Archive for January, 2010
Posted on January 28, 2010 - by Nurse Virginia
Avoiding Conflict or Episodes of Agitation When The Confused Elder no Longer has Safety Awareness
When the confused elder just doesn’t understand something is dangerous
An elderly person diagnosed with Alzheimer’s disease might want to go outside and take a walk. He may not be aware that the temperature is a dangerous 5 degrees, or that there is now 6 inches of new snow.
The best solution is always if you can accompany or join the elder in the activity they want to do, thus making it a safe activity, join them. But many times the caregiver is unable to just drop what they are doing and accompany the elder.
The elderly confused person might not realize they can no longer drive safely. As a friend just told me, when her family was faced with the same situation. The family put the “club” on the elder’s car. When he went out to the car, of course he was angry, but no longer able to reason out who probably was responsible for this. Eventually he got out of the habit of going out to the car to drive away. And then became used to having family members take him places.
The elder just no longer had safety awareness and didn’t realize it. He thought he was just fine and telling him differently or worst saying “No”, “Don’t”, “Don’t do that” or “Don’t go there” would only make things worse. These warnings will only anger the person who doesn’t know that they are unsafe.
So much kinder to change the subject or cause a distraction
Telling an adult “No” can be very hurtful. It is so much kinder think of something to distract. Especially an activity that the elder enjoys doing.
Direct the attention to yourself, “Boy I am really tired, I am going to sit here for awhile.”
After you cause the distraction, you suggest a pleasant alternative
“I was just going to make a phone call to our son Bob. You haven’t talked to Bob in quite awhile. Why don’t we call him now?”
“I was just thinking of making some cookies, how about giving me a hand?”
Change the subject/cause a distraction/suggest a pleasant alternative.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on January 26, 2010 - by Nurse Virginia
Eldercare Tips: It continues to be Important to Nursing Home Residents to Dress Nicely and Look Good
Ask your self “Are these clothes right for this Nursing Home resident?”
Every Sunday I visit my Mother. And sometime during the visit I straighten out her closet and organize her clothes. This Sunday I found two new pieces of clothes with Mom’s name on them. The problem was that they were both sweatshirts, a piece of clothing that would be terribly difficult for a caregiver to assist my Mom to put on.
Since Mom’s stroke her left arm has become rigidly extended and fixed in place. Thus making it very difficult to assist her in dressing. Mom also has a history of eczema which can be triggered by being too warm. A sweatshirt is much more difficult to change if she gets too warm than just removing a cardigan sweater.
Clothes continue to be important for the Nursing Home resident
Whether the resident is confused or not a person’s appearance has much to do with how they are perceived. A person who continues to have coordinated clothes, their hair always done, looks and smells clean will be perceived in a more positive way.
(The following is an excerpt from: Please Get To Know Me – Aging with Dignity and Relevance)
Even the small day-today things can mean so much. Mother likes to wear colored beads everyday with her outfits. We couldn’t expect the nursing assistants to keep track of her jewelry, so we installed removable adhesive hooks to the inside or her closet door within easy reach, to hang the beads on.
Mother has a standard outfit of black pants and a white or black cardigan sweater that she wears with a bright colored top and a string of beads every day. The system has proved successful because staff members no longer had to try to coordinate her clothes. Mother is happy. The staff is happy because we haven’t tried to add any additional duties for them. They can easily help her put an outfit together and it creates less stress for everyone involved.
A standing appointment in the beauty parlor every Friday helps Mother keep track of the days in the week and provides an additional opportunity to visit with other people and make more acquaintances. Mother has a simple, short, and curly hairdo. Each Sunday afternoon, I reorganize Mother’s closet as well as straighten up her room as part of her care team.
Changing Mother’s clothes seasonally and taking them home to store, as well as bringing in special seasonal outfits like her black velvet pants suit, keeps her and the staff interested in her appearance. When Mother needs new clothes I bring in catalogs and we make an occasion out of shopping.
See other blogs from this site on dressing.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on January 21, 2010 - by Nurse Virginia
When the Elder has Signs of Dementia – Early Alzheimer’s Disease before the Diagnosis (Part II)
When the main activity is watching TV – and yet elder is not following the program
Gary can watch TV all day long even re-runs, because he is now so unsure of what he has seen. When watching with his wife he will frequently ask her for info on what they have just seen. “Who was that guy?” “Is she the same woman who was there before?”
Gary no longer seems to follow the story line or remember the characters. Sometimes when his wife laughs he will turn to her as if to say why are you laughing? Gary seems now to do the best with old re-runs especially The Andy Griffith Show.
Those simple story lines in the half hour comedy are much easier to follow. Although it is disconcerting for his wife to hear him say “this is one we haven’t seen.” When she knows they have seen this episode many times. And she can say some of the dialogue along with the actors.
Forgetting to eat – not sure if he has eaten
Gary is a man who never missed a meal.
Many times Gary forgets to eat until he realizes he is hungry. Some days when his wife comes home from work, Gary isn’t sure he has eaten at all. When his wife leaves him a sandwich for lunch and calls him from work to ask if he has eaten it, he will say he ate it. Then she will see it still in the refrigerator when she comes home.
This doesn’t mean he didn’t eat. He might have had a bowl of cereal. Gary just didn’t remember the sandwich and didn’t notice it in the refrigerator.
Gary is doing just fine he would tell anyone he is a happy man. He certainly looks happy and contented and well taken care of. However Gary is living with his wife who has noticed these changes and keeps track of things for him.
Would Gary be safe if living alone? Would Gary be eating spoiled food? Probably. When is it the right time for a family to step in?
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on January 20, 2010 - by Nurse Virginia
Caregiver Tips: When the Elderly with Alzheimer’s Disease are too distracted to eat
Restaurant might be first time elder appears too distracted to eat
Many families have told me that they started seeing problems with their loved one, when they would go out to eat.. When you have a distraction problem, the noisy environment of a restaurant is often too much for the person with Alzheimer’s disease. It might be too loud, dishes and utensils clattering, people talking, music playing and people walking around.
Persons who wear hearing aids often turn down the volume on their aid while in a restaurant because of the increase in background noise. Background noise is very easy for the elderly with dementia to be distracted by.
Six ways to help the elder focus better while eating:
- The person with Alzheimer’s disease might just need a rest time before a meal so that they can be more attentive during the meal.
- Mealtime should in a quiet calm environment – this wouldn’t be the time to have the TV on.
- A regular routine – eating at the same time, sitting in the same place so that everything looks the same.
- Have the elder come to the table when everything is ready so the person can see the food and know it is time to eat.
- Sitting poorly and too far from the table may cause a distraction – especially for the elder in a wheelchair. Whenever possible transfer the elder to a regular chair for meals.
- Conversation is good if pleasant, this wouldn’t be the time for tablemates to discuss problems or have loud angry conversations.
Most of all a person with Alzheimer’s disease needs someone who is interested in them and paying attention to them.
Make sure everything is ready and available so the caregiver doesn’t have to get up and down. Having the caregiver getting up and down causes a distraction, right when the elder needs the total attention of the caregiver.
Virginia Garberding, R.N.
Director of education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on January 18, 2010 - by Nurse Virginia
When the Elder has Signs of Dementia – Early Alzheimer’s Disease before the Diagnosis (part I)
Elder wears the same clothes all the time and has poor hygiene
Gary told everyone, when they asked why he had the same clothes on, “I decided to wear shorts all year, they’re comfortable.” This reference to comfort comes up often these days with Gary. His uniform of the day is a tee shirt and very short black knit shorts. His wife doesn’t complain because not that long ago his “comfortable” uniform was his underwear. Now the addition of the shorts seems an improvement.
(See also blog: 1/22/2009 – Confused Elder with Alzheimer’s disease wants to wear the same clothes all the time.)
Gary sleeps, eats, and spends the day in his favorite outfit. If he ventures out into the neighborhood at all he will be seen sporting his favorite outfit. He tries very hard despite living in a northern state to make it through the year in his beloved shorts. Only adding a tattered sweat suit over his outfit when forced to by the elements.
His wife knows that he only bathes when he is going out to dinner, a movie or to visit. This means he can easily go a couple of weeks between showers. Sometimes he tells her he washed up in the bathroom sink and he feels this is sufficient.
Watching TV all day and not moving
Gary sleeps about 10 hours a night and then wakes up bright and early around 10am to start his day of watching TV. He is up till midnight; his wife knows she hears the drone of the TV. In the morning the only sign that he is about is the sound of the TV. He stays in his room for hours because watching TV in bed is so “comfortable.”
Gary will venture out of that dark room in the evening to eat dinner with his wife and watch some more TV. While she is making dinner, Gary will call to her, “You should come and see this.” Whatever is happening on the TV is very much the priority.
(See also blog 2/9/2009 – When watching TV is bad for elderly people with Alzheimer’s disease)
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on January 15, 2010 - by Nurse Virginia
Caregiver Tips: Bathing the Elderly, Confused Patient
What could be more personal than bathing another adult?
This healthcare worker consistently receives high praise for the shower or bed bath she gives. Patients have said:
“You have an angel working here, and she gives showers.”
“I never feel embarrassed when she gives me a shower.”
“I just had the best shower of my life, it made me feel so good.” This from a cancer patient.
Actual praise for getting another adult totally undressed and bathing them?
What is so special about this healthcare worker’s showers?
She uses the same shower products; soap, towels, shower chair and shower stall. The equipment is the same as everyone else’s. The patients are usually straight from the hospital after recent surgery, and are still hurting. They may be confused due to their recent hospital stay and the aftermaths of medication or suffer from ongoing cognitive decline.
Whatever the situation, when it comes to the most intimate area of caregiving, the shower, this healthcare worker not only is competent but provides a special experience.
Here are the princiles she follows:
- Talk to the patient, get to know them before you suggest undressing and bathing them.
- Get all of the supplies ready before you bring the patient to the shower. At least four towels and four washcloths, soap, shampoo and clean clothes.
- Get the area warm, turn on warming light and start running warm water.
- When the patient is undressed and in the shower, ask them if they would like to wash their face. Give resident wash cloth with just plain water and let them wipe their face.
- Starting with the top of the body, ask the patient if they would like to wash their arms and offer a wash cloth with soap on it. Or would they like you to “help” them? There is a difference between doing somthing to someone or asking if they would like your “help.”
- Take your time and let the patient know that their shower is important to you. This is not just a chore you want done quickly, and out of the way. For this time you are totally with them and attending only to them.
- For every body part ask the patient if they would like to do it themselves.
- When the caregiver does the washing, she folds the soapy washcloth into a envelope she puts over her hand. She never just splashes around with a flying loose washcloth. But she carefully and slowly soaps the body part with her folded cloth.
- She keeps the patients private areas covered with small towels throughout the shower time. And only washes the patients private areas when they are unable to do this themselves.
The big four principles of a great shower
1. Keep the patient warm.
2. Take your time. You might give four showers today, but this is the only one this patient is having.
3. Provide privacy for the patients private areas, as well as the shower area.
4. Use the word “help” often.
5. Most important, spend some time getting to know the person, before you do something so sensitive as undressing and bathing them.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on January 12, 2010 - by Nurse Virginia
AVATAR – The Message for Healthcare Workers
“I See You”
What is the real message of Avatar?
Is it the story of a white man and a blue woman? The story of military against environment? The story of the early frontier and treatment of the American Indian? The story of Pocahontas? There are so many stories that come to you while viewing Avatar. But the thought that is expressed over and over throughout the film is “I see you.”
Does the Healthcare worker really “see” the person they care for?
Pg, 16- of Please Get to Know Me – Aging with Dignity and Relevance
A close friend explained the difference between a new purchase of a costly picture and a nursing-community resident. Often when we purchase something new for our home such as a prized picture, we pick exactly the right spot for it, and we know it will look beautiful in that special place. For a period of time we enjoy it: however, after awhile we no longer notice it unless someone calls our attention to it. That reminds us how much we like that picture.
The more I thought about it, the more I believed it was a fair analogy. Staff members who don’t respond when residents call out may have become desensitized. They might be kind caregivers and sincerely care about the elders, but not everyone can maintain a high awareness day after day, feel and express empathy, and “see” those for whom they care.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Please Get To Know Me – Aging with Dignity and Relevance
By: Virginia Garberding and Cecil Murphey
Posted on January 12, 2010 - by Nurse Virginia
Caregiver Support – Why did he get dementia? Learning to Move Past the Guilt
If I can ever find my elusive birth certificate I am sure I will find stamped on it in capital letters my real middle name: GUILT.
I have nothing but time to think now, and I find that some times I am flayed with feelings of inordinate guilt: If I hadn’t once wished to be alone, I wouldn’t have magically conjured George’s illness. Nor would I be experiencing such indescribable grief for that brilliant man who has already begun to forget all that he’d been and done and those he has loved. And for our children and me who have to go on without him.
I wonder, too, why it is George who is felled by dementia. I mean, the man I’ve loved all my life, a brilliant physician, could be saving people’s eyesight. How does that compare with writing books and playing the piano? In simplest of terms, my husband’s life is worth more than my own. I feel guilty for being, at least for the present, healthy and whole.
In the claustrophobic silence that surrounds me, my mind runs wild with guilty questions. Was I a good wife? Did I make George’s life happy? Was I smart enough, caring enough? Did George know how much I valued everything he did for me and our children? Did I tell him how much I appreciated his kindness, his gentleness, his patience? Did I say “I love you” enough?
I visit George three times a week, listening to National Public Radio on the way, trying to distract myself from the inevitability of what I will find when I knock on the door to his room…the increasing sadness and pain of being with him the way he is…removed, less able to converse, an unfamiliar George in a familiar body.
From: Moving to the Center of the Bed - The Artful Creation of a Life Alone
By: Sheila Weinstein www.centerofthebed.com
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get to Know Me – Aging with Dignity and Relevance
Posted on January 7, 2010 - by Nurse Virginia
The Confused Elderly Person Lost in the Community
An elderly person capable of walking away unattended is at highest risk for becoming lost
When the confused elderly person, looks particularly good, they are at the highest risk for walking out of their home. Whether their home is the family home or in a nursing community. When the confused elderly person is physically fit, walks well, is friendly and cordial they look very good and fit right in, out in the community. Visitors at a nursing community will hold the door, and walk a confused elder right out the door, many times.
Confused elderly who are at risk for walking away:
- The person who had a life style including walking.
- The person with a new place of residence who is not accepting of the move.
- The person, who shows poor judgment, makes poor choices.
- The person who gets angry easily or is easily frustrated.
- The person who is difficult to redirect when they have a fixed idea.
- The person who is always saying they have a place they must be – work, take care of children, go home.
- The person who has their days and nights reversed – wake up during the night, think it is time to be up, and walks out the door.
- The person who is always looking for someone – like their mother.
The best thing to do with a person who wants to walk is to walk with them while using calming conversation to distract them. Knowing the elderly person, so that you can use the names of family members, favorite pets, favorite activities, helps the situation if the elder is upset.
When looking for a Nursing Community, always ask about their security measures.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Rlelvance
Posted on January 6, 2010 - by Nurse Virginia
When an Elderly Family Member is in a Nursing Home with Alzheimer’s Disease, who decides who can visit?
My “Best friend has Alzheimer’s Disease”
“She was my best friend since we were in grade school, and I didn’t see her for these last five years, because you wouldn’t tell me where she was” accused the crying elderly woman. We were in the line of mourners waiting to speak our words of comfort to the grieving daughters. When to everyone’s surprise and discomfort the very elderly woman right in front of the daughters spoke these words. The daughters tried to comfort their mother’s old friend, but those accusing words just hung there in the air.
“Mom didn’t really know anyone anymore. She didn’t even know us” said the oldest daughter.
“I don’t care, I would have known her, and you wouldn’t tell me” replied the elderly woman.
The old woman then spent the rest of the time at the wake, just sitting off to the side by herself.
The daughters as caregivers
Mom was 87 years old and had spent the last 5 years of her life in an Alzheimer’s unit of a Nursing Home. During that time the progressively dementing disease robbed her of the ability to care for herself, eat independently and eventually no longer recognize her family or herself in a mirror.
This was the latest in the many hurtful experiences for this family, after the last five painful years and the so recent loss of their Mother. Of the many decisions the family has had to make: letting family and friends know Mom has Alzheimer’s disease, finding and taking Mom to live in a Nursing Home, seeing the on-going loss of the Mother they knew. Now they were asking themselves, did they do the right thing not letting anyone know where she was?
Mom wouldn’t have wanted her friends to see her with Alzheimer’s disease.
Knowing their Mother, and what a really private person she had always been, had prompted the daughters to agree not to share their Mom’s location her last years. Now in their grief what they needed to hear was that they had done the best they could under bad circumstances. Getting to really know your loved ones and be able to act on their behalf when needed, gives the comfort that you did the best you could.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
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