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Approach and Communication

Tuesday, June 22nd, 2010

As Alzheimer’s disease progresses, it can impact the way a person communicates. And we all know that communication is vital in the caregiving process. Alzheimer’s makes it difficult to express our ideas, feelings, and wants. In order to maintain a quality life, this basic need must be met.

Each person with Alzheimer’s disease is unique, as are each person’s communication abilities and deficits. An individual with Alzheimer’s may have trouble finding the right words, may misunderstand statements that are made, may repeat the same words or statements, or may revert to speaking a native tongue. As the disease progresses, caregivers may also see the person relying more on gestures than words. For example, it may be easier to point to an object such as a cup of water, than to ask for a drink. She may pat the sides of her waist to indicate she needs to go to the bathroom. Some people may have trouble speaking in cohesive statements, often with the phrases sounding more like “word salad”, an incomprehensible mixture of words or phrases. Consequently, caregivers must learn to rely on gestures and other forms of nonverbal communication in order to understand what the person is trying to communicate.

Despite the fact that communication may become more challenging as the disease progresses, sensitive ongoing communication is important. Although the person with Alzheimer’s may not respond to each statement, she still benefits from continued communication.

Here are some tips to enhance communication:

• Approach from the front and never from behind.
• Get eye-level and at a comfortable distance (at least 2 feet from face)
• Identify yourself by name (and/or role) and what you are going to do for/with the person. Even if you have known the person for years, it is still important to identify yourself and the task.
• Call the person by his/her familiar name.
• Use short, simple, one step instructions
• Give the person plenty of time to respond to questions and statements
• Limit available choices to two (2) for the person to decide from ( i.e. the blue dress or the red dress, a brownie or ice cream)
• Don’t ask questions that rely on memory (remember when you ate eggs for breakfast last week?).
• Speak in a strong clear voice; don’t yell unless the person has a hearing impairment.
• Don’t talk down or childlike.
• Turn negatives into positives. Say “Let’s go here” instead of “Don’t go in there.”
• Turn questions into statement. Say “Let’s go eat” instead of “Are you ready for lunch?”
• Be aware of your tone of voice. Convey an easy going attitude.
• Approach from the front and never from behind.
• Use positive, friendly facial expressions, even if you’re doing a difficult task.
• Be aware of your stance – avoid standing with hands on the hip or crossed arms.
• Focus on feelings not on facts.
• Validate feelings and help put those feelings into words.
• Be patient, flexible and understanding.
• If you cannot understand her, tell her, “I’m not sure what you’re trying to say, and we’ll come back to that later.”

Good communication will bolster self worth, validate feelings, stimulate memories, and calm and reassure.

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Fall Harvesting

Wednesday, September 16th, 2009

Fall Harvesting

 

            Harvesting vegetables and putting them up for the winter is an old tradition.  It was the life blood for families during the winter until the supermarket became popular in the late 1970’s.  Many people today continue to “put up” vegetables to save money and to gain the benefits of fresh vegetables. Here are a few ideas that will work well to stimulate reminiscing and be a purposeful activity.

 

Shucking Corn:

Have the residents shuck corn cobs.  Once the corn is shucked, cook the corn in water until the water boils and let it simmer for about five minutes.  Have each resident butter a piece of bread, then they can use the bread to butter the corn by sliding the buttered side of the bread along the corn.  Be prepared to cut the corn off the cob if someone is having difficulty due to dentures.

 

Breaking Beans:

Bring in a bushel of beans to be snapped.  Place the beans on the table and have residents sit around the table and snap the beans.  Once the beans are snapped, they can be cooked with some bacon for about an hour.  This is a great activity to do in the morning.  The beans can be cooking around lunch time.  The smell of the beans and bacon cooking will have everyone ready to eat by the time lunch arrives.

 

Pickling:

Cucumbers can be pickled using safe cold brine.  Have a group of residents chop the cucumbers into the desired size.  Then have the group measure out the following ingredients:

                Two cups vinegar                                             One cup water

                One half cup sugar                                          One cup salt

                Three tablespoons dill

Mix all ingredients together, and then add cucumber pieces (three cups).  Place cucumber and pickling ingredients in a bowl with a tight fitting lid.  Let sit for three-five days.  Then enjoy!

 

While the residents are participating in these cooking groups ask questions to get everyone talking about past cooking experiences.

               

                “Did you grow a garden in the summer?”            

                “What kind of vegetables did you grow?”

                “How did you put the vegetables up for the winter?”

                “Did you sell your vegetables at the farmer’s market?”

                “Did you ever have a glass jar bust while you were canning?”

                “Did you make homemade jams or jellies?”  

 

Trivia:

A pickle crunch should be heard from 10 paces away.

26 billion pickles are packed each year in the U.S.

Half of all cucumbers are made into pickles each year.

The average ear of corn has 800 kernels, arranged in 16 rows.
There is one piece of silk for each kernel.
A bushel of corn contains about 27,000 kernels.

 

For more information  contact 317-218-5111 or www.behomelivelife.com

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Sleep

Thursday, September 3rd, 2009

Sleep

 

            One of the most common issues that care givers face when providing care for someone with dementia is a lack of sleep.  Between the stress of the day to day care and the struggles with getting a full night sleep, care givers find that exhaustion is their daily companion.           

            There are many factors that can cause a person with dementia not to get a full nights rest.

  • The internal clock is disrupted causing confusion between days and nights.
  • Elderly adults may not need as much sleep
  • The dementia makes it difficult for the person with dementia to recognize the difference between dreams and reality.
  • Diet changes or poor eating habits

 

            A common “quick” fix for sleep is often the use of prescription sleep aids or over the counter medications as in common pain medications with PM effect.  Consulting the physician is very important when beginning this type of intervention.  These medications can in fact cause an increase in confusion as well as make the person with dementia unsteady and at risk for falls that might cause a break of a bone.  Another important point to remember is that the effectiveness of a sleep aid is 14 days.  After that, the medication is often not able to work effectively leading to a need for an increase in the dose.

 

Tips that Succeed:

  • Change the diet:  eliminate coffee or other foods/beverages that contain caffeine.
  • Don’t drink after 6:00 pm.  Trips to the bathroom at night may lead to difficulty falling back to sleep. 
  • Stay busy with meaningful activities during the day.  The common misunderstanding is that when an elderly person is sleeping in his chair it’s because he really needs his rest.  Often the days of sleep are caused by boredom and a lack of anything meaningful to keep him occupied.
  • Keep a structured routine.  As much as possible ensure that the person with dementia is rising and going to bed at the same time everyday.
  • Ensure that the lighting is good all day.  Shadows and poor lighting give the feeling of nighttime.
  •  Assess for all pain and treat it promptly.
  • Avoid rigorous activity five hours before bed.

 For more information contact 317-218-5111 or www.behomelivelife.com

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Resident to Resident Altercations

Saturday, August 22nd, 2009

Resident to Resident Altercations

            Resident to resident altercations can be a serious and difficult issue to face as a caregiver in a nursing home.  Aggressive behaviors can be verbal (yelling, cursing, name calling) or physical (hitting, pushing).  These events can occur without any provocation or because of a misinterpretation of facts or situations.  Caregivers must be able to respond appropriately when one resident begins arguing or fighting with another resident.

              No group of people living together will get along all of the time.   Even the closest families will argue or become annoyed with one another.  Residents living on an Alzheimer’s Care Center are confused due to the cognition loss that they are experiencing from the disease process.  A roommate for example is a stranger, in most cases, that she has never met before.  She is now sharing this space with someone who she is expected to trust automatically.  If she is already experiencing paranoia then becoming accustomed to sharing her space may even be more of a challenge.  When this is tied together with the fact that all of the residents are living with the same cognition loss and confusion about living in an unfamiliar place, the situation may be fertile for aggression.

            Caregivers must approach the situation in a calm manor.  Typically residents with dementia suffer from lability.  They will mirror the emotions of those around them.  If caregivers rush into a situation yelling, pushing, or threatening, the resident will become even more aggressive.  Caregivers must try to identify the immediate cause of the agitation.  What happened right before the incident occurred?  What is occurring in the environment?  Is it too loud?  Caregivers should focus on feelings and not facts.  Validate what the person is feeling and help put those feelings into words.  “I understand you do not want Sally in your room.  Tell me about this photo of your mother.  Did you help her with the garden she is standing next to in this photo?”  Once a caregiver has been able to put those feelings into words, then use redirection to help refocus the energy onto a new task. 

            The best way to eliminate resident to resident altercations is prevent them before they occur.  Programming is the key to success with this goal.  Caregivers should integrate as much of a resident’s past interests into her current daily schedule.  This will not only help the resident to feel as though she has a purpose, it will also prevent boredom.  The need for a purpose does not diminish as a person’s dementia progresses.  In fact, staying focused with purpose is as important in the late stages of the disease process as in the early stage.

            Caregivers need to remember the following important tips in dealing with resident to resident altercations:

·         Never raise your voice to the residents fighting

·         Focus on the feelings not on the facts

·         Limit distractions during the incident

·         Validate feelings and help put those feelings into words

·         Shift focus onto another activity

·         Prevent behaviors by developing a person centered daily purpose programming calendar.            

For more information call 317-218-5111 or www.behomelivelife.com.

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Meaningful Engagement

Saturday, August 8th, 2009

Meaningful Days

 

A meaningful day is a day filled with activities that create a sense of belonging and well-being, and the person with Alzheimer’s disease can participate in easily.  Here are some strategies to create a meaningful day for your residents.

 

  • Enjoy reminiscing with your resident.  Short-term memory may be damaged, but long-term memory often remains.  When reminiscing it is helpful to talk about subjects such as winter snowstorms or making holiday dinners rather than a specific memory or event from the past.
  • Recognize the special abilities that often remain and enjoy them together.
  • All people, with or without Alzheimer’s disease enjoy the same things:  a good meal, animals, babies, or favorite music.
  • People with Alzheimer’s disease enjoy other forms of affection.  Sit close and look at pictures.
  • Look for activities that will be interesting to the person.  In seeking activities the individual would enjoy, it helps to think about past work experiences and past and present interest.
  • Look for activities that will be failure free.   A craft project with a pre-set outcome or appearance may be too difficult, whereas arranging silk flowers in a vase is a failure free task.
  • Reduce distractions so the person can focus on the task, eliminating things such as background noise from the television.
  • Keep exercise and physical activity part of everyday, as it helps keep sleep and nighttime habits normal.
  • Familiar activities such as setting the table and folding laundry should be part of the daily routine that the person with Alzheimer’s disease helps with.  The tasks are meaningful, familiar activities and assist to remain skills as long as possible.
  • If music, exercise, or spiritual activities were part of your resident’s routine each week, those type of activities should occur frequently during the week now as well.

 

For more information contact 317-218-5111 or www.behomelivelife.com

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A Common Alzheimer’s Disease Challenge

Thursday, July 2nd, 2009

 

 

 

A catastrophic reaction is the emotional and behavioral reaction to a situation that is either overwhelming or stressful to the individual with dementia because the situation is beyond the person’s ability to understand or comprehend.

            This may happen suddenly without any warning to the caregiver.  One minute the person with dementia may be happy without a care in the world and the next minute the person begins to yell and scream.

           

Some situations that might trigger a catastrophic reaction:

·         A small accident such as spilling water

·         A loud sudden noise such as lightening

·         A change in routine

·         Pain

·         Too many steps in a task

·         Misinterpretation of person, place, or thing

 

            Alzheimer’s disease is a progressive disease that will decrease a persona’s ability to comprehend and use written and spoken words, know the correct day, date, time or place, and to use proper judgment.  Rapid mood swings with no apparent reason is a typical symptom of Alzheimer’s.  It is important to take into consideration a person’s cognitive level when problem solving behaviors and reactions to stimuli.

Remember when problem solving catastrophic behaviors that the situation must be assessed. 

·         What is triggering the reaction? 

·         What happened just before the episode?

·         Was the task too overwhelming?

·         Is the environment uncomfortable?

·         Is the person in pain?

 

            Make sure all instructions during a task are broken down into simple one step sentences.  Adhere to a routine whenever possible to avoid unfamiliar situations that may cause anxiety.  Never scold or talk down to the person with dementia because this will demean the person and cause the episode to continue.  Never push or rush the individual to go faster than he is able. 

            Finally, remember that tactics today may not work tomorrow; and a catastrophic reaction is not a reflection on care.

 

 

 

For additional information please call 317-218-5111 or check out:   www.alzcaregroup.com.

 

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“How do I begin reminiscing with my residents on my Alzheimer’s Center?”

Tuesday, June 2nd, 2009

“How do I begin reminiscing with my residents on my Alzheimer’s Center?”

As Alzheimer’s progresses conversations can become more difficult.  As a person with Alzheimer’s begins to notice gaps in his memory, or has trouble understanding questions, he will withdraw from social situations that may become uncomfortable.   As the disease progresses, care givers must learn to rely on non-verbal body language in order to anticipate the needs and wants of their residents with dementia.

 

Try these tips to encourage conversations:

 

  • Pick a topic of interest that you know your resident enjoyed during his 20’s-50’s – for example, fishing.

 

  • Choose materials such as old photos of fish, free fishing guides available at most bait shops and a tackle box. These items can be used for cueing.

 

  • Talk about the items:
    • “Joe, look at this picture of you  at Pike Lake.  Do you remember what kind of fish you caught that day?” 
    • If Joe isn’t able to recall the answer right away, try saying:  “It looks like a Northern Pike to me.  It has sharp teeth, and I remember trying to catch one of those myself.  It wasn’t easy.”
    • Ask:  “What fish was the most fun to catch?  Did you like Largemouth Bass or Bluegill for eating?  What is the best bait to use to catch Catfish?”

 

  • If answering questions is difficult when you first begin the conversation, try going through all of the photos and narrating what happened in each one.

 

  • Once you’ve gone through the photos, try asking the questions again.  If you know the answers to the questions, use a picture to cue your dad to the correct answer.  For example:  “Joe, which fish do you think has the best flavor?” (Show a picture of a Bluegill or which ever fish you know he prefers.)

 

  • You may use the tackle box in an additional way to guide the conversation.  By touching each of the items in the box, your resident will be using his sense of smell, touch, and vision to cue his memory. 

 

Remember, the key to unlocking conversation is using tools to cue his memory.  The more you remember about your residents and their past roles and hobbies, the more cueing you can offer.

 

For more information call 317-218-5113    or www.alzcaregroup.com

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Call to Action

Monday, April 13th, 2009

CALL TO ACTION

 

I received this information today in the Alzheimer’s Association’s ENewsletter.  Please join all caregivers to make a difference in the lives of those who are battling this difficult disease.

 

 

Advocate Impact: Forum 2009 

Last month, over 600 advocates from around the country marched on Capitol Hill to demand that our lawmakers make Alzheimer’s a national priority.

During meetings with advocates, members of Congress made the following commitments:

*       188 indicated support to end the two-year waiting period for Medicare;

*       181 indicated support for a $250 million increase in Alzheimer research funding; and

*       83 indicated support the creation of an Alzheimer’s Solutions Project Office.

*       65 members indicated support for all 3 issues!

You can catch a glimpse of the action at: http://www.alz.org/forum

We have great momentum and now is the time to “seal the deal”. Read on…

What Can I Do Now?

Ask your members to co-sponsor the End the Medicare Two-year Wait Bill!
People under age 65 with dementia who lose their jobs are likely to lose job-related health insurance. Many become uninsured and uninsurable. Just when they need coverage the most, federal law requires them to wait two years to become eligible for Medicare. Because of this wait, families face soaring out-of-pocket costs for health care or completely forego care. http://alz.kintera.org/endthewait 

Email your members of Congress now. Ask them to co-sponsor the Ending the Medicare Disability Waiting Period Act of 2009 (S.700 / H.R.1708).

Go to:

For more information on how you can impact the lives of those with Alzheimer’s contact www.alzcaregroup.com or 317-218-5113

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Sensory Kit: Spiritual

Wednesday, April 1st, 2009

Approach and Communication

 

            As Alzheimer’s disease progresses it can impact the way a person may communicate.  Communication is vital in the care giving process.  It is the way we express our ideas, feelings, and wants.  In order to maintain a quality life, this basic need must be met.   

 

            An individual with Alzheimer’s may have trouble finding the right words, may misunderstand statements that are made, may repeat the same words or statements, or may revert to speaking a native tongue.  As the disease progress, caregivers may also see the person relying more on gestures than words.  For example, it may be easier to point to an object such as a cup of water, than to ask for a drink.  She may pat the sides of her waist to indicate she needs to go to the bathroom.  Some people may have trouble speaking in coherent statements where the phrases sound more like “word salad.”  Word salad is an incomprehensible mixture of incoherent words or phrases.    Caregivers must rely on gestures and other forms of nonverbal communication in order to understand what the person is trying to communicate.

 

            Despite the fact that communication may become more challenging as Alzheimer’s disease progresses, sensitive ongoing communication is important.  Although the person with Alzheimer’s may not respond to each statement, she still benefits from continued communication.

 

Tips to enhance communication:

 

·         Identify yourself by name and what you are going to do for/with the person. Even if you have known the person for years, it is still important to identify yourself and the task.

·         Call the person by his/her familiar name.

·         Use short, simple, one step instructions

·         Give the person plenty of time to respond to questions and statements

·         Limit available choices to two (2) for the person to decide from ( i.e. the blue dress or the red dress, a brownie or ice cream)

·         Don’t ask questions that rely on memory (remember when you ate eggs for breakfast last week?).

·         Speak in a strong clear voice; don’t yell unless the person has a hearing impairment.

·         Don’t talk down or childlike.

·         Turn negatives into positives. Say “Let’s go here” instead of “Don’t go in there.”

·         Turn questions into statement.  Say “Let’s go eat” instead of “Are you ready for lunch?”

·         Be aware of your tone of voice.  Convey an easy going attitude.

·         Approach from the front and never from behind.

·         Use positive, friendly facial expressions.

·         Be aware of your stance – avoid standing with hands on the hip or crossed arms.

·         Focus on feelings not on facts.

·         Validate feelings and help put those feelings into words.

·         Be patient, flexible and understanding.

 

 

            Good communication will bolster self worth, validate feelings, stimulate memories, and calm and reassure.

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Alzheimer’s in the News

Monday, March 30th, 2009

This week in the news, the Alzheimer’s Association released its Facts and Figures 2009.  According to the Alzheimer’s Association 5.3 Million Americans have Alzheimer’s disease and the direct and indirect cost to the nation is $148 billion dollars annually.  Additionally, Newt Gingrich presented The National Alzheimer’s Strategic Plan for improving the care of those with Alzheimer’s disease and other related dementia to Congress.

What are you going to do to make a difference in the lives of those with Alzheimer’s and their caregivers? 

So often we become stuck in the mindset that people with dementia have no hope.  The media often reports the stories of heart ache and despair, but we never hear the heroic stories of people making a difference for others being afflicted with this devastating disease.

Who are those heroes?

·         Families who continue to make life the life of the loved one valuable even when that means adapting past interests to current abilities

·         Families who continue to visit their loved one even when it appears she doesn’t remember them any longer

·         Family members who regularly rotate care and responsibility to ensure the primary caregiver receives some respite

·         Caregivers in long term care who engage their residents in dementia with personally meaningful activities

·         Caregivers who provide care despite  Congress cutting Medicare/Medicaid benefits

·         Owners of nursing homes who put Person Centered Care before the dollar

·         Innovators who continue to find new ways to bring quality of life to some who can no longer remember

Are you making a difference?  Do you know where to begin? 

For more information:  Call 317-218-5111 or www.alzcaregroup.com

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