Tag: dementia care Montgomery County

Why Care Teams Fail: Avoid these four common mistakes

At NursePartners, we understand that each client is unique.  Each person was crafted by their a history of rich life experiences  If they are living with a progressive disease such as dementia, knowing these stories becomes even more important.  Eventually we will have to be the ones to remind them of their stories.

 

Realistic and transparent goals need to be set from the onset of services.  Our standards are high, but the perfect care team needs time to mature.  NursePartners screens employees based on their personality fit with specific clients.  However, just like most relationships, it takes time for clients to trust carepartners.  The best results are realized after several assignments, not the first one.  This brings us to the first reason why care teams fail:

  • Client does not give the care team enough time to mature

Solution: Exercise patience.  Let us know what we can do better and give your loved one a chance to get used to the carepartner.

 

The communication between members of the care team is also important.  NursePartners works well with other service providers, including life managers, social workers, hospitals, nursing homes, hospice, estate attorneys, and other specialists.  The family members are also part of the care team.  However, too much or too little communication can be detrimental to the level of care being provided.  Every one should be on the same page while they work for the same goal: the best care for the older adult.

  • Poor communication among members of the care team

Solution: Share the same documents, do not reinvent the wheel, and include one another in your correspondence.

 

Various sets of expectations by multiple Power of Attorneys or children can set the stage for disagreement.  Sometimes these conflicting actors may not even agree with the diagnosis and subsequently, how to best care for the client.  It is important to remember, the focus should be on the well-being of the client.

  • Disagreement on the diagnosis and expectations of care

Solution: When you talk to your siblings and family, focus your conversation on how to best support your loved one.  It is about them, not about you.  If you want to rule out other possible diagnoses, consult specialists, but consider the impact it has on the quality of life of the older adult.

 

A stable schedule helps the older adult build a routine and encourages the same carepartner(s) to work with client over the medium and long-term.  When schedules change often, so does the daily routine.  It also has consequences for the care team.  We cannot guarantee that the same carepartners will return to your care team if the schedule is interrupted regularly.

  • Erratic schedule changes

Solution: Make a commitment to choose a realistic schedule that allows your loved one to form a relationship with their carepartners.  This allows the plan of care to be executed successfully.  The minimum amount of service for clients with the least needs is usually three to five days per week, of at least four hours each assignment.    

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Vision Changes for those Living with Alzheimer’s disease or another form of dementia

Our field of vision changes as we age, but the changes are drastic for a person living with dementia.  Eventually the field of vision becomes so restricted that sight becomes a main obstacle in carepartners connecting before providing care.  The results could worsen anxiety, hallucinations, mood swings, aggression, and other behavioral issues. 
Visual deterioration progresses in the following order:
  1. 45* peripheral (This is the normal range of vision for an older adult 75 years young.)
  2. Tunnel vision (The width is about a yard in diameter.  Loss of sight occurs in all directions: left, right, up, and down.)
  3. Binocular vision (Cup your hands around your eyes or use a pair of binoculars to experience this for yourself.)
  4. Restricted binocular (Cup your hands tighter around each eye, until they are just loose enough to fit a pencil through each opening.)
  5. Monocular (The brain shuts off vision to one eye.  This is because the brain is prioritizing other bodily functions such as digestion, respiration, and blood circulation.)
NursePartners practices the positive physical approach to care.  We emphasize the importance of recognizing these changes in order to build meaningful and successful relationships.  Admin includes dementia practitioners and coaches that train our carepartners in dementia care before placing them to work with our clients.  
Want to learn more about our dementia training?  Think these approaches can enhance the quality of life for your loved one? 

Call us to learn more about how we can help: 610-323-9800.

Philadelphia demenia care, Philadelphia home care, Philadelphia Alzheimer's disease“Ambers”, or clients living in a middle stage of dementia, experience the world with binocular vision.
If you want to learn more about reducing challenging behaviors, check out this article from Pines Education.
 

Hallucinations in Lewy Bodies and other types of dementia

Below is a video clip from Teepa Snow, explaining how the type of hallucination dictates our response.  This video clip is the basis of this article.

Hallucinations: Visual, Verbal, Tactile

Hallucinations are common for older adults living with dementia, especially Lewy Bodies.  As carepartners, it is our responsibility to address the vision and make the care recipient more comfortable.  In order to do this, we need to understand how the person feels about their hallucination.

  • Does the person living with dementia think they are in their childhood home with their favorite dog?
  • Does the person living with dementia believe other residents are hiding in their bathroom?
  • Is someone stealing something from the client’s room?
  • Is a traumatic childhood experience resurfacing?

Our first task is to answer the following question: Does the hallucination scare our client?

If the hallucination is not scary, ask the person how they feel about the image.  Go over to the area with the older adult and look where they gaze.  Ask questions.  Listen to their responses and formulate new questions based on those answers.  Your goal is to get as many details as possible about the hallucination.

As you delve deeper, the original hallucination will disappear.  Eventually their brain will not be able to match their own verbal responses to the image “seen” by their visual sensory organs.

This is your opportunity to switch the topic.  Engage them in a new activity and move out of the original environment.  Do not mention anything that allows them to circuit back to the hallucination.

 

In order to help, we first must understand how the hallucination makes the older adult feel.  

If the client is visibly scared by the hallucination, our approach needs to be different.

We should not ask them for more information about the image!  Instead, we need to offer them more immediate sensory input.

Those living with dementia have a heightened sensation in the palm of their hands.  They also loose the “skill” capacity in some fingers as all fingers become used for “strength”.  By using the hand-under-hand technique, you protect the care recipient and yourself, while providing reassurance.  You are able to guide their next action by retaining a grasp.

When faced with scary hallucinations, you can apply immediate and repeated pressure to their palms by pumping your palm against theirs.  This sensation feels good and will help to redirect their attention.

You will want to be on the person’s preferred side.  This is also known as their dominant side or the side in which they prefer to write.  This is important because it allows you to draw their view more easily.  The client also pays more attention to data and sound on their dominant side.

Simultaneously, you should show that you are worried!  Ensure your face and words match.  Tell and show them how worried you are about the hallucination.

Follow up with an action plan.  Now that you understand, how will you help?  What will you do to get the object to go away?  Where will the client go to be safe?  Describe your next few action steps to the care recipient.  Continue to use the hand-under-hand approach, pump their palm, and continue to look and sound concerned.

Hallucinations are not preventable for those living with Lewy Bodies dementia.  However, we can work to minimize their occurrences in other forms of dementia.  The typical triggers for hallucinations are an emotional experience from that day or week that causes the client to time travel, emotional distress, infection, and dehydration.  A hallucination may be a sign that something else is wrong physiologically with the client.

 

 

 

 

 

The 10 Warning Signs of Alzheimer’s Disease

The Alzheimer’s Association presents the following as warnings signs of Alzheimer’s disease:

  1. Memory loss that disrupts daily life
  2. Challenges in planning or solving problems
  3. Difficulty completing familiar tasks at home, work, or leisure
  4. Confusion with time or place
  5. Trouble understanding visual images and spatial relationships
  6. New problems with words in speaking or writing
  7. Misplacing things and losing the ability to retrace steps
  8. Decreased or poor judgment
  9. Withdrawal from work or social activities
  10. Changes in mood and personality

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As we age, our organs do not perform as before.  The brain is no exception.  Some natural cognitive decline is natural.  When presenting the early warning signs, it is important that we put each warning sign in its proper context.

It is also important to remember that each person has their own baseline.  We do not all have the same skills or personalities.  Life experiences and family relationships also impact how we develop as individuals.  In order to receive a proper diagnosis, a physician must take the time to fully understand the personality and life experiences.  Other factors such as  stress, depression, and vitamin deficiencies might be to blame.

  1. Memory loss that disrupts daily life
    • Forgetting the names of new classroom of students is normal.  This is different from being unable to remember the name of your spouse or children (if you have a few!).  Typically we forget names, but are able to remember them on our own later.
  2. Challenges in planning or solving problems
    • This is relative to your problem solving skills when you were younger.  If these skills were never strong, they will also be weak as an older adult.
  3. Difficulty completing familiar tasks at home, work, or leisure.
    • The key word is “familiar”.  If you have never been good at folding clothes, this is not a familiar task, and therefore there is no cause for concern that you still cannot do it well.
  4. Confusion with time or place
    • It is normal to write the year wrong in January or to think it is Tuesday when it is in fact Wednesday.  Life stresses causing us to loose track of the passage of small periods of time.  However, it is not normal to perceive yourself as being in the opposite season or many years in the past.
  5. Trouble understanding visual images and spatial relationships
    • Vision generally worsens as we age.  Older adults aged 75+ typically have peripheral vision of about 45 degrees in each direction.  Older adults living with dementia will develop tunnel vision.  Eventually this vision becomes binocular and then monocular.  They will also have issues gauging distance while driving or recognizing the depth perception of items in a room.
  6. New problems with words in speaking or writing
    • Some older adults may have a stutter or become timid in large group settings.  Their energy level or stress can also impact their ability to speak well.  We also all forget the names of items, especially words that we use infrequently.  It is not normal to forget words that are common to our every day life.  If we forget them, we may remember them by mentioning other related words.  If we think of the common word after this activity, this may be a sign of a developing cognitive impairment.
  7. Misplacing things and losing the ability to retrace steps
    • We all loose our keys, unless we are very disciplined!  We may leave them in our pockets, put them on the counter, or periodically forget to even bring them out of the car.  These are all normal acts.  What is abnormal is putting keys in the fruit bowl, refrigerator, or give them to a friendly stranger.
  8. Decreased or poor judgment
    • Related to the above, poor judgment might be falling victim to a sweepstakes scam or donating more than you can afford.  We all have different levels of judgment, but typically this decline is hard to uncover in family and friends.
  9. Withdrawal from work or social activities
    • This is especially relevant for extroverts.  If a person finds themselves suddenly lost in a conversation this could be an issue.  However, we should consider other issues such as depression or exhaustion.  Introverts may avoid social activities, but enjoy gatherings among family and a few friends.  If these behaviors change over the course of months or years, this might be cause for concern.
  10. Changes in mood and personality
    • These are differences that arise over the course of the medium and long term.  Keep in mind that life experiences can also permanently impact one’s personality.  It is important to take the time to understand if traumatic incidents are to blame.

 

 

 

 

Visual Cues and Decluttering for Those Living with Dementia

On Monday, November 13 at 12:30pm the National Aging in Place Council of Philadelphia will present on dementia and the importance of decluttering.  The program is titled “Visual Cues and Decluttering for Those Living with Dementia”.  It will be hosted at the Presbyterian Church of Chestnut Hill.

The goal of the seminar is to educate participants as to how dementia changes our senses and our responses towards external stimuli. Understanding the disease progression is crucial for being able to successfully adapt and to begin the dialogue of decluttering. 

Older adults thrive in an organizes and simplified environment.  By reducing clutter, older adults will be able to find the items they need and minimize the risk of falls.  However, even given the risks, the actual tasks of organizing and decluttering needs to be handled in a sensitive way.  The disposal of an item does not imply that we are forgetting experiences. 

We will also discuss the physical removal of items from the home.  This step must be done in a sensitive way too, understanding that each individual values items differently.  The removal is done in a responsible manner, always considering the possibility for donation, resale, and recycle.   

The presenters are founding members of the National Aging in Place Council (“NAIPC”) of Philadelphia.  Together the NAIPC serves as a consortium of industry leaders who hold themselves to ethical standards in their commitment to helping older adults age in place. 

If you would like to join us next Monday , please email philadelphia@ageinplace.com

Our presenters include:

  • Bode Hennegan, Life Managers & Associates
  • Bill Read, JDog Junk Removal & Hauling
  • Peter Abraldes, NursePartners, Inc.