Category: Connecting

ARTZ Philadelphia Opens the Doors to People Living with Dementia

NursePartners seeks out resources for family members of clients living with dementia  We find that children and spouses often find themselves burdened with their new role as caregiver, forgetting how to connect with their loved one on other levels.  Programs such as ARTZ Philadelphia brings the client and their caregiver together to talk about what they learn.  Caregivers are often surprised by how they are able to reconnect with their family members or clients.

 

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The following answers were provided by Susan Shifrin, Founder and Executive Director of ARTZ Philadelphia.

 

 

How do families participate in your program?

In our museum programs, people with dementia diagnoses and their family members come together to engage in conversations that we facilitate about art.

Carepartners and those they love to participate on an even footing.  What ends up happening is that participants rediscover the joy of conversing with one another about things other than illness.

The carepartners tend to witness their loved ones behaving differently than they might at home.  They see their wit, their humor, their intellectual engagement with the art and with others in the group. This can remind the carepartners of all the attributes they love about the people they are caring for.

 

What is the cost of admission?

Absolutely free.

 

Can I bring my loved one if they are in a wheelchair?

100% yes.  All of our ARTZ @ The Museum sites accommodate individuals in wheelchairs.  When people first register for our programs, we send them an informal survey to assess their particular needs before their first experience with us: do they have low vision, are they hard of hearing in one ear, do they require assistance walking?  When we set up the seating for our programs, people in wheelchairs will be front and center for group conversations.

We do our best in general to ensure that participants are physically positioned to take the most from the program.

 

I am a professional carepartner, not a family member.  Can I still attend?

Absolutely.  We had a wonderful woman named Eve who came to museum programs for three years, hardly missing one.  Eve came with her professional carepartner.

After Eve passed away, the professional carepartner approached ARTZ director about assisting other clients.  Now she accompanies a new client to the program.

The carepartner was almost as beloved as Eve by the original group.

The connection is the same for all attendees.

 

I am not an art history expert, is this the right program for me?

Our programs aren’t about art history or expertise (though both are welcomed if participants bring them).  It is about being in the moment and connecting with other people around a work of art.

80% of participants start by saying they do not know anything about art.  They end up being the liveliest and most opinionated about art, receiving validation by group.

 

What other similar resources are available to me?

ARTZ has one program specifically for carepartners, called Cafes for carepartners.  This is to give carepartners time to do things they believe are fun, engaging, and stimulating with others who know what they are going through.  These cafes are not support groups, though they offer supportive experiences. While care partners sometimes choose to talk about their caregiving experiences with each other, just as often, they don’t. It’s completely up to them to set the agenda.

Cafés for Care Partners also offer opportunities to tour gardens and museums.  When we are about to partner with a new museum or art center, we invite our care partners to vet the new sites before we incorporate them into our programs.

ARTZ is hoping to develop new programs around music.

ARTZ has a partnership with Jefferson that pairs people living with dementia at various stages  and/or care partners (both are called “mentors”) to medical, nursing, pharmacy, and occupational therapy students over a period from six to eight weeks.  The program participants first get to know one another through shared experiences around works of art.  Over time, students get to know those with the diagnosis as people first, through series of one-on-one encounters.  Mentors teach future healthcare providers what it means to live with dementia, from the inside out.

Health professions students tell us that they are reminded why they chose to go into medicine through this program.  They went into medicine to make human connections.

 

If I want to go to your next event, what should I do?

If you have access to the Internet, go to website www.artzphilly.org.  Choose “participate in a program” on the home page.  You will see “ARTZ in the museum”.  Click on this.

The new page will tell you more and what you can expect.  Go to the section “Explore Upcoming Events”.  There is a little button next to the program that says, “Register Now”.

If you do not have access to the web, you can make a phone call to Susan, 610-721-1606 and she will make sure you are listed on the program.

There is a monthly newsletter, you can sign up for it via the website (https://www.artzphilly.org/) of their Facebook page (https://www.facebook.com/ARTZPhiladelphia/).

Patience when caring for someone living with dementia

Patience is crucial when caring for someone living with dementia.  Often times the burden of care falls uneven on a spouse or a child who lives close to their parents.  It takes us a while, if at all, to realize that it takes more than one person to support another living with dementia.

When an interaction is not going as planned, we suggest the following steps:

 

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1.) Step Back: It is okay to not have an immediate response.  Think before you react and ensure your facial and body language matches your words.  We want to make sure we are engaging visual stimuli before offering a verbal message.  As Teepa Snow suggests, engage the senses by offering cues in the following sequence: visual, verbal, touch.

If the person living with dementia is doing an undesirable activity, consider if the activity is dangerous to them or others.  If it is not, reassess the urgency of change.  Could this be a moment for connection?

 

2.) Respond instead of Reacting: A thorough response requires doing the analysis to see why we seek to change the current behavior.  Are we imposing our logic on their situation?  Could it be that we are not taking the time to enter their reality?  This can be a mentally draining task and is one of the reasons why caregivers become frustrated with the person entrusted in their care.

Sometimes we are not trying to correct a behavior, but rather a narrative.  A person living with dementia might be time traveling or experiencing a hallucination.  Instead of trying to reorient them to reality, take that time to ask them questions about their past or their visions.  Often times we can find our best moments of connection by patiently requesting that they tell us more.

Throughout our response, we want to incorporate the art of substitution before subtraction.  If we want to remove something from their hands, offer them something else to hold first.  If we want to free them from a hallucination, ask more questions.  Often times they will reach a point where their mind no longer can describe the often that does not exist.

 

3.) Make plans, but expect them to change: Put your agenda in your back pocket.  It is often very difficult for non-caregivers to understand why it takes so long to accomplish the activities of daily living.  Why does it take an hour to take a shower?  Why does it take two sittings to finish a meal?

Our approach matters, and unlike caring for a child, an older adult has lived a long life and is used to be being treated with dignity and respect.  Although their memories may have faded, these feelings of pride are deeply engrained.  We need to go with their flow, not the other way around.  We need to take extra measures that may not seem “logical” in order to satisfy their emotional needs.

A classic example of this would be wrapping a towel around the care recipient in the shower.  Although this might make the cleaning process more challenging, it allows the person being showered to feel less exposed to caregiver.

 

4.) Figure out what you can and cannot control:   We need to remember that activities are a means to connect with the person living with dementia.  If we are playing a known game, it is okay to throw out the rules.  For example, instead of playing a card game, why not sort the deck?  As the disease progresses, your loved one might derive more comfort from holding items versus sorting them.  This is okay.  We are learning to adapt to their changing senses and using these to find new ways to say hello.  If you are unfamiliar with GEM levels, learn more here.

Here are some ideas for activities for someone living with dementia.  At NursePartners, we provide activity baskets to our clients living with dementia.  These typically include coloring, puzzles, and cards.  Activities are introduced and rotated out as interests or abilities change.

 

5.) Take care of yourself: We impose our logic on the person living with dementia, but fail to apply it to ourselves.  No matter how much help you have, you also need a break!  Caring for a person living with dementia can be a daunting task.  If you are emotionally drained or physically inept to perform your role, you become less helpful for the person needing your care.  It is not selfish, but rather essential, to take time to enjoy your life and keep yourself healthy.  

Please ask us for more support resources.  NursePartners is a founding member of the National Aging in Place Council of Philadelphia.  We invest our time in this organization in order to comfortably refer you to resources in our community, some of which are free.

 

This article was inspired by Teepa Snow and a post by AgingCare.com.

 

 

 

 

 

Making mealtimes easier

Family members and caregivers play an important role in identifying eating-related problems of those with dementia. Mealtimes can be made easier by implementing a variety of strategies that promote independence.

These are six common problems and solutions:

Cognitive issues: include the inability to express needs or desires. Sometimes they forget to eat or are unable to distinguish food from the plate as a consequence of changing visual and spatial abilities.

  • Solution: Set an alarm clock or a phone call as a useful reminder for mealtimes. Snacks that don’t need to be refrigerated can be left out where they are easily seen.  Use contrasting plates with placemats.  Remember to keep water or another beverage within sight.  Your loved one might not always be able to tell you when they are thirsty.

Physical problems: include the inability to hold and use utensils; proper posture; fatigue; vision impairment; decreased depth perception; mouth sores; gum disease; dry mouth; poorly fitting or missing dentures; chewing or swallowing problems (dysphagia); and inability to move food inside the mouth.

  • Solution: Finger foods can be a nutritious and easy alternative, enabling a continued level of independence. If the person’s head tilts backward, move it to a forward position while allowing them to eat at their own pace.  You can also use double hand-under-hand to simulate the motion of the person feeding themselves.  This often is the most effective approach.

Menu-related concerns: include an overwhelming amount of choices; unappealing food presentations, smells, flavors, or textures; and foods that from the individual’s personal, cultural, or religious preferences.

  • Solution:  Keep long-standing personal preferences in mind when preparing food.  Understand that new food preferences usually develop. Simplify mealtime by serving one dish at a time.  Whenever possible, engage the care recipient in the process.  Let them express their likes and dislikes and adjust the offerings accordingly.

Lack of physical activity: can decrease appetite.

  • Solution: Encourage simple exercise, such as going for a walk, gardening, or washing dishes.  If your loved one is enrolled in a physical therapy session, try to incorporate the physical therapy suggestions.

Environmental issues: can be noise, visual stimulation, poor lighting, and temperature.  These  all have an effect on your loved one’s ability to eat.

  • Solution: Try serving meals in quiet surroundings, away from the television and other distractions. Keep the table settings simple. Avoid any table arrangements that may distract or confuse the person.  Use only the utensils needed for the meal.  Vision changes for all older adults, but especially for those living with dementia.  Remember that you will need to approach from the right angles in order for them to see you.

New medications or a dosage change may affect appetite.

  • If you notice a change, call the doctor.

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It is common for individuals in later stages of dementia to lose a considerable amount of weight. Physiological changes associated with aging, such as decreased thirst and hunger perception, can further complicate nutrition and hydration status in dementia patients.

 

It is important to address a decreased appetite while still making the most of your loved one’s abilities. Adapt recipes to enable self-feeding abilities at mealtimes, These are important opportunities for them to make choices.

Effective Communication Strategies

Tomorrow Angela Geiger will present on behalf of the Alzheimer’s Association. Angela is a certified dementia practitioner, registered nurse, and founder of NursePartners, Inc. We have been servicing older adults living with a diagnosis of dementia since 2002.

Effective communication is crucial for establishing a good relationship between the carepartner and the care recipient. You will learn new ways to “say hello” and connect as the disease progresses. Angela will show us how to incorporate the Positive Physical ApproachTM into daily interactions to make them more meaningful and successful.

She will also explain how we can connect through each of the senses. As the disease progresses, some senses are heightened. We will also learn how to use visual cuing over verbal cuing. Often those living with dementia invent words to communicate. We should anticipate these changes and react accordingly. By knowing the care recipient’s history, we will increase the odds of our success.

It is also important to ensure that the care recipient still feel competent and involved in their own care. We can make this possible by simplifying the decision process. This is done by minimizing distractions and communicating directly with the care recipient.

We look forward to seeing you tomorrow at the Delaware Valley Veteran Home at 2pm.

The address is 2701 Southampton Road, Philadelphia, PA 19154.

Teepa Snow on Planning Activities to Enrich the Lives of People with Alzheimer’s

Strategies and techniques for dementia care

By now, you all know why we love the nationally renowned dementia care expert Teepa Snow and her GEMS® classification system techniques and strategies.  This Huffington Post article covers the essentials in providing family members and care partners the tools and tips that lead to positive and meaningful relationships with loved ones with Alzheimer’s and dementia.

As a person with Alzheimer’s and dementia progresses, it is important to continue to provide quality of life at each stage. Entertainment and activities are essential for the wellbeing of people with Alzheimer’s. While they do not slow the progression of dementia and Alzheimer’s, these activities can improve the quality of life for your loved ones.

“They can make the difference between a deadly boring day of staring at the floor and a rich sense of purpose and contentedness. They can also help the caregiver make a connection with the person, no matter how brief.”

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Move beyond entertainment

Games and activities help maintain motor skills and lessen agitation, depression, and stress. Projects that match your loved one’s skills and profession can provide a sense of independence and ownership. It’s important to adapt the activities you use to your loved one’s natural likes and  disposition. Here are some things to consider when providing a plan of care:

  1. What profession did you loved one choose?
  2. Which roles did they have and can you preserve or re-imagine some of that?
  3. Are they an extrovert or introvert?
  4. What were their hobbies?

While an extrovert is likely to enjoy group activities like bingo, your introvert will much rather do something on their own, such as solving puzzles or organizing coins.

For people with Alzheimer’s disease, a successful activity, whether it’s listening to music or playing a game, helps create meaning and pulls from past interests. These activities can provide your loved one with a chance to be more engaged, while fostering an emotional connection and self-expression.

According to Teepa, the single most important thing for family and professional care partners to keep in mind is:

“Provide more than just entertainment.

People with dementia can become tired or overstimulated if they have too much entertainment.”

Include productive and relaxation activities

It’s important to balance the day, by including productive activities (that the person can realistically to expected to be able to achieve), leisure time, fitness activities and, finally, rest and relaxation. Teepa stressed the importance of modifying your expectations as your loved one progresses through the stages of dementia. Activities that worked well with those in the early stages will not necessarily be successful for those in the mid- to late-stages.

People with dementia have the right to enjoy the highest possible quality of life and care by being engaged in meaningful relationships that are based on equality, understanding, sharing, participation, collaboration, dignity, trust, and respect.

At NursePartners, we work to match a highly qualified and experienced care partners to your preferences and expectations. We strive for hand-picked, exceptional care that meets the needs of each unique individual. Our specialized approach to care includes a customized treatment plan – our caregivers are dedicated to improving quality of life.

By keeping a record of everything from mood behaviors, health problems to daily activities, we can begin to understand what factors contribute to positive moods and overall happiness. Furthermore, our care partners have leading expertise and experience with dementia and Alzheimer’s care. Care partners also assist with transportation, preparing individualized meals, light housekeeping, and personal care.

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

Consider joining our support group in south Philadelphia

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CAregivers REducing Stress (CARES)

Are you informally taking care of an older adult: a spouse, parent, sibling, friend or neighbor? Whether you help out full-time or just a few hours a week, caregiving is hard work and can be a strain on your emotional, psychological, financial, and physical well-being. Maybe you work at the same time, or have a family of your own to take care of, too. Maybe you’re just too exhausted to keep on top of it all. This monthly meet-up group is for informal (non-professional) caregivers of older adults. It is a space to share your experiences and learn from other caregivers who are in a similar position.

The group will be organized and facilitated by Sarina Issenberg, a Licensed Social Worker and counselor with CARES, a caregiver support program at Lutheran Settlement House. Additional times, locations, and events can be arranged. Please call or email with any questions!

Understanding Alzheimer’s and other dementias: Hand Under Hand™ Approach

As dementia progresses, it is vital to appreciate the changes in a person’s ability to be able to connect. One critical element that is often missed when trying to share information is the value of changing our delivery process. Dementia care pioneer Teepa Snow developed the hand-under-hand technique, as a guiding and assisting technique that provides family members and caregivers with an amazing connection. It promotes a physical touch connection that is friendly, comforting, and successful, without being intrusive or overbearing.

 

 

 

The hand-under-hand technique also provides a system of feedback and communication between the a loved one living with dementia, and a caregiver. It uses the much practiced and automatic connection between the eye and hand to form a closed circuit between the person who is struggling to understand words and tasks and the care partner. It provides a comforting and calming human connection using a familiar grasp and proprioceptive (deep pressure) in the palm at the base of the thumb.

This eye-hand connection is one of the very first sensory-motor loops established in infants is used endlessly throughout our lives. By using the palmer surface of the hand, and taking the person through the desire motion or movement, we are communicating with touch and movement, without the need for words.

It’s also important and helpful to position yourself below the eye level of the person with dementia. By lowering yourself to their eye level and by using hand-under-hand, you will be able to accomplish your caregiving goals and form a meaningful connection in the process.

Remember: the purpose is to control the situation, not the person. Dementia care partners are in the process together: always do whatever you can to respect the independence, rights, and dignity of the person with dementia.

The use of hand-under-hand is multi-faceted:

  • It is used when greeting someone to sustain a physical connection, allowing the person to become more comfortable with your presence in their intimate space. It differs from a normal handshake that can be uncomfortable to sustain. By having a hand-under-hand rap, you will be able to tell if the person is enjoying your presence and wants you to allow them more space. If they keep trying to let go you, let go and move back further. They may need a break or may not want you in their intimate space at that moment.
  • It can be used when helping your loved one move around. It provides greater stability and support as well as a feedback loop.
  1. Since the arm is the rudder that guides the ship, by rotating the foreman outward or inward you can direct the walking path.
  2. By tipping the forearm down you can indicate physically the cue to sit down in a seat or on the bed.
  3. By tipping the forearm upward you can help the person stand upright.

When used in combination with a gesture or point, it can help provide directions and reassurance when moving through the environment in the later stages, or when in an unfamiliar setting. Because a family member or caregiver is close to the person, the awareness of balance, coordination, fear, or distress is telegraphed can be responded to in a timely manner.

  • Hand-under-hand is essential during the Amber, Ruby, and Pearl gem stages. It allows you to use their dexterity to operate the tool or utensil while your loved one is still actively participating and moving their body parts toward their body (hand to mouth, hand to chest) as they have done for their entire lives. This automatic loop allows people living with dementia a sense of both control and involvement.

Finally, it provides the care partner or family member a way to get feedback on preferences, understanding, readiness, and willingness to participate. It provides a way to do with, not to do or do for.

Is it time to find care for your loved one?

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Many families struggle to make decisions about the best living situation and care for their loved one. There are many signs that indicate your loved one might benefit from home care services:

  • Confusion and uncertainty when performing once familiar tasks;
  • Unexplained weight loss;
  • Spoiled food in the fridge;
  • Difficulty standing and walking;
  • Forgetfulness and loss of interest in favorite activities;
  • Neglected personal hygiene;
  • Inability to keep up with house maintenance;
  • Missed appointments, unpaid bills, and late payment notices.

Seniors who live alone often experience isolation and poor nutrition, contributing to depression, cognitive decline, and a lower quality of life. It may be time to consider home care if you find your loved one with some of these symptoms.

In-Home Care Offers Independence

Many individuals, if given the choice, would choose to remain in the comfort of their own home for as long as possible. In-home care is an option for providing support, without moving them from their current residence. A plan of care can be tailored to meet the likes and needs of your loved one.  This is the superior option to scheduled activities and regimented care that is often provided in assisted living facilities.  At home, your loved one can set their own schedule and find comfort in the familiarity of their surroundings.

NursePartners works with each family to enable safety, comfortability, and happiness through home care services. As part of this process, we match your loved one’s needs to a select group of compassionate carepartners.

Our carepartners are dedicated to improving our clients’ quality of life. Our approach to Alzheimer’s and dementia care is based on The GEMS™: Brain Change Model created by Teepa Snow.  

The GEMS™: Brain Change Model

NursePartners recognizes Teepa’s positive approach to care as an effective method to provide care for loved ones affected by dementia. This approach categorizes dementia stages with six different gemstones, each defined by unique characteristics. Understanding each stage of the process allows carepartners to gain a deeper insight into what your loved one is experiencing.

After an in-home assessment, we work to create a plan of care to help your loved one live comfortably and safely. By keeping a record of everything from mood behaviors, health complications, to daily activities, we can begin to understand what factors contribute to positive moods and overall happiness.

In-home care offers independence, and NursePartners delivers with flexible, customized solutions. Ready to learn more? Our care team would love to offer a complimentary in-home care consultation. Contact us today.

Developing Trust with Your Doctor

As family members and caretakers, we play a large role in overseeing the medical needs of our loved ones. Your relationship with medical professionals is based on trust, communication and understanding.  The stronger the patient-physician relationship, the more value it provides. It’s been shown that individuals who establish relationships with their doctors tend to have better health outcomes. Building a plan of care that includes their doctor enables you to help meet the medical needs of your loved one throughout their later years.

Chupein with Shy

Here’s how you can establish a relationship and keep it on track:

 

  • Prepare for your appointment.

Bring all current medications, along with notes and facts about the state of health of your loved one. Write down any recent health problems or concerns that you have beforehand, so you make sure to bring them up.

 

  • Choose a relationship style.

Whether it’s a new doctor that you’re meeting for the first time or one that you’ve had a relationship with for a while, state clearly at the beginning of your visit that you want to be involved as a partner in the decision-making process.

 

  • Provide some background.

Share your point of view. How is a new technique working?  You should let your doctor know either way. If your loved one has a complicated medical history, or if you are meeting with a new doctor, bring a summary of recent tests, treatments and health problems so the doctor understands quickly.

 

  • Make sure you leave with the information you need.

You need to leave the doctor’s appointment with the information to provide care.  Record your visit, or bring someone to take notes. There’s often a lot of information to absorb during a doctor’s appointment, particularly if you’re facing a major, frightening health challenge. You may be distracted by trying to take in a diagnosis, so it can be helpful to take notes of everything discussed.

 

  • Ask how to reach your doctor after hours.

It’s important to ask your doctor how to keep in touch in the event of a medical emergency that happens outside of regular hours. Every doctor will have a different preference, so find out which method works best.  If you know the system for getting in touch before a crisis.

 

Our carepartners are dedicated to improving quality of life. NursePartners works diligently to ensure carepartners fill their time together with positive interactions. By keeping a record of everything from mood behaviors to daily activities, we can begin to understand which factors contribute to positive moods and overall happiness.  Our carepartners are trained in the Positive Approach to Alzheimer’s and Dementia Care (GEMS™) and work with families to enable safety, comfortability, and happiness through home-care services.

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

NursePartners can alleviate the need for informal caregiving services

Caring for an aging relative on your own is no easy task. Eventually you will need a team of individuals for guidance and support.

NursePartners provides care for those who can no longer care for themselves. We relieve families from the chore of providing informal caregiving services. Our approaches to care allow family members to maintain enjoyable relationships with their loved ones.

Our early intervention prevents you from “learning on the job” as you try to anticipate the next development in dementia. The techniques that worked well last week will probably not work well this week. Unfortunately, informal caregivers lack the resources they need to provide adequate care to the loved ones. In consequence, the informal caregiver becomes frustrated and feels unfulfilled.

We prefer that you maximize on the enjoyable moments with your loved one, and let us handle the rest. The longer you spend as informal caregiver, the less time you have to advance your career and build your own retirement security.
Here is some data from AARP and MetLife that show you some the consequences of the decision to become the informal caregiver for an aging relative:

AARO Duration of Care - 2MetLife Impact of Parental Caregiving on Lost Wages

Why reinvent the wheel? Normally care begins by doing the laundry, preparing meals, and assisting with hygiene. However, the progressive nature of the disease will soon demand that you become the first caregiver. By the end, you will find yourself surrounded by a team of 5 to 10 other caregivers.

Providing care independently is a massive undertaking. The first step should be to establish a living estate or business. You will also be responsible for hiring, firing, and managing staff daily operations. Remember to also mitigate symptoms of depression, fatigue and deteriorating health, not just for the care recipient, but for other caregivers and yourself!

Don’t forget to seek a Workers’ Compensation policy, establish payroll to properly submit taxes, and keep meticulous bookkeeping. If your loved one has a long-term care policy, you will need to submit flawless reimbursement requests or face rejection. In your free time you will be coordinating all medical appointments, pharmacy prescriptions, and speaking to other vendors.

Our business is built to account for these needs. We provide the expertise and the employees to help you through this difficult period. We want you enjoy the best moments with your loved ones, while we help you through the worst. You and the care recipient are our clients.

Do not underestimate the advantage of introducing us to a care recipient earlier on in the diagnosis. Trust needs to be established and we want to connect before providing care. When our introduction is delayed, so too is our ability to make this meaningful connection.