Tag: Alzheimer’s disease Philadelphia

So, you can do it all by yourself?

It is a natural instinct to jump into the caregiving role. What else would you do for someone that you love? If it is a parent, what better way to return the favor for them raising you? If it is a spouse, you vowed to take them in sickness or in health.

Yes, you should pitch in to care for your parent or spouse, but not alone. Unlike raising a child, an older adult has lived a life rich in experiences and has needs very distinct from a child. Also, unlike a child, the care recipient will become more dependent on you over time, which is a different outlook compared to a child who is growing, developing, and becoming ever more independent.

If you are caring for someone living with dementia, it is even more important to prepare yourself mentally for the road ahead. Have you heard of Teepa Snow’s Positive Approach to CareTM? NursePartners practices this methodology while caring for our clients. As clients progress through the stages of dementia, we focus on what they can still do, not on what they cannot. There are still ways to connect, even far along in the disease progression.

It is important to build your care team. This can mean you and many family members, a completely private staff, or a combination of family and private. Never underestimate the value of having certified nursing assistants in the home, overseen by a registered nurse.

Without a care team, both the carepartner (you) and the care recipient are left with a bad situation. The carepartner is unsupported and operates in a high stress environment, often neglecting their own needs. Over time lack of self-care not only hurts the carepartner, but becomes reflective in the care delivered. Care becomes more routine and less focused on creating meaningful interactions. These meaningful interactions are important for someone living with dementia, especially as their way of communicating evolves over time.

Want to add us to your care team? Call us today to learn more about how NursePartners can better support your loved one at home, or wherever home may be: 610-323-9800.

 

Philadelphia home care, Philadelphia dementia care, Devon home care, Devon dementia care

Dementia during the Holidays: Emerald

Brain Change Model

This is the continuation of our series about connecting with a loved one, living with dementia, during the holiday and winter season.

In the previous article about Diamonds, we discussed someone exhibiting the first signs of dementia. About half the time, the person and/or their loved ones, may not know they are living with the disease. During the Emerald stage, the signs become more obvious.

The path is different for everyone

The previous article defined dementia. It is important to remember that although there is a general disease progression, the path will be different for everyone, primarily for two reasons:

  1. There are different types of dementia. A dementia is defined by at least two parts of the brain with larger accumulations of insoluble tau protein tangles and amyloid plaques protein molecules. The brain is subdivided into many parts, specializing in different functions. If some parts are more compromised than others, this will impede upon a person’s daily existence in a unique way.
  2. We are all different. Our personalities and life histories will play their role. Repressed desires or family conflicts may reappear as the person loses the ability to filter their words, put their feelings in context, and control their actions.

 Seeing the glass half full, engage with your Emerald

  • The person living with dementia will still feel capable and independent, and usually has a very limited awareness of any change in their ability to complete most tasks. Allow them to participate as much as possible in their routine daily activities. Remember to do with instead of for them.
  • There will be times when your loved one appears much more lucid. They will remember and then forget. Look for changes in their cognitive reasoning skills and ability to perceive others’ feelings. Anticipate faulty logical trains of thought and help steer them towards better decision making, by including them in the process. If they appear inconsiderate of your feelings, it is not their fault, but cause of the disease. This is especially common in frontotemporal dementia types. Do not take offense.
  • Their ability to understand language is changing. Begin to introduce other visual and touch cues while speaking. Change the way you speak but remember not to be condescending. If you speak to them as a child, they will pick up on this and your relationship will worsen. We recommend speaking slowing and repeating the same words in your sentences to convey singular thoughts.
  • They will repeat themselves. Although this can become exhaustive to the listener, try to avoid stating the obvious, that they already said the same thing before. They will not be able to help it or remember not to say it again. Insisting on logic in these situations will only further tire the caregiver and recipient.
  • Notes, along with other visual and touch cues, will help them complete a daily routine. The more consistent the routine, the better muscle memory will guide them through their day.
  • Do not insist on awareness of the correct time, place, and situation. Meet them wherever they are and make the best of that moment. If they are packing for a childhood vacation, pack the suitcase, and use this as a time to talk about their favorite childhood memories. You can often spin these situations into others that allow you to bond with your loved one.
  • Beware of strong emotional reactions. These are often based on fears, desires, or unmet needs. Your loved one will become increasingly incapable of verbally expressing themselves, so find refuge in other senses, such as smell, taste, and sounds. These can serve as emotional outlets in times of frustration.
  • They will look to you to fill their day with meaning. They are either on the go and cannot unwind, or the opposite, not being able to begin their day without you. The more you emphasize a routine, the better they will feel. Show gentle guidance and assist, remembering to include them in the process.

You will need a team

If you have not started building your team, now is the time. Your loved one is beginning to depend on you for their daily routine. If you are the only one, as their dependence grows to include physical needs, you will also be the natural provider.

Remember, someone living with dementia does not have needs that are met at your convenience. Increasingly they circadian clock will not match yours. They may lose ability to perceive your own frustrations and sleep deprivation. They will begin to not parse words or practice tact in conversation. If you are the only caregiver, under a lot of stress, this quickly leads to a deterioration of your relationship, and subsequently the health of both the caregiver and recipient will suffer.

Assessments at no cost

NursePartners has decades of experience constructing care teams to support older adults. If you reference this article, we will provide your loved one a wellness assessment at no cost. Call us today at 610-323-9800.

Dementia during the Holidays: Sapphires

Brain Change Model

NursePartners’ approach to Alzheimer’s and dementia care is based on The GEMS™: Brain Change Model created by Teepa Snow. NursePartners recognizes the 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, defined by unique characteristics.

This approach to care serves as an effective method for understanding and meeting the needs of individuals affected by Alzheimer’s Disease and other forms of dementia.  To learn about all the GEM levels, explore here.

Other methods of dementia classification might use numbers or levels of severity to describe the progression of dementia. However, we at NursePartners speak in GEMTM levels. It is not enough to simply describe the stage of dementia, we need to emphasize how to connect with your loved one, wherever they are in the disease process.

During the holiday season, you may see changes in an older adult. This article series is meant to help you reconnect with them.

Sapphire

The first GEMTM level is Sapphire, the only level that describes the absence of dementia. This is included because we must remember to always investigate other possible causes for forgetfulness, confusion, poor concentration, personality changes, apathy, and inability to do everyday tasks.

Depression can share many of the same side effects as dementia. Older adults can feel isolated, especially during the winter months. They may struggle to fill their days with meaningful activity and social interaction. The Sapphire level is “a true blue” color for this reason.

Depression severity varies and may require pharmacological and psychotherapeutic intervention, but we can do little things to help our loved one, even if it is in conjunction with these other treatments. Even if we are pursuing other solutions simultaneously, the causes of depression are often complicated and persistent. It helps to make real and consistent changes to our daily life in order to combat the effects of depression.

Three Ways to Combat Depression

  1. Fill their world with meaningful activity
    • If they do not have a schedule, make one. The schedule does not have to be arduous, but there should be a reason to get out of bed each morning, dressed, showered, and out in the world.
    • Choose activities that are aligned with their interests and personality. Just because someone is an introvert, does not mean they cannot visit the craft store or volunteer at the local animal shelter.
    • All activities should make the person feel loved and needed. When someone feels as a contributing member in society, mood generally improves.
    • Involve them in the decision making. If they cannot decide, switch up your approach. Try presenting a few options versus proposing open-ended questions.
    • Ask them to help you. Do you need help wrapping presents, meal prep, or picking up the kids from the bus stop? Request their assistance. This helps them feel needed while helping you get everything done.
    • Don’t forget to schedule time for your visits! As you help build their schedule, do not be surprised if they become “too busy” for your visits.
  2. Exercise
    • Start with moving more around the house and then take it outside, weather permitting.
    • If your loved one benefited from a program designed by a physical therapist, continue those exercises even when the physical therapist sessions end. The adage “move it or lose it” applies here.
  3. Boost their Diet
    • What are they eating? Sometimes vitamin deficiencies are the culprit. Try enriching their diet and involving them in the process. Start slowly, by adding a few new options each week.
    • You can teach them how to use these new ingredients but bringing them a freshly baked meal instead might persuade them quicker. They may be surprised that eating well can also taste good.

Bring in an ally

You can enlist the help of professionals to kickstart a change in lifestyle.  The advantage of working with a certified nursing assistant is that they can be your eyes and ears on the ground.  While you are at work or with your family, they are helping mom or dad out of bed and into the world.

There are additional benefits you might not have expected:

  • Constant and ongoing fall risk mitigation
  • Light housekeeping
  • Meal preparation and socialization
  • Performing and assisting with personal care activities
  • Home exercise program support
  • Detailed family updates
  • Familiarity and rapport
  • Coordinate grocery purchases and deliveries
  • Medication management

Older adults are not children.  They have lived a life rich in experiences.  It is unrealistic to think that one adult can take care of all the needs of another.  Enlist help to optimize the results for both you and your loved one.

Want to talk more or schedule a wellness assessment?

Call us at 610-323-9800.  Expect you call to be answered by a member of our administrative team, never a call center or third party.  Mention this article and receive the wellness assessment completed by a registered nurse, free of charge.

Debunking common myths about hospice. Why you should seek hospice benefits sooner.

When is the right time for hospice? Many families wait too long to take advantage of this free benefit that complements home care services.
Below we debunk a few of the common misconceptions:

1) Your relative is actively dying. False. Two physicians must determine that your loved one has less than six months to live, if their illness would run its normal course.

2) There are no additional treatments. The client receives palliative care, that considers all aspects of their physical, emotional, and spiritual health. They may continue taking most medications, just cannot seek “extreme remedies”, such as chemotherapy. Currently there is no cure for Alzheimer’s disease or other forms of dementia. Clients in the later stages of dementia, “Ruby” or “Pearl”, are usually eligible for hospice benefits.

3) Hospice is only for the client. The family also receives emotional and spiritual support.

4) All hospice clients die. Clients have “graduated” from hospice if their condition improves.

5) You lose benefits after six months. If clients survive for more than six months, they must seek eligibility again. We have also worked with clients who have used hospice services for many years.

6) You will have to get special medical equipment. Hospice is constantly evaluating the needs of your loved one. Almost anything that is needed can be provided by hospice and paid by Medicare. This is one of the best benefits!

7) Hospice must be provided at home. Although many families would prefer hospice services be given at home, hospice goes anywhere.

8) You must relinquish your other home care services. Hospice works best as a compliment to other support services. There is a maximum amount of hospice services per day, usually around two. Clients eligible for hospice usually also benefit from 24/7 care. Hospice aides and home care certified nursing assistants can work together to care for clients, especially with transferring those unable to get out of bed.

We always recommend that clients explore hospice service options, sooner rather than later. Hospice is a great resource to support the client and their family.

Want to learn more about home care services or hospice options?

Call us today at 610-323-9800.

 

hospice care Philadelphia, home care Philadelphia

 

Caring for the Caregiver

Both formal and informal (family) caregivers provide care for older adults.  It is important that carepartners practice self care, in order to continue being effective in their roles regardless of whether they are compensated for caregiving services.

Formal carepartners are better able to establish personal boundaries if they are working set hours at established rates via a reputable company.  Although paid carepartners are connecting and building a relationship with the older adult, there are times that they are able to take care of themselves.

In contrast, family caregivers often find themselves in a caregiving role unexpectedly.  They usually find themselves faced with some of all of these predicaments:

  • The needs of the care recipient are increasing over time.
  • The caregiver had another relationship with the care recipient before the illness.  This often complicates the dynamics of the developing relationship as the care recipient feels embarrassed of their condition and the caregiver becomes stressed.  Communication issues and stress can fuel tension.
  • The caregiver does not necessarily know about the disease progression or have medical training.  They may be in denial of basic facts concerning the care recipient’s condition.
  • The caregiver needs to work at least one other job to support themselves and possibly their families and/or care recipient.
  • The caregiver is giving up opportunities for self development, career advancement, and/or building their own immediate families.  The can cause built up feelings of resentment, inhibiting the quality of care of the older adult.
  • The caregiver needs to navigate internal family dynamics.  Typically children are allocated responsibilities based on geographic proximity or other circumstances.  A child without their own family or job may be the first candidate to move in with mom and dad.  Children usually disagree about the equity of task distribution, leading to feelings that can compromise the level of care provided to the care recipient.
  • The caregiver may be caring for an older adult for the first time.
  • They or members of the care team are in disagreement on the basic facts of the situation, such as the validity of the disease diagnosis.  
  • Informal caregivers are always on call.

Regardless of whether you use formal, informal, or both methods of care, it will take more than one person to care for an older adult, especially someone living with a progressive disease such as Alzheimer’s or another form of dementia.  

One important step is developing relationships with other informal caregivers, through organizations such as ARTZ Philadelphia and the CARES program of the Lutheran Settlement House.

ARTZ Philadelphia organizes a meeting of caregivers on a periodic basis to discuss ongoing challenges.  They also host separate events that are meant to provide bonding opportunities for the caregiver and care recipient.

The CARES program of the Lutheran Settlement House organizes events exclusively for informal caregivers.  The creator of the CARES program, Sarina Issenberg, also provides individual counseling meetings free of charge, outside of the organized events.

It is also important to employ the help of formal caregiving services.  There are numerous advantages for having a home care agency involved.  .  Here at NursePartners, we have been extensive experience caring for older adults exclusively for over 18 years.  Although we care for older adults with a variety of chronic and progressive conditions, we formally incorporated a dementia training module into our business operations in 2015.  All carepartners and management are trained and certified in the Positive Approach to Care methodology.

We welcome the opportunity to tell you more about how we can form a new care team, or supplement one that you have established.  Give us a call at 610-323-9800 to learn more. best home care Philadelphia, dementia care Philadelphia, Alzheimer's disease Philadelphia

 

Angela scheduled to be keynote speaker for “Remembering Those Who Forget”

We are excited to announce that Angela will serve as the keynote speaker for the Presbyterian Older Adult Ministry (POAM) at the event, “Remembering Those Who Forget”.  Angela will talk about her decades of experience working with those living with dementia.  She will be sure to touch upon practical care approaches that can be implemented immediately, in addition to giving her clinical perspective on the disease.  The event is open to those wanting to learn more about Alzheimer’s disease and other forms of dementia.

We would appreciate registration prior to attending the event.  This event is scheduled for next Thursday, May 2, at 8:30am to 1pm in Plymouth Meeting.  Exact details can be found via this link: https://presbyphl.org/events/presby-older-adult-dementia-workhop/

How dementia care is different from traditional home care

Why work with a home care company that specializes in dementia care?

Most non-medical home care companies care for those living with dementia, but services are not equal among providers. There are over 80 types of known dementias and each present a unique set of challenges.

In addition, a client’s progression of dementia depends on their background, personality, and support system. No two clients are ever alike.
Even if a company develops a comprehensive plan of care that includes all of these components, they still need to ensure that the direct care team remains informed and is relatively stable. If either falter, so does the quality of care. Carepartners must remain in communication with one of our registered nurses or dementia coaches throughout the process. They communicate with one another through client care record sheets and a journal that symbolizes the development of their relationship with the client.

Carepartners undergo an educational seminar, role playing scenarios, and additional dementia training before ever assuming their first assignment with a client living with dementia. Additional training is provided for more challenging types of dementia.

NursePartners created the GEM division to care for those living with dementia. This is distinct from our traditional home care division. We put together a plan of care based on the client’s type of dementia, specific needs, background, personality, and support system. Each client is associated with a GEM stone, which indicates where they are in the progression of the disease.

At each stage, we alter our approaches for connecting and providing care. Verbal cues become less effective than visual and touch cues as the disease progresses. We also are aware of the client’s visual scope and in which directions it declines.

If you have questions about how your loved one could benefit from GEM care services, we are available 24/7 to take your call: 610-323-9800.

home care, home health care
Carl and Melva painting together on a cold winter day.

The GEMS™ brain change model

NursePartners embraces the GEMS™ brain change model developed by Teepa Snow.  Unlike other scales, such as the Global Deterioration Scale or the Dementia Severity Rating Scale, the GEMS focuses on creating constructive opportunities to engage with the person living with dementia.  Clients are still seen as people, rather than former individuals lost to the disease.

The GEMS allows us to adapt our care approaches to connect with the person in their moment.  We acknowledge what is lost, but use other senses to build meaningful relationships with our clients.

Services begin with a comprehensive assessment that goes beyond the clinical needs.  We want to know as much as possible about our clients’ preferences and personal histories.  This will allow us to connect from day one, building a durable and trusting relationship.   NursePartners changes the plans of care as we learn new information about each client.

All carepartners attend an initial orientation where they actively participate in a dementia workshop.  Carepartners learn the positive physical approach to care and contribute to a dialogue about the disease.  Dementia coaches then stimulate real life scenarios, filming each carepartner as they approach the hypothetical client.  Carepartners watch themselves as they approach clients, recognizing their strengths and acknowledge an area for improvement.  Scenarios are repeated until carepartners feel confident in the learned approaches.

Carepartners then complete a proprietary training module and final assessment, ensuring that they have understood the training.  At this point, they are ready to be assigned to a client living with dementia.  NursePartners admin will then assess if a client and carepartner would be a good match based on their personalities, interests, and general disposition.

All families are given a description of the GEMS model.  We want them to also connect with their loved one, continuing their relationships.  We help families understand that care techniques must adapt as a person progresses through the disease.  Here is a good summary of the six GEM levels.

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Want to learn more about how we can help your loved one living with a diagnosis of Alzheimer’s disease or another form of dementia?  Call us today at 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.

 

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.