Tag: daily life dementia

Understanding Behaviors and Adapting Approaches in Dementia Care

Your role as caregiver, family member, or friend evolves with the progression of dementia.  Even faced with challenging behaviors, you can still connect with your loved one and fill their day with meaningful activities.  NursePartners is here to support you while your relationship evolves with the person living with dementia.

 

What is their behavior telling you?

We are constantly learning more about the brain’s ability to comprehend messages.  This includes messages that are delivered through speech versus writing, in a crowded space versus a one-on-one situation, or even a familiar voice versus one of a stranger.

Alzheimer’s disease and other dementias can cause people to act in unpredictable ways. Some individuals become anxious or aggressive while others repeat certain questions or gestures. Messages can be misinterpreted, surprising both the care recipient and caregiver. These types of reactions lead to misunderstanding, frustration, and tension.

It’s important to understand your loved one is not trying to be difficult and that these behaviors are also forms of communication.

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Tips for managing behavioral changes

As carepartners, we need to adapt our delivery process throughout the progression of the disease. When we carry on a traditional conversation, we usually engage in a back and forth volley of information. When a person is diagnosed with dementia, it is important to realize that the three essential language skills for processing and sharing verbal messages need to be supported in different ways. These core linguistic skills are:

  • Vocabulary (the words – the meaning of the content)
  • Comprehension (receptive language – the ability to process the message)
  • Speech production (expressive language – the ability to deliver the message)

Certain retained skills will assist you in conveying a message:

  • Social chit-chat (the back and forth that can mask loss of comprehension, but covers in short simple conversations)
  • Rhythm of speech (this includes awareness of the rhythm of a question that is seeking an answer, as well as ability to sustain rhythm or hear a rhythm that sounds familiar).  Additionally it can and does signal changes in emotion – changes in frequency, intensity, or volume can indicate shifts in emotional state or discomfort.
  • Rhythmic speech as is present in music, poetry, prayer, counting and even spelling.

What you can do:

There are important supportive phrases that can help when they are used in combination with pauses, inflections, visual cues, props, and partial reflective statement to confirm what was said or south:

  1. Seek more information by being nonspecific, try phrases such as  “Tell me more about it.”
  2. Seek demonstration or visual representation with phrases such as  “Could you show me how you would use it?” or“Show me how you’d do it.”
  3. Offer simplified options, by using two options at a time, or encouraging yes/no responses.  Employ the use of object pronouns.

What can help:

Awareness, knowledge, skill and support for both parties.

Mary Stehle, licensed social worker and Senior Care Advisor says, “A person with Alzheimer’s who has lost the ability to understand and communicate through language is always looking for cues from us as to how to interpret the world. They are constantly reading our tone of voice, facial expressions, and body language. When we are tired, stressed, and resentful, they pick up on this and it often impacts them negatively.” It’s important to remember that asking for help is not an act of selfishness, it’s providing better care for both you and your loved one.

We can be by their side when you can’t be. If your loved one need home care assistance or relief – Contact us today.

NursePartners is committed to providing uncompromised care to those living with a diagnosis of dementia. Our carepartners work with each family to enable safety, comfort and happiness through home-care services.

Daily Care: Late Stage Alzheimer’s Disease

How can we, family and carepartners, support the people we know living with Alzheimer’s disease or another form of dementia?

Keeping loved ones stimulated and providing ability-based care and support cannot be overstated. At NursePartners, we recognize the GEMS™ model as an effective method for providing a treatment plan for individuals affected by dementia.  Click here for an introductory overview of the classification system describing the stages of the journey.

By appreciating what is changing and what is still possible, we can provide care that is more effective and less challenging.

 

Stage 3 – Severe/Late (lasts about one 1-3 years) – Rubies and Pearls

As dementia moves into the final stage, it can be difficult to know how to meet needs. Many lose their ability to control movement and respond to the environment. As memory and cognitive skills worsen, your loved one may need extensive help with daily activities.

The goal of care at this stage is to focus on preserving dignity and quality of life. Although your loved one may lose the ability talk and express needs, you can still connect with them, enjoying interactions and experiences of their past life.

 

About Rubies and Pearls

Rubies

Rubies experience late stage changes as fine motor skills are very limited. Losses in depth perception, as well as limited visual awareness and major sensory changes result in needed assistance with utensils, brushing, buttoning and moving. Hand-under-hand assistance helps rubies feel safe and secure. Suggested activities together include: reading, playing music, and looking through old photos.

Pearls

Pearls are still and quiet, unable to actively move or respond, with limited awareness of the world. Pearls enjoy pleasant sounds and familiar voices, grasping onto moments of connection.  Whether it’s the smell of their favorite perfume, or a beloved radio program, these small experiences can help capture a moment in time and evoke pleasant memories. Being present, patient, and understanding with your loved one will help them escape feelings of isolation associated with late stage Alzheimer’s.

Planning the Day

  • Tailor the environment with the interests of your loved one. This can allow them to emotionally connect to things they previously enjoyed.
  • Plan the days to have a balance of restful and active periods to help your loved ones transition slowly and gradually from one to the other.
  • Observe the person for signs of stress. Keep lights low and noise to a minimum. Consider visiting in smaller numbers.
  • Use your voice to engage and encourage, talking quietly to tell stories and reminiscing about past events.
  • Discover which eye they use for vision.  Do not obstruct their line of site and get on or below eye level when speaking with them.

At this point in the disease, the world is primarily experienced through the senses. You can express your caring through touch, sound, sight, taste and smell.

Activities for Rubies and Pearls

  • Playing their favorite music
  • Reminiscing about past events
  • Reading portions of books that have meaning for the person
  • Looking at old photos together
  • Preparing a favorite food
  • Rubbing lotion with a favorite scent into the skin
  • Brushing their hair
  • Sitting outside together on a nice day

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NursePartners is committed to providing uncompromised care to those living with a diagnosis of dementia. Our carepartners are trained in the Positive Approach to Alzheimer’s and Dementia Care (GEMS™) and work with families to enable safety, comfort and happiness through home-care services.

If your loved one need home care assistance or relief, our team would love to help.

Contact us today.

 

 

Daily Care: Moderate Stages of Alzheimer’s Disease

We can support the people we know living with dementia by keeping them mentally stimulated and providing ability-based care and support. At NursePartners, we recognize the GEMS™ model as an effective method for providing a plan of care for individuals living with Alzheimer’s disease or another form of dementia.  Click here for an introductory overview of the classification system and to understand the stages of the journey.

By appreciating what is changing and what is still possible, we can provide care that is more effective and less challenging.

 

Stage 2 – Moderate/Middle (lasts 2-10 yrs) – Emeralds and Ambers

At NursePartners, we use the “Emerald” or “Amber” classification for clients with moderately developed dementias.  We prefer this terminology because we know that all clients are operate at their best with the right approach to care.

A client normally persists in the Emerald and Amber stages the longest out of the other GEM levels. During this time, damage to the brain can make it difficult to express thoughts and perform routine tasks. It is important to allow your loved one to be involved in their day-to-day routine. Provide meaning through relevant activities that were part of their past because this will provide them with a sense of self-worth and add to their quality of life.

There will be acute changes to their self-awareness and senses.  We need to be able to distinguish daily changes and overall trends.  By having an established relationship with the client, we are also able to tell the difference between a client’s personality quirks and further developments of the disease.

 

About Emeralds and Ambers

 

Emeralds

Emeralds may get lost in time, thinking that are in another place or assuming a former role. They have problems with communication and comprehension, often asking questions that begin with “who”, “what”, “where”, and “when”.  At this GEM level, clients are making small mistakes with their personal care, but may not recognize it.  Some examples of this might be fastening buttons in the wrong holes, putting shoes on the wrong feet, or not changing clothing or brushing hair before leaving the home.  It is not important that we “correct every mistake”, but make changes subtly by using the right approach.  Sometimes this requires relating to the “mistake”, by discussing how we do this ourselves.  We could also pull out another piece of clothing and convince the client how good they look in that particular piece.

Emeralds are most comfortable when doing familiar tasks. They like to engage and help others, as well as feeling like they have a purpose. At a family functions, engage them by asking to help set the table and then clean it up. Choose favorite activities or hobbies of the past, but do not impose time limits for completing each task

Activities at home

Activities around the house can help Emeralds feel involved and provide a sense of normality. Activities such as setting the table, watering plants, and cooking can reflect past hobbies and interests, and can be a good way of retaining skills. Helping in the kitchen can also bring people together, as many experiences revolve around meals: holidays, birthdays, church potlucks, summer barbecues, weddings. Some activities for Emeralds include:

  • Cooking: salads, ice cream, Jell-O, pudding, no-bake cookies and pies, etc.
  • Copying recipes from magazines onto cards
  • Making a grocery list of items needed for recipes
  • Setting the table: Folding or rolling silverware into napkins

 

Ambers

Ambers like to live in moments of time, and are focused on sensation – manipulating, gathering and touching.  They are focused on wants and needs, and sometimes are exploratory without safety awareness. Their communication is limited with difficulty understanding and expressing needs, so activities selected need be familiar and sensory stimulating. Ambers may enjoy sing-alongs or being in visually stimulating outdoor locations.

Family members find it hard to find new ways “to say hello”.  We need to remember that there are other ways to communicate beyond verbally.  This is the time to start using those our methods.

Some activities for Ambers include:

  • Sorting nails, screws, and other hardware.
  • Organizing nail polish and lipsticks by color and shape.
  • Grouping coins, according to date, value or place of origin.
  • Rearranging the order of the silverware drawer by forks, spoons and knives.
  • Categorizing playing cards into decks or suits that match.

Planning the Day

  • Make a schedule and follow it: be structured but allow flexibility.
  • Offer a variety of activities everyday: leisure, work, rest, and self-care.
  • Create a flow for the day: build up and then slow down.
  • Build a foundation of familiar and favorite activities.

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NursePartners is committed to providing uncompromised care to those living with a diagnosis of dementia. Our carepartners are trained in the Positive Approach to Alzheimer’s and Dementia Care (GEMS™) and work with families to enable safety, comfort, and happiness through home-care services.

If your loved one need home care assistance or relief, our team would love to help.  Contact us today.

 

Daily Care: Early Stage Alzheimer’s Disease

 

The early stages of dementia sometimes go unnoticed, especially if the older adult lives alone.  In the cases that we do learn of an early diagnosis, the challenge becomes how to best support the person living with dementia.  Typically the diagnosis may be Alzheimer’s disease, but the reality is that there are over 80 types of dementia and other conditions that produce symptoms similar to dementia.

Keeping loved ones stimulated, and providing ability-based support and care cannot be overstated. At NursePartners, we recognize the GEMS™ model as an effective method for providing a treatment plan for individuals living with dementia. Click here for an introductory overview of the classification system and to understand the stages of the journey.

 

Stage 1 – Mild/Early (lasts 2-4 yrs) –  NursePartners refers to these individuals as “Sapphires” and “Diamonds”

In the early stages of dementia, your loved one may withdraw from activities they previously enjoyed. It is important to help them remain engaged and stimulated. Even the most simple, everyday tasks such as setting the table or folding clothes can help a person with Alzheimer’s or another form of dementia feel connected to “normal” life. Activities linked to hobbies and interests can maximize choice and help build the relationship between that person and the carepartner.

 

About Sapphires and Diamonds

Sapphires

Sapphires may feel “blue” due to changes with the aging process, although there may be no significant changes in cognition.  Sapphires are committed to lifelong patterns, enjoying the things the way they always have. Sapphires prefer being asked what to do when making decisions. Pamper them – spending a spa day or a trip to the barber/beauty salon can help them feel less blue.  Sapphires are not living with dementia.

Diamonds

Diamonds are “clear and sharp,” successful with established habits and routines. Diamonds like to feel competent and valued, and it is important for them to feel comfortable and in control. A diamond can still do things as they always have, but they become more territorial and less aware of boundaries. Diamonds enjoy familiar places, whether that be a family member’s home or a favorite restaurant. Suggested activities include attending concerts or plays and getting fresh air – picnicking or walking outdoors.

 

 

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A stroll in the neighborhood helps animate most older adults.

Activities for Sapphires and Diamonds

  • Thinking: crosswords, jigsaw puzzles, cards, board games, and reading.
  • Physical: walking animals, gardening, walking, swimming, and dancing.
  • Social: visiting with family or friends, or going to a favorite restaurant.
  • Home Activities: folding laundry, feeding pets, cooking and helping in the kitchen.
  • Creative: arts and crafts projects, knitting, painting and drawing, playing music or singing.
  • Daily living: taking a shower, brushing teeth, eating, and getting dressed.

Reminiscence activities:

  • Looking through photo albums.
  • Creating a scrapbook, pasting photos onto the pages and writing notes about the memory beside the photo.
  • Reading saved letters and greeting cards.
  • Life Story Game: Ask your loved one to list the steps and necessities associated with an activity. For example: “We are going on a picnic, what would we bring in the picnic basket? Where would we go for the picnic?”

Some suggestions could be:

  1.   A day at the beach.
  2.   A ride in the country.
  3.   First day at school.
  4.   Getting married.
  5.   Social functions.

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NursePartners is committed to providing uncompromised care to those living with a diagnosis of dementia. Our carepartners are trained in the Positive Approach to Alzheimer’s and Dementia Care (GEMS™) and work with families to enable safety, comfort, and meaningful activity through home-care services.

If your loved one need home care assistance or relief, our team would love to help.

Contact us today.

Exercise for those living with dementia

Exercise is essential for a healthy lifestyle, contributing to physical and mental health, muscle control, coordination, and a sense of wellbeing. It plays a huge role in reducing Alzheimer’s and dementia, by maintaining blood flow to the brain and stimulating cell growth.

These are the benefits of physical exercise for these individuals:

  • improved cognition, sleep, and mood;
  • opportunities for social interaction;
  • reducing feelings of confusion and isolation;
  • improved confidence and self-esteem;
  • reduced risk of breast and colon cancer, stroke, and type II diabetes;
  • improved physical fitness (maintaining strong muscles and flexible joints can help people maintain independence for longer).

Getting started

The Department of Health recommends 150 minutes of physical activity per week. This equates to 30 minutes of activity per day. This can be broken up into shorter sessions throughout the day, with each session lasting a minimum of 10 minutes. Allow your loved one to go at their own pace. Plan a day around physical activities: a fifteen minute walk in the morning, followed by housework or gardening tasks in the afternoon.

It is important to consider ability, stage of dementia, and preference, as individuals undertake physical exercise. Some might be more adaptable to exercise, while others start with simpler activities.

Always talk to a healthcare professional before creating a exercise plan.  Often clients have previously worked with a physical therapist.  NursePartners is able to help clients follow those plans already developed.

What is the right exercise?

An exercise program incorporated into a routine in the early stages of dementia is more likely to be maintained, extending the benefits to health and well-being.

Consider a physical activity that is mentally and socially engaging, such as walking, gardening, dancing, or an exercise group. Repetitive activity such as walking on a treadmill or using an exercise bike can also help reduce anxiety and confusion.

Exercise in the later stages of dementia

If possible, physical activity can be very beneficial in the later stages of dementia.

Some suggested exercises:

  • Have your loved one sit on one end of the bed, and then scoot to the other end while sitting. This exercise is good practice for getting up from a chair;
  • Encourage them to sit in a different chair at each mealtime throughout the day;
  • Help them sit without support. This exercise helps with balance and posture and can form part of everyday activities;
  • Have your loved one walk short distances between rooms as part of a daily routine.  This will help maintain muscle strength and joint flexibility.

Physical activity creates an opportunity for your loved one to socialize with others, as well as working to improve and maintain their independence. NursePartners is committed to providing uncompromised care to those living with a diagnosis of dementia. Our carepartners are trained in the Positive Approach to Alzheimer’s and Dementia Care (GEMS™) and work with families to enable safety, comfort, and happiness through home care services.

If your loved one need home care assistance or relief, our team would love to help.

Contact us today.

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.

Is it time to find care for your loved one?

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Many families struggle to make decisions about the best living situation and care for their loved one. There are many signs that indicate your loved one might benefit from home care services:

  • Confusion and uncertainty when performing once familiar tasks;
  • Unexplained weight loss;
  • Spoiled food in the fridge;
  • Difficulty standing and walking;
  • Forgetfulness and loss of interest in favorite activities;
  • Neglected personal hygiene;
  • Inability to keep up with house maintenance;
  • Missed appointments, unpaid bills, and late payment notices.

Seniors who live alone often experience isolation and poor nutrition, contributing to depression, cognitive decline, and a lower quality of life. It may be time to consider home care if you find your loved one with some of these symptoms.

In-Home Care Offers Independence

Many individuals, if given the choice, would choose to remain in the comfort of their own home for as long as possible. In-home care is an option for providing support, without moving them from their current residence. A plan of care can be tailored to meet the likes and needs of your loved one.  This is the superior option to scheduled activities and regimented care that is often provided in assisted living facilities.  At home, your loved one can set their own schedule and find comfort in the familiarity of their surroundings.

NursePartners works with each family to enable safety, comfortability, and happiness through home care services. As part of this process, we match your loved one’s needs to a select group of compassionate carepartners.

Our carepartners are dedicated to improving our clients’ quality of life. Our approach to Alzheimer’s and dementia care is based on The GEMS™: Brain Change Model created by Teepa Snow.  

The GEMS™: Brain Change Model

NursePartners recognizes 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, each defined by unique characteristics. Understanding each stage of the process allows carepartners to gain a deeper insight into what your loved one is experiencing.

After an in-home assessment, we work to create a plan of care to help your loved one live comfortably and safely. By keeping a record of everything from mood behaviors, health complications, to daily activities, we can begin to understand what factors contribute to positive moods and overall happiness.

In-home care offers independence, and NursePartners delivers with flexible, customized solutions. Ready to learn more? Our care team would love to offer a complimentary in-home care consultation. Contact us today.

Developing Trust with Your Doctor

As family members and caretakers, we play a large role in overseeing the medical needs of our loved ones. Your relationship with medical professionals is based on trust, communication and understanding.  The stronger the patient-physician relationship, the more value it provides. It’s been shown that individuals who establish relationships with their doctors tend to have better health outcomes. Building a plan of care that includes their doctor enables you to help meet the medical needs of your loved one throughout their later years.

Chupein with Shy

Here’s how you can establish a relationship and keep it on track:

 

  • Prepare for your appointment.

Bring all current medications, along with notes and facts about the state of health of your loved one. Write down any recent health problems or concerns that you have beforehand, so you make sure to bring them up.

 

  • Choose a relationship style.

Whether it’s a new doctor that you’re meeting for the first time or one that you’ve had a relationship with for a while, state clearly at the beginning of your visit that you want to be involved as a partner in the decision-making process.

 

  • Provide some background.

Share your point of view. How is a new technique working?  You should let your doctor know either way. If your loved one has a complicated medical history, or if you are meeting with a new doctor, bring a summary of recent tests, treatments and health problems so the doctor understands quickly.

 

  • Make sure you leave with the information you need.

You need to leave the doctor’s appointment with the information to provide care.  Record your visit, or bring someone to take notes. There’s often a lot of information to absorb during a doctor’s appointment, particularly if you’re facing a major, frightening health challenge. You may be distracted by trying to take in a diagnosis, so it can be helpful to take notes of everything discussed.

 

  • Ask how to reach your doctor after hours.

It’s important to ask your doctor how to keep in touch in the event of a medical emergency that happens outside of regular hours. Every doctor will have a different preference, so find out which method works best.  If you know the system for getting in touch before a crisis.

 

Our carepartners are dedicated to improving quality of life. NursePartners works diligently to ensure carepartners fill their time together with positive interactions. By keeping a record of everything from mood behaviors to daily activities, we can begin to understand which factors contribute to positive moods and overall happiness.  Our carepartners are trained in the Positive Approach to Alzheimer’s and Dementia Care (GEMS™) and work with families 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.