Tag: best dementia care Rittenhouse

Dementia and Loneliness

Posted on by Peter R. Abraldes

Social Isolation for those living with dementia

Living with dementia can often be isolating. Over time, the ability of a person with dementia to communicate may become worse and interactions that once seemed to come so easily may become more difficult. This can be frustrating for everyone involved, though it is important to try and understand the loneliness your loved may be experiencing so you can best engage them.

Take note that there are different types of loneliness – for example, someone can feel lonely, even if they have regular contact with friends and family, while others may have limited contact with people and not feel lonely. NursePartners alters our care approach depending on a client’s personality and life history. We engage with introverts differently than extroverts. We also need to consider the person’s skills when creating opportunities for engagement.

These days it can be tough to have regular face-to-face contact, especially if your loved one lives in a facility or if you live far away. FaceTime will only go so far for someone living with dementia. If they are a Pearl, Ruby, or Amber stage of dementia, it might be nearly impossible to connect with them via video chat. This is because the best way to connect with these people if through sight, touch, taste, and smell. However, you may be able to have a virtual breakthrough if you can engage them through song.

Another factor to consider is that those living with dementia are also usually living with diminishing social circles. They may move away from friends and older loved ones die. It also becomes harder for them to initiate new conversations and build new relationships. This is just another reason why it is important to build you care team early!

Social Isolation in the Age of COVID-19

How would you experience social isolation if you were not processing the rationale behind it? As we head into future months of quarantine and social isolation, consider how this is affecting a loved one living with dementia. Consider how your loved one is remaining socially connected in safe way. Do they have close friends or family that visit? Do they see someone at least once a week? How often do you check in and are these calls effective?

If you are answering no to any of these questions, it is understandable. Life gets busy and sometimes we forget how those living with dementia come to depend on us more over time. Nonetheless, you may want to consider seeking help for your loved one if you feel you are unable to provide this care yourself. (Over time it will become impossible for one person to provide all the necessary care for one other person living with dementia.)

The NursePartners Difference

NursePartners has been caring for older adults since 2002. We specialize in Alzheimer’s disease and other forms of dementia, focusing on what the client can still do, not what they cannot. We build stable care teams for our clients, supporting them from three assignments per week to 24 hours a day, every day of the year.

Let us show you how NursePartners can make the difference in the life of you and your loved one. Call us today, 610-323-9800.

610-323-9800

Personalizing care techniques can reduce behavioral and psychological symptoms of dementia

Posted on by Peter R. Abraldes

The most effective care begins with forming a connection, which includes meeting clients where they are in the disease process.

2 Personalizing care techniques can reduce behavioral and psychological symptoms of dementia

The Tailored Activities Program (“TAP”) aims to reduce behavioral and psychological symptoms of dementia (“BPSD”). This is often what we struggle with as family members and caregivers. How do we engage the person with just enough activity to make them feel loved and needed?

Unchecked challenging behaviors can lead to increased healthcare costs, caregiver burden, and care recipient placement into facilities. There the person living with dementia usually faces pharmacological intervention, which may exacerbate these challenging behaviors or worse.

An Australian trial randomized 180 participants living with dementia by placing them into two groups. One group received 8 home care visits using the training from TAP to train the caregiver and engage with the person living with dementia. The control group received three phone calls with the caregiver about basic dementia related materials from a book, and did not involve the care recipient. Follow up continued four and eight months after the home care visits and phone calls.

The trial was done with individuals living at home or with relatives, outside of formal care facilities.

The results of the TAP pilot trial:

The TAP pilot trial showed overall reductions of incidences of challenging behaviors or BPSD. There were also reductions in other specific behavioral categories as defined by the study:

BPSD overall: F(1,41) = 7.58, p = 0.009, Cohen’s d = 0.72,

Shadowing: F(1,4) = 58.9, p = 0.003, Cohen’s d = 3.10, agitation, Wald X2(1) = 6.0, p = 0.014, Cohen’s d = 0.75

Repetitive Questioning: F(1,22) = 5.94, p = 0.023, Cohen’s d = 1.22

Argumentation: Wald X2(1) = 6.6, p = 0.010, Cohen’s d = 0.77 ()

To read more about the study, click here.

In many ways, TAP is like the Positive Physical Approach to Care as pioneered by Teepa Snow. NursePartners has embraced this methodology since the inception of our GEM division in 2015. It builds on the intuitive notion to engage with people living with dementia according to their life experiences and interests. By appealing to their sense of self-worth, we can prevent or mitigate some of the most challenging behaviors.

NursePartners trains all carepartners in the GEM methodology as perfected by Teepa Snow.

All carepartners are trained to engage with clients, focusing on what they still can do and letting go of what they cannot. Even at the most advanced stage of dementia, you can find new ways to say hello and make the person feel valued and with purpose.

To learn more about how we can engage your loved one living with Alzheimer’s disease, Frontotemporal dementia, or another form of dementia, call us at 610-323-9800.

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Caring for the Caregiver

Posted on by Peter R. Abraldes

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

 

Lakeya meets with PAC Trainer at our site in Philadelphia

Posted on by NursePartners

NursePartners’ Senior Recruiter, Lakeya Dula, completes her training to become a PAC certified dementia coach.  After on site training in Baltimore with Teepa Snow, Rebekah Wilson visited us at the NursePartners office in Philadelphia.  Rebekah served as Lakeya’s mentor throughout these past 8 weeks.  Lakeya and Rebekah used the PAC materials and tools from the course to increase Lakeya’s confidence in becoming an effective coach to our carepartners.

The Positive Approach to Care (PAC) methodology was created by Teepa Snow in response to the shortcomings of other dementia progression models.  Other models seemed to focus on the cognitive decline, versus emphasizing what the person could still do.  Each in the last stage (Pearl), a person still exists behind the ugly façade of the disease.  Teepa sought to teach others how to connect before providing care, which is the bedrock of any effective carepartner relationship.

As a dementia coach, Lakeya plays a fundamental role in training each carepartner before they begin working with us.  Lakeya leads a dementia workshop where we act out various difficult situations with our carepartners.  NursePartners’ admin takes on the role of our clients and the carepartners show us how they would respond in a given situation.  Carepartners consent to being video recorded.  This allows them to watch their own interaction later, from the view of the client.  This activity helps them break preconceived conceptions and to adapt their own care approaches to become more effective carepartners.

During this workshop, carepartners learn about the GEM levels, the Positive Physical Approach to Care, and receive a general overview of dementia.  Afterwards, carepartners must complete additional training in order to become eligible to work with any of our clients living with dementia.

Lakeya is the third member of the NursePartners administrative team to complete a certification with Teepa Snow.  Angela Geiger embraced the methodology as the basis to create the GEM division in 2012.  She became certified as the company’s PAC dementia trainer in additional to another national certification as a dementia practitioner.  Peter Abraldes developed the dementia program with Angela in 2016 to make this training a requirement for any carepartner working with a client living with dementia.  At this time, all other admin members were trained as well.  This prepared us to respond to any issue arising from clients, family members of clients, or carepartners.

NursePartners also provides training to family members and other organizations as requested.  We have seem the effectiveness of this approach in the field and always glad to help others provide more effective care to their loved ones or clients.

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Lakeya received her PAC certified dementia coach certificate!

 

How do you know it’s time to start home care services?

Posted on by Peter R. Abraldes

The holidays are coming!  Sometimes with our own busy lives, time passes between each visit to our parents and other older relatives.  At a certain point, home care services can best support them, regardless of if they live at home or in a community.

When is it time to begin home care services?  It is important to remember that home care services can increase gradually.  NursePartners believes a minimum of three, four-hour assignments per week is the best way to start.  This allows the carepartner team time to establish a relationship with your loved one. All carepartners are trained to connect first.  A developed relationship is crucial for providing optimum care.

NursePartners also supports clients 24/7 in their homes, assisted living communities, and nursing homes.

But how do you know it is time to begin services?  When we notice some of the following signs, it may indicate that it is time to start.  Remember, NursePartners provides a health and wellness assessment at no cost before the initiation of services.

We welcome you to take this 20-question quiz to determine if it is time for home care services.  If you score a 25% or higher, it is probably time to schedule a no cost assessment.  All answers are confidential and will not be used for marketing purposes.

If you are still in doubt, give us a call at 610-323-9800.  All calls are answered by a real member of our administrative team.  We do not close at 5pm or on holidays.  NursePartners is a privately-owned company, founded and operated by a registered nurse and certified dementia practitioner.  We have been serving older adults in the Philadelphia area since 2002.

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Carepartners work through role play scenarios with dementia coaches and practitioners

Posted on by Peter R. Abraldes

NursePartners practices the Positive Physical Approach to CareTM as developed by Teepa Snow and her team.  Each client living with dementia is classified by a GEM stone.  The characteristics of these GEM stones, along with the client’s personality and unique life experiences, dictate our approach.

All carepartners are trained to connect before providing care.  Simply put, we find this the most effective method.  Too often, carepartners push forth their agenda without enough emphasis on how it is affecting the client.  The mentality is to complete the “to do” list as soon as possible.

Unfortunately, older adults are not always moving at our speed.  If they are living with Alzheimer’s disease or another form of dementia, the situation becomes even more complicated.  The older adult may not realize what we are trying to do, even though these actions are intended to assist them.  When we rush to complete tasks, this can lead to unfavorable outcomes.  If we provide care before connecting, this can increase anxiety, depression, or lead to aggression.

All carepartners are trained in the Positive Physical Approach to CareTM methodology.  During orientation, carepartners work with dementia coaches and practitioners as they role play challenging scenarios.  We want carepartners to be prepared for all types of situations.

Carepartners are trained to put their agenda away and go with the flow.  They focus on connecting before rushing to provide care.  This simple investment of time pays dividends in the long run as a meaningful relationship is developed between the carepartner and the client.  The result is that the client becomes more receptive to receiving care.

In this video, Denise encounters a client actor (dementia coach) who is non-verbal and fixated on a task.  Instead of demanding that the client focus on her, she engages him in his task first.  She continues to have a conversation, even though he does not respond to her.

When it is time to perform the caregiving task, Denise is patient as the client stands up.  She respects his independence and does not rush to do everything for him.  Denise helps explain how to get up and helps stabilize his gait during the process.

As he stands, she lightens the mood with movement and rhythm.  Music and rhythm are deeply engrained in our brains and is one of the best ways to connect with someone living with dementia.  Carepartners that employ this preserved skill are more likely to succeed than those who do not.

Would you like to learn more about GEM care services or want to join our team?  Call us today at 610-323-9800.

Click to the link to see the full video:

Denise demonstrates the Positive Physical Approach to Care

 

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Denise uses the Positive Physical Approach to Care to guide non-verbal client

Patience when caring for someone living with dementia

Posted on by Peter R. Abraldes

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.

homecare3 Patience when caring for someone living with dementia

 

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

 

 

 

 

 

What is Alzheimer’s disease?

Posted on by Jessica Snyder

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.