Category: Progression of Dementia

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.

 

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.

Connecting through meaningful activities

One of the common mistakes we make as caregivers is to eliminate the very activities that give older adults a sense of purpose.  Our first inclination is to “entertain” instead of giving older adults a “job-related” activity.  However, older adults also need to feel needed and seen by others as productive members of society.  For many of us, productivity equates to the feeling of importance.

Assigning tasks requires creativity.  It is most successful upon taking the time to understand an individual’s unique history and personality.  For someone living with dementia, traveling back in time is common.  We can anticipate some of possible job-related activities by knowing what our clients did for work 20,30, or 60 years ago.  We piece this puzzle together through a thorough initial assessment and continued conversations with family and friends.

Sometimes job-related tasks can be accomplished by involving the client with their own care. Depending on their GEMTM level and living arrangements, clients may even want to take part in activities for other residents.  In the Diamond and Emerald stages, we need to take care to control for external stimuli that might distract from the schedule or make unnecessary changes.  For later GEM stages, we will then have to adapt tasks to ensure that the client continues to successfully complete them.

We welcome the opportunity to tell you more about our dementia care services.

Why Choose Us?

  • We focus on what our clients can do, not what they cannot.
  • There is a no cost, collaborative health and wellness assessment.
  • 24/7 availability, including holidays and weekends.
  • We are staffed with Certified Nursing Assistances (“CNA”s), not Home Health Aides.  All of our CNAs have years of geriatric experience and exhibit a passion for caring for those with progressive diseases.
  • Regular visits by licensed clinicians to ensure customer satisfaction.
  • Carepartners are employees of NursePartners, not subcontractors.
  • We seek to engage our clients in meaningful activities; we seek to exceed your expectations.
  • Our standards are higher than those set by the healthcare industry.

 

Study to evaluate the impact of a cancer fighting drug on slowing neurodegenerative disease progression

This NPR article discusses how Nilotinib seems to work by eliminating toxic proteins that build up in the brains of people with Parkinson’s and Alzheimer’s. The drug seems to activate a mechanism in brain cells that acts like a sort of garbage disposal.  Read the entire article on NRP.

Currently Georgetown University is looking for participants for a randomized, double blind, placebo-controlled study to evaluate the impact of low doses of a cancer fighting drug on slowing the progression of neurodegenerative diseases. Learn more about the study.

NursePartners does not advocate for any specific type of medication.  Our holistic approach seeks to connect before providing care.  For clients with advanced forms of dementia, we explore different ways to say hello and communicate.

Our carepartners follow the Teepa Snow’s positive physical approach to dementia care.  Through extensive training, carepartners learn how to deescalate situations and build meaningful relationships with our clients.  We do not promote a purely medicated method for working with clients living with dementia.

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.”

home care, meaningful activities, engaging, home health care

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.

Dementia Care Services

Dementia Care Services in Delaware, Montgomery, and Philadelphia counties:

NursePartners has been serving its clients for over 15 years.  Each of our employees have years of geriatric experience and exhibit a passion for caring for older adults.  Carepartners that work in the GEM (dementia) division have undergone an 8-hour paid training.  They also receive continued coaching from a certified dementia practitioner and coach as they work with our clients.

Carl and Melva painting together on a cold winter day.

These are some of the services offered to our clients living with dementia:

  • We begin by working with the family to create a customized plan of care developed by an experienced Registered Nurse.
  • We help create and maintain a safe environment to prevent falls, injury, and wandering.
  • Light housekeeping
  • Meal preparation and assistance
  • Performing and assisting with personal care activities
  • Home exercise program support
  • Detailed family updates
  • Daily monitoring of each client
  • Permanent team of carepartners
  • Long-term care insurance reimbursement support
  • Coordinating grocery purchases and deliveries
  • Medication management

We may be able to offer dementia consulting services upon request.

What is Alzheimer’s disease?

The basics about Alzheimer’s disease


What is Alzheimer’s disease?

Alzheimer’s disease is a progressive, degenerative disorder that attacks the brain’s nerve cells (neurons) resulting in loss of memory, thinking and language skills, and behavioral changes.

 

Alzheimer’s is the most common form of dementia.

Dementia is a general term for memory loss and other intellectual abilities serious enough to interfere with daily life. Alzheimer’s disease accounts for 60 to 80 percent of dementia cases.

 

Alzheimer’s is not a normal part of aging.

Although it is true that increasing age is associated with increased rates of the disease development, Alzheimer’s is not just a disease of old age.  Individuals in their 40s and 50s can also develop dementia.

 

Alzheimer’s worsens over time.

Alzheimer’s is a progressive disease, where dementia symptoms gradually worsen over a number of years. In its early stages, memory loss is mild, but with late-stage Alzheimer’s, individuals lose the ability to carry on a conversation and respond to their environment. Alzheimer’s is the sixth leading cause of death in the United States.  Alzheimer’s disease kills more than breast and prostate cancer combined.  At the time of death, one of three seniors dies with Alzheimer’s or another form of dementia. Those with Alzheimer’s live an average of eight years after their symptoms become noticeable to others, but survival can range from four to 20 years, depending on age and other health conditions.

 

There is no cure for Alzheimer’s disease.

Since there is no known cure or treatment for this disease, it is important to use the right approach to care.  The right approach can slow the worsening of symptoms and improve the quality of life of those living with dementia.

 

Alzheimer’s and the Ability to Walk

Dementia can affect areas of the brain that are responsible for movement and balance. Because of this, many individuals affected by Alzheimer’s and other types of dementia can gradually lose the ability to walk and perform everyday tasks. Knowing what to expect can make an easier transition for you and your loved one in the late stages of dementia.

Understanding Balance and Gait

A crucial and sometimes neglected part of dementia care is the observation of gait. Gait refers to the motion and stride of walking. One of the first signs of loss of mobility, is walking unsteadily and shuffling. Your loved one may seem slow or clumsy, causing more accidents and bumping into things. This “slowing” is typically associated with a syndrome called “parkinsonism.” Other signs of Parkinsonism include the shortening of steps, “stooped” posture, and the narrowing of the space between feet. When a person with Parkinsonism turns, they no longer pivot on their heels, but instead turn in a series of short steps. During the turns, their balance can become unstable; and are likely to fall backwards.

Apraxia is another condition associated with dementia and the ability to walk. An ataxic gait is characterized by imbalance, and abnormal, uncoordinated movements. Typically the individual can stand, but is very unsteady, taking small irregular steps. Very early in the course of apraxic walking in dementia, a cane or a walker can help. It is not uncommon to see a person go from a slow, cautious gait, to a normal walking pattern simply by taking up a cane.

How you can help:

  • It is important to note that people with dementia can have problems with walking that are not associated with Dementia. Exhaustion and pain can limit how far a person can walk. Sometimes that pain can reflect an unattended problem in foot care or muscle fatigue.
  • The person you care for may also require a mobility aid, such as a walking cane or a wheelchair in order to feel secure. Sometimes just being physically present can provide your loved one with the confidence and security to walk.
  • Consider a physiotherapist: They can help with anything from exercises to strengthen muscles to walking aids.

Care for a person with dementia who is immobile enough can become difficult. Many other problems can develop, such as constipation, blood clots and pressure sores. If you or a loved one needs home care assistance or relief, our team can help: Contact us today.

Sources:

Understanding Dementia: Balance and Gait Examination – DementiaGuide.com. DementiaGuide, 2001. Web. 23 June 2016.

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.