Category: Progression of Dementia

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.

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.

Building Hands-On Caregiving Skills for Dementia Care

doctor-holding-elderly-ladys-hand-752x501As 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 attention-getting without being intrusive or overbearing.

It also provides a system of feedback and communication between the a loved one living with dementia, and a caregiver. Hand-in-hand 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. If you do only these two simple things (get down and use Hand Under Hand), life will be much easier on everyone. Guaranteed.

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 you in their intimate space (within arms reach) 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 caregiver 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.

In the video below, Snow demonstrates how to use Hand Under Hand™ as part of the process of helping someone to bathe. But Hand Under Hand™ can be used in multiple ways: to help someone to eat, to walk, or even to calm down in a crisis.

NursePartners is committed to providing uncompromised care to those living with a diagnosis of Dementia. Our CarePartners are trained in the GEM Level Approach, and work with each family 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.

Contact us today.