Tag: best home care Philadelphia

Visiting a loved one with dementia

The relationships we have with others form a central part of our identity. However, these relationships change with someone living with dementia. As the disease progresses, we need to change our approach and still work to mitigate the possibility of social isolation.

Those living with dementia may find it difficult to recall friends and family and the many shared memories created with them. Although they may forget, it is important to continue to visit them as social isolation will still lead to loneliness. Socialization may even slow the progression of dementia.

Here are some tips on how to spend your time together:

 

  • Focus on the present. If you focus on your current environment by engaging them with new tastes, smells, and things to touch.   Do not quiz or force their memory. If conversation is tough, try singing, playing an instrument, or even dancing. You can share a moment without having a long conversation in words.
  • Make them feel needed. Even though they are living with dementia, they still need to contribute. Give them a task to do so they feel helpful rather than a burden.

 

  • Watch your voice tone and connotation. Just because they are living with dementia does not mean they do not have feelings and emotions. If they do not respond, it does not necessarily mean they did not understand what you said. If you hurt their self-esteem or dignity, there may be a backlash.

 

  • Although you want to make them feel needed, keep tasks simple. Focus on one topic at a time. If you are offering choices, try to limit them to two or three. Open ended questions are particularly difficult as the diseases progresses. If they get lost in conversation, you can gently remind them by continuing the conversation instead of pointing out that they forgot.

 

  • Use names with the relationship. For example, instead of just saying “your son” or “Michael”, say “your son Michael” is coming to visit today.

 

  • Watch your body language. This includes your face. Your faces and expressions can indicate that you are not being genuine in your messaging. The person will pick up on this and can react adversely if your overall message is not consistent.

 

  • Minimize external distractions that may exist in the background of your conversation. Spending time together in the right environment can make all the difference when you are visiting a loved one with dementia. Try talking in a comfortable, quiet place, and avoid any other noises which could be coming from a TV or radio. If you position yourself in their line of vision and stay still while you are talking, you will help make the conversation easier to follow.

Remember, the amount of time you spend visiting a loved one with dementia can make all the difference in their quality of life. As we live through quarantine, consider the overall quality of your loved one’s life. Consider companionship options with certified nursing assistants who can assist with care as the disease progresses. Continual social interaction will help improve the quality of life for those living with dementia, with earlier intervention being more rewarding.

Want to learn more about the NursePartners difference?

Call us today: 610-323-9800.

 

What is the difference between Dementia and Alzheimer’s Disease?

Dementia and Alzheimer’s disease are often used interchangeably even though they mean different things. Put simply, dementia is a broad term we use to describe a collection of symptoms associated with the decline of neurological function. Dementia can be present in a patient for many reasons, although Alzheimer’s disease accounts for roughly 75% of known dementia cases.

Other types of dementia include vascular, Lewy Body, Frontotemporal, and mixed. There are also ‘reversible dementias’ which can be remediated when the root cause is addressed such as severe urinary tract infection, vitamin deficiency, sleep deprivation, and severe depression.

Different forms of dementia have different early symptoms. But there are common early signs across many types. These include:

  • Short-term memory loss
  • Decreased concentration
  • Disorientation
  • Mood changes
  • Judgement lapses

And while some forms of dementia share similar symptoms, others can be identified by their unique effects on patients. For example, someone with Lewy Body dementia might experience visual hallucinations, stiffness and slowness of movement, tremors, night terrors, or may even be observed acting out their dreams. In the case of Alzheimer’s disease, one of the first things to be affected in patients is their short-term memory. In brain scans of patients with Alzheimer’s disease a deterioration of the brain’s regions associated with short-term memory functions can be observed. While Alzheimer’s disease is much more commonly diagnosed than Lewy body dementia, it is important to understand that both are only types of dementia.

There is no test to definitively confirm the presence of Alzheimer’s or other types of dementia, while the person is alive.  However once symptoms begin to appear, physicians can examine the person to determine potential causes. If a neurodegenerative disease such as Alzheimer’s disease is present, early identification allows for the best possible intervention and treatment. This allows you to better structure your relationship, complete future planning with the input of the diagnosed person and try pharmacological remedies.

NursePartners prides itself on our commitment to clients, and their families, who are living with dementia. Are you living in the Philadelphia metro and are looking for support? Give our team a call at 610-323-9800.

An Easter basket or activity box for someone living with dementia

We often think to put Easter baskets together for children.  It can be exciting to hunt for eggs or to find a basket full of sweets.  Children sift through the contents, sorting out favorite candies and toys.  If you are lucky, they will clean up the plastic grass afterwards.

We can similarly engage older adults living with dementia, of any religious affiliation.  As dementia progresses, certain senses are heightened.  One of these is touch.  During the “Amber” stage, those living with dementia have a tendency to touch surfaces.  As eyesight and gait (walking ability) worsen, touching surfaces help orient the person.

Touch can also be reassuring.  Holding their hand or feeling different textures can be a way to communicate as their traditional conversational skills worsen.

Consider putting together an activity box, or Easter basket, if applicable.  Remember, this should be a fun activity so do not worry if the end result is not as imagined.  You might even want to consider some music in the background.

The search can be limited to your own home.  Find objects of varying sizes, textures, densities, and colors.  Once you gather these all, ensure that none have sharp edges and are large enough not to be swallowed.  Layer them into a basket or box.

Bring the basket or box to your loved one.  Get them started by finding the first or second object.

Simple activities such as these add meaning to the lives of older adults living with dementia.  They may remind them of Easter as a child, or simply serve as a task to make them feel loved and needed.  Never underestimate how feeling loved and needed can improve their quality of life.

Some of the ideas behind the activity box were found from Crossroads Hospice.  The suggestions about tactile simulation and the Amber stage of dementia can be learned about here.

 

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.

How to know when its time for home care

Give your thanks by showing them you care

 

This day each year, we gather to give thanks for another year. We are seeing some relatives for the first time in a while. At these reunions we usually put our best face forward. This is no exception for older adults.

 

The Positive Approach to CareTM classifies dementia by six gemstones (click here to learn more). The first two are sapphire and diamond. The sapphire symbolizes normal aging and forgetfulness, which is not dementia. The diamond, however, is the first stage of dementia.

 

A diamond is highly functioning and may not be aware of its own cognitive decline. It can cover up forgetfulness and other warning signs for periods of time, such as during your reunion.

 

We should spend extended periods of time with our loved ones to truly understand their needs. Although casual conversation throughout the reunion will not paint a perfect picture, it can help us understand if we should investigate further.

 

As you talk, test their short-term memory. Alzheimer’s disease inhibits our ability to form new memories first. Discuss something new and bring up the same topic a few hours later. See if they remember having this discussion.

 

During conversion, do they appear frustrated or fixated in a train of thought? Are they unable to “shift gears”?

 

Even if your loved one is not experiencing a cognitive decline, they are still a sapphire. How is their mobility, hygiene, and nutritional intake? Would they be happier or healthier if these basic needs are met? How about socialization? Have they been getting out of the house and trying new things?

 

GEM care for dementia or traditional home care can help your loved one operate at their best. Old age or a progressive disease does not need to prevent them from enjoying their time with us. Have questions about how GEM care or traditional home care can best support your loved one?

 

Call us to learn more or to schedule a complementary wellness assessment by a

Registered Nurse and Certified Dementia Practitioner: 610-323-9800.

 

NursePartners is open 24 hours a day, 365 days a week: 610-323-9800

Personalizing care techniques can reduce behavioral and psychological symptoms of dementia

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

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.

Philadelphia dementia care, Philadelphia home care, Philadelphia caregiver

 

Pride month may be over, but our LGBT sensitivity training continues!

NursePartners offers a LGBT sensitivity training in additional to our base dementia (“GEM”) training.

Why is the LGBT sensitivity training important?

According to SAGE, there are 3,000,000 people in the U.S., aged 55 and older, that openly identify as LGBT. When providing care to this community, there is a distinct set of challenges and way to connect before providing care. It is important that the employees providing the caregiving not only understand basic terminology, but listen and understand needs, said and unsaid.

Based on a SAGE survey of 1,857 LGBT older adults, here are some of our key considerations when caring for those in this community.

  • 40% of LGBT older adults, ages 60 to 75 report that their healthcare providers do not know their sexual orientation.
  • 40% of this same group report that their support networks have shrunk compared to 27% of non-LGBT people.
  • 34% are concerned about “being lonely and growing old alone”, compared to 19% of their non-LGBT counterparts.
  • 34% live alone, compared to 21% of their non-LGBT counterparts.

In Philadelphia, we commit ourselves to LGBT older adults through board membership and activism via the LGBT Elder Initiative of Philadelphia. Many of the SAGE findings have also been reported by the LGBT Elder Initiative here. (The LGBT Elder Initiative also offers great programming… if you were not already aware.)

So, what can a potential client that identifies as LGBT expect from NursePartners before the initiation of services?

  • An in-person assessment by a registered nurse, dementia practitioner, and a SAGE-certified employee. Subsequent LGBT sensitivity training has been done internally.
  • The development of a plan of care that not only outlines physical care needs but paints a picture of that individual’s life up until this point. This allows the care team to find ways to relate to the client before they even meet.
  • Given that the client commits to a regular schedule, they can expect a regular care team with whom they can establish trusting relationships. We take our commitment to HIPAA seriously, and this includes issues particular to LGBT older adults.
  • All carepartners are trained in the Positive Physical Approach to Care, as outlined by dementia care revolutionary, Teepa Snow. Many of these care approaches directly translate to individuals who are not living with dementia. It emphasizes connecting, patience, and “joining the client’s world”.
  • Carepartners working with LGBT older adults will also have received a LGBT sensitivity training provided by us.
  • A continuous relationship with NursePartners admin throughout the entirety of their time with us. We are an open book, with 24/7 effective hours of operation. Yes, we in admin sleep, but never all at the same time!
  • We are locally owned and have been hard at work since 2002. Since then, we have developed a network of providers that have also earned our trust. We are happy to share these resources with you if they are needed.

Want to learn more about NursePartners?  Why not give us a call at 610-323-9800?

Fall Costs for Older Adults in the Philadelphia Metro, Fall Risk Mitigation Techniques

Healthcare Costs Attributed to Falls:

The Pennsylvania Department of Health collects statistics for injuries that result in hospitalizations, per cause, per age group. In 2014, these injuries increased greatly for ages 45 to 64, decreased slightly for those 65 to 74, and increased again greatly for those over 75.

Below are the results for three counties in Pennsylvania: Delaware, Montgomery, and Philadelphia. The numbers are not weighted for total population of each county, but rather represent individual counts.

dementia care costs, home care costs, fall risk Philadelphia, Alzheimer's Association of Philadelphia, Alzheimer's Association of Delaware River Valley

 

The National Council on Aging reported that in 2013, that out of 25 injury categories and 7 age groups, total hospital charges for all injuries and ages was greater than $9,100,000,000. Of this amount, $3,700,000,000 was spent on one injury type for one two age groups. This was for fall injuries for adults aged 65 years and older.

Using numbers from the U.S. census for 2013, the population of these three counties aged 65 years or older is approximately 385,762. In costs are divided evenly among the approximate U.S. population of this same age, 44,701,074.  The total cost of falls for older adults in Delaware, Montgomery, and Philadelphia counties was approximately $31,930,316 in 2013.

9,790 individuals in the Delaware, Montgomery, and Philadelphia counties were reported as having sustained hospitalizations due to a fall.  If we consider national costs consistent, the average hospitalization cost for these local older adults was $3,261.52 per fall.  This figure obscures the true cost. Some of these falls result in death while others lead to chronic and permanent injuries, which require increasing amount of funding for the remainder of that individual’s life.

How can you help prevent falls in older adults?

We do not have to wait around for a fall in order to act. Each of us has a role in mitigating the fall risk of older adults. In the senior’s home, we need to be especially vigilant, because this is where they spend the most time, and usually alone.

These are the concrete steps we can take:

  • Clear floor of clutter.
  • Ensure older adult is wearing nonskid footwear or shoes that fit.
  • If they wear glasses, clean them regularly and ensure use.
  • If the older adult is living with dementia, pay attention to the position of their head. Their line of sight is restricting, so they should be looking down at their path ahead.
  • Complete physical therapy exercises to make gains when possible and reevaluate weaknesses.
  • Keep corridors and bathroom properly lighted.
  • Be available to assistance in case of emergencies.
  • Reorganize closets and kitchen to be easily assessible to older adult.

Most, if not all, of these tasks require a consistent presence in the home to ensure compliance. NursePartners is a privately-owned home care company providing traditional home care and dementia care services. We have been around since 2002, founded and operated by a registered nurse and certified dementia practitioner.

Let us help you help them. Call us to learn about what makes NursePartners the agency of choice for families in the Delaware, Montgomery, and Philadelphia county areas. We also call this area home!

610-323-9800

All sources were referenced today, on June 29, 2019.  The organization names are hyperlinked below.

 

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/