space versus a one-on-one situation, or even a familiar voice versus one of a stranger.

Alzheimer’s disease and other dementias can cause people to act in unpredictable ways. Some individuals become anxious or aggressive while others repeat certain questions or gestures. Messages can be misinterpreted, surprising both the care recipient and caregiver. These types of reactions lead to misunderstanding, frustration, and tension.

It’s important to understand your loved one is not trying to be difficult and that these behaviors are also forms of communication.

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Tips for managing behavioral changes

As carepartners, we need to adapt our delivery process throughout the progression of the disease. When we carry on a traditional conversation, we usually engage in a back and forth volley of information. When a person is diagnosed with dementia, it is important to realize that the three essential language skills for processing and sharing verbal messages need to be supported in different ways. These core linguistic skills are:

  • Vocabulary (the words – the meaning of the content)
  • Comprehension (receptive language – the ability to process the message)
  • Speech production (expressive language – the ability to deliver the message)

Certain retained skills will assist you in conveying a message:

  • Social chit-chat (the back and forth that can mask loss of comprehension, but covers in short simple conversations)
  • Rhythm of speech (this includes awareness of the rhythm of a question that is seeking an answer, as well as ability to sustain rhythm or hear a rhythm that sounds familiar).  Additionally it can and does signal changes in emotion – changes in frequency, intensity, or volume can indicate shifts in emotional state or discomfort.
  • Rhythmic speech as is present in music, poetry, prayer, counting and even spelling.

What you can do:

There are important supportive phrases that can help when they are used in combination with pauses, inflections, visual cues, props, and partial reflective statement to confirm what was said or south:

  1. Seek more information by being nonspecific, try phrases such as  “Tell me more about it.”
  2. Seek demonstration or visual representation with phrases such as  “Could you show me how you would use it?” or“Show me how you’d do it.”
  3. Offer simplified options, by using two options at a time, or encouraging yes/no responses.  Employ the use of object pronouns.

What can help:

Awareness, knowledge, skill and support for both parties.

Mary Stehle, licensed social worker and Senior Care Advisor says, “A person with Alzheimer’s who has lost the ability to understand and communicate through language is always looking for cues from us as to how to interpret the world. They are constantly reading our tone of voice, facial expressions, and body language. When we are tired, stressed, and resentful, they pick up on this and it often impacts them negatively.” It’s important to remember that asking for help is not an act of selfishness, it’s providing better care for both you and your loved one.

We can be by their side when you can’t be. If your loved one need home care assistance or relief – Contact us today.

NursePartners is committed to providing uncompromised care to those living with a diagnosis of dementia. Our carepartners work with each family to enable safety, comfort and happiness through home-care services.

Understanding Fall Risks

Falls are a common and serious problem affecting many older adults. Individuals suffering with Alzheimer’s disease or another form of dementia however, are twice as likely to experience annual falls and fractures. This varies from a range of factors including medication, night waking, shuffling, weakening musculature and balance. The first step in protecting your loved one from a serious injury associated with a fall is understanding the risk factors.

 

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The following are common causes of falls:

Health Conditions

While everyone is at risk for falls, older adults are at the greatest risk due to chronic health conditions such as heart disease, arthritis, low blood pressure, Parkinson’s disease, dementia and other cognitive impairments. While some individuals in the early stages of Alzheimer’s are in excellent physical condition, many others seem to develop difficulties before cognitive impairment even begins. As Alzheimer’s progresses, it can cause lack of coordination, muscle weakness and diminished joint flexibility.

Reaction Time

As we get older, the nerves that carry information to and from the brain deteriorate. This slows reaction time and the ability to navigate around obstacles. This can be hazardous as seniors do not react as quickly in dangerous situations.

Medication

Many medicines also have side effects, causing dizziness, drowsiness and impaired vision.

Environmental Hazards

Many times, falls can happen because of environmental factors and hazards found throughout the home. These include everything from wet or slippery floors, poor lighting, to tripping hazards such as loose rugs, uneven floors, and trailing wires.

Visual-Spatial Problems

Because Alzheimer’s disease can affect the visual-spatial abilities, an individual can misinterpret and misjudge steps, uneven terrain, shiny areas on the floor or changes in floor color.

What you can do:

  1. Identify the risk factors for your loved one. Many people with Alzheimer’s and dementia suffer from poor eyesight, shuffling gait, muscle weakness and generalized frailty.
  2. Minimize or avoid medications that have been linked to falls. People with dementia are also more likely to fall when taking sedatives, tranquilizers, and antipsychotics.
  3. Exercise is important in preventing people from falling, especially if it includes balance and strength exercises. Ask the doctor about leg strength, gait, and balance evaluations. These tests help can determine physical risk factors.
  4. Consider a physical therapist or occupational therapist. These experts can work with your loved one to develop exercises strengthen joints.
  5. Make sure your loved one has eye tests regularly. Low vision is a huge risk factor for falls, and many vision problems come on gradually but steadily.  NursePartners’ use of theGEMTM methodology will also alert us towards changes in vision.
  6. Finally, get a home-safety assessment. Carepartners routinely perform these and can target danger spots and suggest easy improvements. This assessment can focus specifically on the needs of your loved one.

If you or a loved one is thinking about home care assistance, our team would love to help. Contact us today.

 

Sources:
Heerema, Esther. “Common Causes of Falls in People with Dementia.” Verywell.com. N.p., 31 Dec. 2015. Web. 30 May 2016.
 Perkins, Chris. “Dementia and Falling.” Continuing Medical Education 35.1 (2008): n. pag. Web. 31 May 2016.

Daily Care: Late Stage Alzheimer’s Disease

How can we, family and carepartners, support the people we know living with Alzheimer’s disease or another form of dementia?

Keeping loved ones stimulated and providing ability-based care and support cannot be overstated. At NursePartners, we recognize the GEMS™ model as an effective method for providing a treatment plan for individuals affected by dementia.  Click here for an introductory overview of the classification system describing the stages of the journey.

By appreciating what is changing and what is still possible, we can provide care that is more effective and less challenging.

 

Stage 3 – Severe/Late (lasts about one 1-3 years) – Rubies and Pearls

As dementia moves into the final stage, it can be difficult to know how to meet needs. Many lose their ability to control movement and respond to the environment. As memory and cognitive skills worsen, your loved one may need extensive help with daily activities.

The goal of care at this stage is to focus on preserving dignity and quality of life. Although your loved one may lose the ability talk and express needs, you can still connect with them, enjoying interactions and experiences of their past life.

 

About Rubies and Pearls

Rubies

Rubies experience late stage changes as fine motor skills are very limited. Losses in depth perception, as well as limited visual awareness and major sensory changes result in needed assistance with utensils, brushing, buttoning and moving. Hand-under-hand assistance helps rubies feel safe and secure. Suggested activities together include: reading, playing music, and looking through old photos.

Pearls

Pearls are still and quiet, unable to actively move or respond, with limited awareness of the world. Pearls enjoy pleasant sounds and familiar voices, grasping onto moments of connection.  Whether it’s the smell of their favorite perfume, or a beloved radio program, these small experiences can help capture a moment in time and evoke pleasant memories. Being present, patient, and understanding with your loved one will help them escape feelings of isolation associated with late stage Alzheimer’s.

Planning the Day

  • Tailor the environment with the interests of your loved one. This can allow them to emotionally connect to things they previously enjoyed.
  • Plan the days to have a balance of restful and active periods to help your loved ones transition slowly and gradually from one to the other.
  • Observe the person for signs of stress. Keep lights low and noise to a minimum. Consider visiting in smaller numbers.
  • Use your voice to engage and encourage, talking quietly to tell stories and reminiscing about past events.
  • Discover which eye they use for vision.  Do not obstruct their line of site and get on or below eye level when speaking with them.

At this point in the disease, the world is primarily experienced through the senses. You can express your caring through touch, sound, sight, taste and smell.

Activities for Rubies and Pearls

  • Playing their favorite music
  • Reminiscing about past events
  • Reading portions of books that have meaning for the person
  • Looking at old photos together
  • Preparing a favorite food
  • Rubbing lotion with a favorite scent into the skin
  • Brushing their hair
  • Sitting outside together on a nice day

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NursePartners is committed to providing uncompromised care to those living with a diagnosis of dementia. Our carepartners are trained in the Positive Approach to Alzheimer’s and Dementia Care (GEMS™) and work with families to enable safety, comfort and happiness through home-care services.

If your loved one need home care assistance or relief, our team would love to help.

Contact us today.

 

 

Daily Care: Moderate Stages of Alzheimer’s Disease

We can support the people we know living with dementia by keeping them mentally stimulated and providing ability-based care and support. At NursePartners, we recognize the GEMS™ model as an effective method for providing a plan of care for individuals living with Alzheimer’s disease or another form of dementia.  Click here for an introductory overview of the classification system and to understand the stages of the journey.

By appreciating what is changing and what is still possible, we can provide care that is more effective and less challenging.

 

Stage 2 – Moderate/Middle (lasts 2-10 yrs) – Emeralds and Ambers

At NursePartners, we use the “Emerald” or “Amber” classification for clients with moderately developed dementias.  We prefer this terminology because we know that all clients are operate at their best with the right approach to care.

A client normally persists in the Emerald and Amber stages the longest out of the other GEM levels. During this time, damage to the brain can make it difficult to express thoughts and perform routine tasks. It is important to allow your loved one to be involved in their day-to-day routine. Provide meaning through relevant activities that were part of their past because this will provide them with a sense of self-worth and add to their quality of life.

There will be acute changes to their self-awareness and senses.  We need to be able to distinguish daily changes and overall trends.  By having an established relationship with the client, we are also able to tell the difference between a client’s personality quirks and further developments of the disease.

 

About Emeralds and Ambers

 

Emeralds

Emeralds may get lost in time, thinking that are in another place or assuming a former role. They have problems with communication and comprehension, often asking questions that begin with “who”, “what”, “where”, and “when”.  At this GEM level, clients are making small mistakes with their personal care, but may not recognize it.  Some examples of this might be fastening buttons in the wrong holes, putting shoes on the wrong feet, or not changing clothing or brushing hair before leaving the home.  It is not important that we “correct every mistake”, but make changes subtly by using the right approach.  Sometimes this requires relating to the “mistake”, by discussing how we do this ourselves.  We could also pull out another piece of clothing and convince the client how good they look in that particular piece.

Emeralds are most comfortable when doing familiar tasks. They like to engage and help others, as well as feeling like they have a purpose. At a family functions, engage them by asking to help set the table and then clean it up. Choose favorite activities or hobbies of the past, but do not impose time limits for completing each task

Activities at home

Activities around the house can help Emeralds feel involved and provide a sense of normality. Activities such as setting the table, watering plants, and cooking can reflect past hobbies and interests, and can be a good way of retaining skills. Helping in the kitchen can also bring people together, as many experiences revolve around meals: holidays, birthdays, church potlucks, summer barbecues, weddings. Some activities for Emeralds include:

  • Cooking: salads, ice cream, Jell-O, pudding, no-bake cookies and pies, etc.
  • Copying recipes from magazines onto cards
  • Making a grocery list of items needed for recipes
  • Setting the table: Folding or rolling silverware into napkins

 

Ambers

Ambers like to live in moments of time, and are focused on sensation – manipulating, gathering and touching.  They are focused on wants and needs, and sometimes are exploratory without safety awareness. Their communication is limited with difficulty understanding and expressing needs, so activities selected need be familiar and sensory stimulating. Ambers may enjoy sing-alongs or being in visually stimulating outdoor locations.

Family members find it hard to find new ways “to say hello”.  We need to remember that there are other ways to communicate beyond verbally.  This is the time to start using those our methods.

Some activities for Ambers include:

  • Sorting nails, screws, and other hardware.
  • Organizing nail polish and lipsticks by color and shape.
  • Grouping coins, according to date, value or place of origin.
  • Rearranging the order of the silverware drawer by forks, spoons and knives.
  • Categorizing playing cards into decks or suits that match.

Planning the Day

  • Make a schedule and follow it: be structured but allow flexibility.
  • Offer a variety of activities everyday: leisure, work, rest, and self-care.
  • Create a flow for the day: build up and then slow down.
  • Build a foundation of familiar and favorite activities.

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NursePartners is committed to providing uncompromised care to those living with a diagnosis of dementia. Our carepartners are trained in the Positive Approach to Alzheimer’s and Dementia Care (GEMS™) and work with families to enable safety, comfort, and happiness through home-care services.

If your loved one need home care assistance or relief, our team would love to help.  Contact us today.