Archive for June, 2009

Posted on June 28, 2009 - by Nurse Virginia

Caregiver Tips: Who ever notices the caregiver pushing the wheelchair for the confused, disabled elderly person.

When you see an elderly person coming toward you in a wheelchair, do you ever make eye contact with the person pushing the wheelchair? Who notices the caregiver? Do you give them a greeting, a smile of encouragement for their difficult days?

The almost invisible caregiver. (by Cecil Murphey)

 
Years ago, two of us stood talking outside a theater. A man pushed a wheelchair past us. Although we continued our conversation, both of us watched. He stopped next to a dark blue Honda, unlocked the passenger’s door, and helped the woman in the wheelchair stand up. Even from twenty feet away, it was obvious that her pain made it difficult for her to move. Once the man helped her inside, he folded the wheelchair, put it in the trunk, got in on his side and they drove off.

“Poor woman,” I said. “She must live in terrible pain.”

After the car drove away, my friend said, “I’ll bet you could describe the woman in the wheelchair, couldn’t you?” After I nodded, he said, “But I’ll also bet you don’t remember nearly as much about the man, do you?’

“Why, he was- “Then I realized I had hardly noticed him. He was just an older man.

Since the, I’ve realized that’s how many of us view such couples. The caregiver easily becomes a non-person. The sick one receives the attention and the concern.

From: My Parents, My Children, Spiritual Help for Caregivers by Cecil Murphey
Westminster John Knox Press, Louisville, Kentucky
Available @: Christianbook.com or calling: 1-800-Christian

Posted on June 23, 2009 - by Nurse Virginia

Caregiver Tips: Get to know the disease the elder has.

When you are a caregiver, getting to know all you can about the disease the elder has is as critical as getting to know the person. Whether it is Alzheimer’s disease, Parkinson’s disease, a Stroke or any number of disease processes that cause disability requiring caregiving, education is important. Many questions can be answered through education.

Change in behavior

 
The elder may display physical aggression, when they had always been a quiet reserved, calm person. The person with a great sense of humor, who laughed all the time, may no longer get the joke.

Change in personality

An elder who has always been known to be very truthful may make up stories to hide some confusion or forgetfulness. An elder who has always been very trusting may become paranoid and suspicious. An elder who has always been very independent may now be afraid to do anything alone.

How will the disability progress and how can it be slowed down.

Becoming informed in how the disease will progress and what medications or caregiver interventions might slow down the progression. Always the best intervention for the caregiver is to:
• Let the elder make as many decisions as possible
• Let the elder do as much for themselves as possible

A great resource, a families “personal organizer”, is available through Alliance for Aging Research at: www.agingresearch.org since everyone experiences a disease process differently; this organizer helps the family track just your elder’s changes in condition.

Posted on June 23, 2009 - by Nurse Virginia

Caregiver Tips: The confused elderly person may no longer be thirsty, 12 reasons to keep drinking

Many times an elderly person will stop drinking water. It could be that they don’t want to make so many trips to the bathroom. The confused elderly may no longer realize they are thirsty.

12 Reasons to give your elder water:

• Water is an absolute requirement for all life.
• Although other nutrition can be neglected for weeks even months, we cannot go without water for more than 100 hours.
• Water content for the elderly is 56% in men and 47% in women.
• All beverages count equally as water intake including items that are liquid at room temperature such as jello, ice cream, sherbet, etc.
• Body water content varies with energy expenditure.
• Body water content is used for temperature control.
• The actual amount of water an elderly person needs depends on age, physical activity, illness, the temperature and humidity of the environment.
• Water is used to move waste products from the body, many elders suffer from constipation.
• Water is used as a lubricant between body structures.
• Keep a close eye on the water consumption of the elderly because, aging diminishes the sense of thirst.
• For the elderly, three fluids must be provided at every meal.
• To keep the elder hydrated, fluids must be provided between all meals.

By the time a person is thirsty – they are already dehydrated. At: www.alzbrain.org you can download a nice poster with reminders to hydrate. (see: Hydration Fact Sheet)

Posted on June 18, 2009 - by Nurse Virginia

Caregiver Tips: When the confused elderly suffer abuse in the Nursing Home

Couple shows signs of Nursing Home abuse.

Every time someone walked by her, she flinched. Ella reacted as though at anytime she thought someone might strike out at her, and so she ducked.
Ella and Carl had come to us from a nursing home out of state. They arrived off the plane, both in hospital gowns, bathrobes and slippers. They looked like they had literally just gotten out of bed and got on the plane. No one had ever arrived like that before or since.

Ella and Carl had decided on retirement to relocate to a southern state, with warmer weather. Their niece visited as often as she could, but as the years went by it became less and less frequent. Now, when she had gone to visit, they both were in a nursing home, and she decided to move them closer to her.

We soon realized during the admission process that both Ella and Carl had numerous bruises. Their niece confirmed that “It wasn’t a very nice place” she had taken the couple out of. Now it was our goal to give this couple, married for 62 years, the opportunity to enjoy their remaining years together.

Abused couple find comfort in Nursing Home.

 
Both Ella and Carl had a moderate degree of dementia. They knew who they were and recognized their niece, but had very limited verbal skills left. A plan was put in place to reassure and reassure them again, that they were “safe.”
All staff were instructed on how to approach Ella and Carl.

• Always approach from the front where they can see you, don’t approach from their side or from behind them.
• Make direct eye contact when you approach.
• Smile – present yourself as a friendly, safe person.
• Say their name as you approach so they realize they know you.
• Never attempt to touch them and begin to provide care before you have followed previous steps.

Carl passed away soon after they came to stay with us. Ella lived for several years after losing Carl. It took four months for Ella to be totally comfortable and we no longer would see that flinch when people approached. Ella spent the rest of her days with frequent visits from her very caring niece as well as the staff that grew to not only care for her but about her.

Posted on June 12, 2009 - by Nurse Virginia

Alzheimer’s disease, not a part of normal aging memory loss or a “Senior Moment.”

Distractions prevent forming new memories.

 
You walk into the house, your husband is calling to you “What are we having for dinner?” The phone is ringing and the TV is on at peak volume. You put down your groceries and run to get the phone in the bedroom, where you can hear. You put down your car keys next to the phone. The next morning when you need to run out to a doctor’s appointment, you can’t find your keys.

Distractions, they are all around us. It is so much harder to set down a new memory, when we are surrounded by distractions. But the first thing an older person worries about when they forget, is that this might be the first sign of Alzheimer’s disease.

4 Differences between normal aging memory loss and Alzheimer’s disease.

• When trying to remember a past event, the senior with normal memory loss will often remember parts of the event and often at a later time be able to remember the whole event. The person with Alzheimer’s disease will rarely have better recall at a later time. And it doesn’t really bother them unless someone keeps calling it to their attention that they can’t remember.
• A senior with normal aging memory loss will usually be helped by keeping a detailed calendar, writing themselves notes and reminders. While this will also help the person with Alzheimer’s disease, gradually these aids will no longer help.
• A senior, with normal aging memory loss, will be able to follow written directions, while the person with Alzheimer’s disease will gradually be unable to do this.
• A person with Alzheimer’s disease will eventually be unable to identify money. Will forget how to dress themselves, feed themselves and do all the things we refer to as Activities of Daily Living.

The next time you can’t find your car keys, think about the many young people who loose their keys as well.

Posted on June 12, 2009 - by Nurse Virginia

Caregiver Tips: Choosing a Nursing Home for your elderly parent (Part III)

The responsibility of choosing the Nursing Home.

Bob was an only son and over the years had wished for a sibling, but never so much as now when he needed to find a Nursing Home for his mom. He had thought he had this done, and she was settled. The entrance to Friendly Acres was elegant, the receptionist so friendly. She offered him coffee and freshly baked cookies, while he waited for the director of Admissions.

The tour couldn’t have been better, so very clean, “hospital” clean. It had all smelled something like a hospital now that he looks back. They had the best of everything, the best equipment, the newest and prettiest bedspreads and curtains. When he visited Friendly Acres it had never occurred to him to look at the elders living there, or to talk to them.

But now after a few months, everything was looking different. While mom never was a big eater, she now said nothing had “any taste.” Whenever he stopped by to see mom, she was sleeping in her chair. He never noticed anyone talking to her. Come to think of it he never saw staff talking to any of the elderly people there. Mom had always liked to take a tub bath, he remembered Saturday nights when he was a kid and they all took turns taking a tub bath. Now I guess at Friendly Acres they only have showers and the schedule for mom didn’t fit for Saturday night. It just isn’t working out.

So here he is starting all over again – wishing for that sibling to talk it over with.

5 Things to look for when choosing the Nursing Home.

• Take someone with you for a second or third set of eyes and compare impressions after the visit.
• Visit more than once – the nursing community should not mind showing you and a friend or family member around again. After all this is a major decision.
• Ask the staff if they like working there – they should say something about how they like working with the elderly. If they say it is “close to home” and “better paying than fast food”, take a closer look.
• Ask permission to talk to a resident. Ask the resident how they like it there, and how is the food? Remember food is subjective and not a deal breaker.
• Do the residents look busy, occupied, in small groups doing something? Or are they all asleep in their wheelchairs?

When looking at a nursing community, keep in mind everyone won’t do everything exactly the way you would. What you are looking for is how does it “feel?”

Posted on June 9, 2009 - by Nurse Virginia

Caregiver Tips: How to choose a Nursing Home for your elder, when you need a break. (Part II)

Finding the right Nursing Home for a respite stay takes as much time as looking for long term care. In the case of a respite stay however, there are fewer emotions involved, because this decision is not a permanent placement. However when a good fit is found for the elder, it becomes much easier for the family if in the future they do need to consider a permanent situation.

5 Things to look fro during your Nursing Home tour:

 
• Are people friendly – everyone you pass during the walk through should smile and at least nod if not say “Hi.” The person touring you from Admissions/Marketing will be very friendly and personable; those are the kind of people who work in Marketing. But how about the rest of the staff? Does the management team – Administrator, Director of Nursing, Owner, smile and greet the residents of the Home? Or, do they just rush past as though they are too busy? From the nursing department to the housekeeping, maintenance department everyone should be greeting you, residents and each other when they pass.

• Are people interacting with residents? Do you hear conversation? When you walk past a resident’s room is the staff chatting with the residents? Or, is the staff off in a little group talking to each other? Nursing staff should be scattered throughout the facility, doing things with the residents?

• Do they use words like “person centered care” and talk about the choices people have. Or do they talk where the elder would fit in on their schedules? Do they seem interested in who your elder is, or do they seem more interested in the tasks needed to be done to care for your elder?

• Are activities in one large group – with most of the residents sleeping?
Or, do they have small group activities going on at the same time. Do the residents seem engaged and enjoying the activity?

• Staffing – how many residents per Nurses or Certified Nursing Assistants.

The time is long past to talk about – how does the facility smell! The nursing home may not smell and may look great, but the question should be how does it feel?

Posted on June 8, 2009 - by Nurse Virginia

Caregiver Tips: When the family caregiver, of a senior with Alzheimer’s disease, is tired…

Respite care, just means giving the family a break.

“I’m just so tired I can’t think” said Myrtle, as she sat across the desk from me. Her white hair was disheveled; she held her head down and kept rubbing her forehead. Myrtle appeared to be in her mid eighties, and so, so tired. She said “We always promised to take care of each other.” This wasn’t the first “Myrtle” I had met.

These Myrtles had gotten into a habit of doing everything themselves. And now after years of being the caregiver, they are providing 90% of the care for a totally dependent elder, while they are now elderly themselves.

They usually:
• Have someone in to help a few hours a week, so they can do errands, banking, grocery shopping, get a hair cut.
• Do not use the time they have help to meet a friend, have lunch, see a movie.
• Have become very isolated, and have lost contact with friends.
• Have not let people know they need help.
• Have not taken a vacation for years.

Two kinds of respite for the caregiver.

 
Two are two kinds of respite. For the first the caregiver goes away and you have home health help come in. This works well for the caregiver going on vacation or for a family occasion away.

For the second, the caregiver is staying home and needs a break, so the elder goes to a nursing facility. Respite is usually short term, from a few days to several weeks.

Watch for Part II, picking the right facility.

Posted on June 4, 2009 - by Nurse Virginia

Caregiver Tips: Making morning care easier for elder with Alzheimer’s disease

Person centered care for the confused elderly.

 
Everyone has a morning routine, their personal way of getting
going in the morning. But for the elderly who many times suffer from chronic pain, stiffness, constipation and confusion, morning routine can pose a challenge.

Morning care, involving getting up, going to the bathroom, washing up, brushing teeth and then dressing requires moving, moving and more moving. If the elder is suffering from arthritis, back pain, headache, osteoporosis or pain from a past injury or fracture all that moving makes morning care difficult.

5 Ways to start a person centered morning routine:

• If the elder suffers from chronic pain, a half hour before starting morning care give their pain medication.
• Know you’re elder; be flexible with their get up time. If they have always been a “rise and shine” person greet them, open the curtains, put on the radio, tell them what the weather is going to be. If they have always had a hard time getting going in the morning they will want a slower and quieter pace.
• If there is a routine to getting going in the morning – putting on a bedside lamp, opening the curtains, a certain greeting – maintaining that routine helps and cues the confused elder as to what is going on.
• How about coffee in bed and a little time to relax before you start. A hot beverage will many times assist an elderly person with moving their bowels in the morning.
• Take breaks; maybe have breakfast in the bedroom during morning care.

My mother starts her day singing a little song to her caregiver, that she learned in kindergarten.
Good morning to you, good morning to you,
We’re all in our places, with bright shiny faces.
Good morning to you, good morning to you.

Posted on June 3, 2009 - by Nurse Virginia

Caregiver Tips: When the elder has Alzheimer’s disease, and every task takes time, simplify.

I dreaded helping him get dressed in the morning because he couldn’t manage the buttons. He refused my help and ended up tearing his shirt.

I finally bought him shirts without buttons. We turned to loafer-type shoes. I put elastic in his trousers and sewed the zippers shut. I also bought jogging pants. As he loses his dexterity, I search for ways to simplify the task so that he can still do as much for himself as possible.

The other day he simplified the problem of taking his pills. I had been giving them to him one at a time, pausing for him to wash each one down with milk or juice. He dumped all the pills into the glass, drank it down in a single swallow, and laughed when he did it.

I thanked him for helping me solve that one.

Father, thank You that we can enjoy the simple moments together. Help us find joy in those moments and in the in-between.

Book excerpt from:
When Someone You Love Has Alzheimer’s by Cecil Murphey and Beacon Hill Press

Good sources for simplifying the task of dressing are:
Silvert’s Adaptive Clothing & Footwear – www.silverts.com
Buck & Buck Adaptive Clothing – www.buckandbuck.com