Tag: dementia care philadelphia

Dementia during the Holidays: Emerald

Posted on by Peter R. Abraldes

Brain Change Model

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

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

The path is different for everyone

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

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

 Seeing the glass half full, engage with your Emerald

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

You will need a team

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

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

Assessments at no cost

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

Dementia during the Holidays: Diamonds

Posted on by Peter R. Abraldes

Brain Change Model

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

In the previous article about Sapphires, we discussed someone exhibiting signs of dementia, but not actually suffering from the disease. Depression, as well as other possible culprits, are mostly curable. Dementia is different.

What is Dementia?

In this article, we will discuss the first stage of dementia: Diamond.

If you are looking for a three-minute explanation of dementia, here is a great video.

Here are a few important statements to keep in mind:

  1. Dementia is progressive, without a known cure, and leads to death. However, medications and engagement can slow the progression of the disease.
  2. There are over 80 known types of dementia, and sometimes some can exhibit multiple types. The most common type of dementia is Alzheimer’s disease.
  3. Many people are only officially diagnosed further in the disease progression, if at all. (There are many Diamonds that do not know they have the disease, nor do their family members.)
  4. A person living with dementia will loose various skills and abilities as the disease progresses, not just their cognitive capacity.

Diamond

The first stage of dementia is a Diamond because this gem is “clear and sharp”. Diagnosis is tricky because sometimes picking up on changes requires a long visit.

Diamonds can be successful at established habits and routines. They can engage in small talk and appear pleasant. This is because the first skill to be compromised, in Alzheimer’s type dementia, is short-term memory. In other types of dementia, such as frontotemporal, the person loses the ability to control their impulses.

Established habits and social mannerisms continue, because they were usually adopted at a younger age. These memories and skills are preserved are stored differently in the brain.

Interactions become more difficult as they become more substantive. During conversation difficulties can arise if you reference recently learned information. The person living with dementia becomes less flexible at changing habits and behaviors in response to new information. In conversation, the person will begin to appear overly rigid and are prone to snap if they cannot follow the conversation.

Recommendations for engaging with Diamonds

For those living with dementia and are operating as a Diamond, here are some recommendations:

  • Throw out the phrase “Do you remember?” and anything similar. They do not remember and you quizzing them will leave no one feeling better. Instead, try to focus on what they remember, resorting to more distant memories.
  • Involve them in the process as much as possible. They will feel frustrated by being unable to accomplish certain tasks, but your job is to find out the ones they still can do with you or on their own. If they can participate, they will feel competent and valued. Best activities will vary depending on physical abilities and past hobbies, but here are some ideas:
    • Ask them to help you sort or organize, preferably a task that you are not highly prioritizing, but would be nice if complete.
    • Have them paint or color certain objects.
    • Request they tell you a favorite childhood story.
    • Enlist their help watching a pet dog or cat.
    • Try a simpler version of a task they used to enjoy. For example, if they used to complete 1,000-piece puzzles, try a 100-piece puzzle.
  • Do not rationalize or try to occupy the moral high ground. Meet them where they are in their moment. If you seek to stop or prevent a certain activity, offer them an alternative. Substitute, then subtract.

GEM levels can fluctuate based on the person’s energy level, stress, and nutrition. For example, a fatigued or sick Diamond, can operate more like an Emerald for periods of time, before the Emerald stage become their modus operandi. Learn when and how your loved one operates best and use these moments to maximize a connection. Remember, always connect before providing care.

Build your team

It is important to build your care team at this stage before you reach a state of desperation. As the disease progresses, the person will become increasingly dependent on the people who are currently fulfilling the role as caregiver. If this person is you, it will be more difficult to introduce outside help effectively. Your loved one living with dementia may develop abnormal sleep patterns and become less considerate of your needs until theirs are met.

Providing hands on care is more effective after a connection is established. It is recommended that you introduce care early, on a regular weekly schedule, to get the person comfortable with the idea of help before someone needs to actively assist with hygiene and other more private care needs. In this way, you can gradually build your team and establish coverage with a reputable care provider.

Let’s talk

NursePartners is happy to complete a wellness assessment, at no cost, if referencing this article. All assessments are completed by a registered nurse and certified dementia practitioner. Your call is answered by a member of the admin team, at any time around the clock: 610-323-9800.

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

Posted on by Peter R. Abraldes

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

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

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

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

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

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

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

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

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

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

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

Call us today at 610-323-9800.

 

hospice care Philadelphia, home care Philadelphia

 

Why Care Teams Fail: Avoid these four common mistakes

Posted on by Peter R. Abraldes

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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Vascular Dementia: causes, progression, and support

Posted on by Peter R. Abraldes

This video from the UK Alzheimer’s Society explains vascular dementia.

As described by the video, our neurons require a healthy blood supply.  Our blood brings oxygen and nutrients to each of these cells.

Vascular dementias typically develop in one of two ways.  A major stroke can seriously damage the brain by cutting off the blood supply for a period of time.  Symptoms of dementia would be observable afterwards.  In contrast, a multi-infarct dementia can develop through a series of smaller strokes or by a narrowing of the blood vessels.  In both cases the blood supply is inhibited, either for lesser time for a series of smaller strokes, or gradually by limiting the amount of blood that reaches each neuron.

Certain cardiovascular diseases put individuals at higher risk for developing a vascular dementia.  These include high blood pressure, high cholesterol, and heart disease.

Symptoms include problems planning, organizing, and concentrating.  We should strive to break down complex tasks into basic steps and to simplify the environment.

Unlike other steps of dementia, vascular dementias tend to progress in a step-wise manner.  Although no treatments exist to reverse the associated effects of previous damage, a person living with the vascular dementia may stabilize at a new baseline if the blood supply remains constant.  However, if the blood supply continues to change, deterioration may happen at a quicker pace than for other types of dementia (Brain Test).

It is important for older adults living with vascular dementia to have the support they need to live their lives.  By focusing on what they can still do, we support clients living with this diagnosis.  NursePartners pairs dementia trained certificated nursing assistants with clients living at home or a facility.  Contact us today to learn more about our GEM care services for clients living with dementia.  610-323-9800

 

 

Tips for the Holidays – a collaborative piece from the National Aging in Place Council

Posted on by Peter R. Abraldes

NursePartners is proud to be a co-founder of the National Aging in Place Council of Philadelphia.  Monthly we meet with other vetted service providers to determine how we can best support older adults as they age in place.

National Aging in Place Councils from across the country have collaborated to prioritize five tips we can offer families during the holiday season.  The original post below has been supplemented by additional tips from NursePartners.

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Tips for the Holidays from NAIPC
      As the holiday season approaches, NAIPC members would like to offer seniors, caregivers and family members some health and safety tips for enjoying the holidays with loved ones.NAIPC members compiled a list of the five most common things that normally concern seniors, caregivers and their families.  We recommend that all stakeholders remain vigilant to minimize the risks and effects of the issues below:

  1. Isolation

  2. Safety

  3. Nutrition/Health

  4. Finances

  5. Transportation

      1. Isolation. Many older adults who have raised families, or been a central figure in their community, are now at a place where those roles are no longer part of everyday life. This leaves them searching for where they fit in the bigger picture and this is especially true during the holidays. It’s important for them to feel their participation is valuable and meaningful. Here are some ways you can mitigate isolationism:

  • Social visits include busy and quiet environments.  If your loved one is living with dementia, consider minimizing excessive noise and chaotic environments.  Try driving around your neighborhood to look at the holiday lights.
  • In they are unable to stand in the kitchen, have them sit and decorate cookies. You are involving them in the process, but also preventing the activity from being exhausting or overwhelming.
  • Reduce lengthy travel for older adults during the holidays.  Try suggesting that younger family members reunite in the home of the older adult.  If not, plan a virtual visit.
  • Older adults have rich stories of past holidays; incorporate these into your traditions and watch how they feel honored and valued.
  • Decorate as an intergenerational affair. From the youngest to the oldest, memories will be built when everyone can participate.

      2. Safety is a big concern, whether it be safety from the elements or safety from the unknown.

      For those aging in place, whether living alone or with the assistance of a caregiver, winter weather can be treacherous. It’s important to ensure that walkways and driveways are cleared of snow and ice before venturing out.  Hire someone to shovel pathways and salt sidewalks. Additionally, it is wise to keep a supply of candles, matches, food, extra blankets and medications at the ready.  If the older adult is living with dementia, consider having someone stay with them during snow storms.  Arrange for a groceries to be delivered before the storm, either online or by a relative or friend.
      Only use flame-resistant decorations and keep power cords away from heavily trafficked areas. Do not leave lights unattended and always assist the older adult while they are decorating.

      3. Nutrition/Health. It is always important to manage a sensible diet, but especially over the holiday season with the rich foods and drinks, that could potentially be detrimental to anyone with a risk of diabetes, heart disease or worse. Encourage those at risk to limit consumption, by taking smaller portions and balancing their diet, or avoid holiday treats altogether.

      4. Finances. We all cope with the financial pressures that our society imposes on us as we approach the holiday season.  We need presents, trees, decorations, festive meals, and constant entertainment.  This can certainly deplete the funds for someone living on a budget.

  • Consider going to another relative’s house rather than cooking a meal yourself.  If this is not an option, consider ordering a meal from somewhere like Boston Market.
  • Minimize holiday decorations by purchasing a table top tree.  This would be more manageable and easier to dispose.  Use holiday decorations that you already own.
  • Shop online for the best holiday deals to save on gifts for family members.  Assist an older adult with this process!
      Beware of charitable fraud.  Checking the IRS website for legitimate charities could be a lifesaver.

      5. Transportation. Whether it be local or long-distance travel, transportation becomes a larger issue around the holidays. Either it’s the inaccessibility of running errands or it’s waiting in long lines, navigating airports and security, claiming baggage and meeting up with relatives.  Don’t subject an older adult to these inconveniences.   Instead, celebrate your holidays by traveling to them.

The holidays are supposed to be full of joy, love and family. So, keep your family safe and happy this year.

      HAPPY HOLIDAYS from all of us at NAIPC!

Visual Cues and Decluttering for Those Living with Dementia

Posted on by Peter R. Abraldes

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.

 

Understanding Fall Risks

Posted on by Peter R. Abraldes

Falls are a common and serious problem affecting many older adults. Individuals suffering with Alzheimer’s disease or another form of dementia however, are twice as likely to experience annual falls and fractures. This varies from a range of factors including medication, night waking, shuffling, weakening musculature and balance. The first step in protecting your loved one from a serious injury associated with a fall is understanding the risk factors.

 

senior care Philadelphia, fall risk Philadelphia, dementia care Philadelphia

The following are common causes of falls:

Health Conditions

While everyone is at risk for falls, older adults are at the greatest risk due to chronic health conditions such as heart disease, arthritis, low blood pressure, Parkinson’s disease, dementia and other cognitive impairments. While some individuals in the early stages of Alzheimer’s are in excellent physical condition, many others seem to develop difficulties before cognitive impairment even begins. As Alzheimer’s progresses, it can cause lack of coordination, muscle weakness and diminished joint flexibility.

Reaction Time

As we get older, the nerves that carry information to and from the brain deteriorate. This slows reaction time and the ability to navigate around obstacles. This can be hazardous as seniors do not react as quickly in dangerous situations.

Medication

Many medicines also have side effects, causing dizziness, drowsiness and impaired vision.

Environmental Hazards

Many times, falls can happen because of environmental factors and hazards found throughout the home. These include everything from wet or slippery floors, poor lighting, to tripping hazards such as loose rugs, uneven floors, and trailing wires.

Visual-Spatial Problems

Because Alzheimer’s disease can affect the visual-spatial abilities, an individual can misinterpret and misjudge steps, uneven terrain, shiny areas on the floor or changes in floor color.

What you can do:

  1. Identify the risk factors for your loved one. Many people with Alzheimer’s and dementia suffer from poor eyesight, shuffling gait, muscle weakness and generalized frailty.
  2. Minimize or avoid medications that have been linked to falls. People with dementia are also more likely to fall when taking sedatives, tranquilizers, and antipsychotics.
  3. Exercise is important in preventing people from falling, especially if it includes balance and strength exercises. Ask the doctor about leg strength, gait, and balance evaluations. These tests help can determine physical risk factors.
  4. Consider a physical therapist or occupational therapist. These experts can work with your loved one to develop exercises strengthen joints.
  5. Make sure your loved one has eye tests regularly. Low vision is a huge risk factor for falls, and many vision problems come on gradually but steadily.  NursePartners’ use of theGEMTM methodology will also alert us towards changes in vision.
  6. Finally, get a home-safety assessment. Carepartners routinely perform these and can target danger spots and suggest easy improvements. This assessment can focus specifically on the needs of your loved one.

If you or a loved one is thinking about home care assistance, our team would love to help. Contact us today.

 

Sources:
Heerema, Esther. “Common Causes of Falls in People with Dementia.” Verywell.com. N.p., 31 Dec. 2015. Web. 30 May 2016.
 Perkins, Chris. “Dementia and Falling.” Continuing Medical Education 35.1 (2008): n. pag. Web. 31 May 2016.

Activities for those living with dementia

Posted on by Peter R. Abraldes

During the first week of services, NursePartners puts together an activity box for each of our clients living with dementia.  These give carepartners the tools they need to start building a successful relationship.

Carepartners know to communicate client needs as they arise.  Sometimes by learning more about our clients we can find activities that will best engage them.  Occasionally we bring additional items into the client’s home as we discover new interests.

We recommend keeping the brain actively engaged.  Families are encouraged to interact with the person living with dementia to find new ways to connect “and say hello”.  Jeremy Miller, BSW is a Certified Dementia Specialist who offers recommendations on his website: http://www.engagingdementia.com/engaging-products.

 

6 Activities for those living with dementia

It is also recommended to involve clients in their own care.  Clients should feel a sense of responsibility.  Carepartners may accompany them to places such as the grocery store or they could shop for these items online.  Grocery delivery and other similar services are coordinated through our office.

Let us tell you more about how we can help you or a loved one age gracefully in place: 610-323-9800.

Substituting and Subtracting

Posted on by Peter R. Abraldes

NursePartners emphasizes the need to substitute and then subtract when helping someone living with dementia.  This requires thinking creatively and making the care recipient feel as though they are effectively communicating their need or desire.

Our team helps the person living with dementia feel heard and acknowledged by joining their world.  We spend extra time connecting before providing care.  If the person is trying to communicate something, we ask them to tell us about it.  If they are noticeably upset or sad, we take that extra moment to enter that emotional state ourselves for a little.  For someone unable to communicate effectively, this opportunity to describe something they forget or connect emotionally will allows us to provide care and for both the carepartner and the client to feel good about our interaction.

Click here to listen to what an assisted living community does in Germany: Waiting for the Bus to Nowhere

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