Archive for May, 2010
Posted on May 27, 2010 - by Nurse Virginia
WHAT TO DO WHEN THE CONFUSED ELDERLY FALL IN THE NURSING HOME
This is one of the most dreaded calls from the Nursing Home. “You’re Mom fell.” You’re first reaction is natural, whether you say it or just think it. “Why do I have her there, isn’t that what you people are supposed to be doing, keeping her safe and off the floor?”
Supporting the confused elderly’s right to walk includes, however strange it may sound, the right to fall.
What to do after the elder falls.
When a family member learns of a fall the first question should be:
“Did anyone see the fall?”
“Did she hit her head?”
“Does she sound like she is in pain?” (A groan for example)
“Are there any outward signs of pain?”
There are many benefits from walking if elders are able to do so. Yet too often families want elders forced into wheelchairs prematurely to keep them “safe” after a fall. Elders want to remain as independent as possible. Even those who are demented but still able to walk can experience opportunities for interaction while “ wandering” the community. When wandering, they have opportunities for social interaction, such as when staff personnel greet them by name.
The elder can remain strong. They may wander, but they also maintain the ability to walk. As an added benefit, it enables them to work up an appetite, breathe deeper, and it supports the process of elimination.
General guidelines for families
When you have identified a change in the elder’s usual condition:
Don’t hesitate to voice your concern to the nursing staff.
Identify and talk to staff that may be more pro-active in problem solving.
Establish yourself as part of the team caring for the elder.
Be willing to participate as part of the solution.
Realize that seeing an unaddressed change in condition can be stressful. Try to communicate your concern without becoming overly emotional.
Pray for your loved one.
Excerpt from: Please Get To Know Me – Aging with Dignity and Relevance
By: Virginia Garberding, R.N. and New York Times Best Selling author Cecil Murphey
Available at: www.pleasegettoknowme.com
Posted on May 26, 2010 - by Nurse Virginia
ANOTHER STORY ABOUT HOARDERS, THE ELDERLY AND THIS TIME ADD A GOOD NEIGHBOR
Did you see the story on the nightly news?
I don’t know about you but I had a hard time falling to sleep last night after watching the nightly news. There they were, the elderly hoarders in Chicago. Removed from their house after a neighbor reported, not seeing them for the past three weeks.
When the police entered the home they found the hoarders barely alive amidst the trash, bugs and rodents. The wife had evidently had a ceiling high, pile of trash fall on her. When her husband tried to dig her out, he too was a victim of falling trash.
The good neighbor had worried everyday about what she should do. No one wants to intrude on another’s life. The elderly couple hadn’t asked her to look out for them. The pictures on the news showed an older brick home, with the porch and yard piled with trash.
The reporter said the neighborhood children would call the elderly man “Fred Sanford, the junk man.” The elderly man was a college educated, retired chemist and his 79yr old wife was a former school teacher.
The city officials said they would be filing an emergency motion to be able to get inside and remove the trash and junk while the couple is in the hospital. At this time they both remain in critical condition. The city spokesperson stated the house is structurally sound and does not need to be demolished.
Elderly need someone to look out for them
Some years ago, my aunt and uncle retired to New Mexico. Before they left, they invited each niece and nephew and their families to their home, for a last meal. Since they didn’t have any children, I thought at this time they would ask one of the nieces or nephews, to look out for them in their old age. But they didn’t, and because they were very private people, even though I wanted to ask at that time what their wishes would be. I never did.
When my aunt passed away, it was my mother who went to New Mexico. She found her brother very confused and taking him to a physician, received the diagnosis of Alzheimer’s disease. While they were not hoarders, they still were elderly people who had not asked anyone to look out for them. In New Mexico they kept their drapes closed at all times, to better see the TV, and never got to know the neighbors.
When my husband and I owned our senior residence in Florida some years ago. We cared for an elderly lady who was the last living person in her family. She had lived in a retirement trailer park, of which there are many in Florida. Her next door neighbors were a couple in their forties who had befriended her. For years this couple had looked out for Lucy. I remember the extraordinary day they called me looking for a placement for Lucy. Not their Mom, or aunt, just their next door neighbor.
If you have an elderly couple in your life – be brave and ask the questions. Who should be called in an emergency – what are your wishes?
Some of the most read blogs on this site are about clutter and hoarding.
See also: March 8th, 2010 – SO MANY ELDERS SAVE EVERYTHING, WHEN IS IT CLUTTER OR IS IT HOARDING?
March 10th, 2010 – WHEN CLUTTER/HOARDING CREATES AN UNSAFE ENVIRONMENT FOR THE ELDER
April 15, 2010 – FALLS IN THE ELDERLY ARE PREDICTABLE EVENTS RELATED TO RISK FACTORS – PERSONAL AND ENVIRONMENTAL
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 May 25, 2010 - by Nurse Virginia
PERSON CENTERED CARE CAN BE PROVIDED AT HOME BY THE FAMILY, BY A PAID CAREGIVER OR IN A NURSING HOME
Whether you are a family member giving direct personal care, a private caregiver in the home, or a caregiver in a Nursing Home you can provide “Person Centered Care.” Person centered only means that you have taken the time to really get to know the person you care for.
Being a “Person Centered Caregiver” means the caregiver knows:
- Does the person they care for like to take a bath or a shower – or maybe for the last 10 years they couldn’t walk up the stairs to the bathroom with a tub – so they have been taking sponge baths at the bathroom sink ever since, and that is what they are comfortable with now.
- Is the person they care for an early rise or do they like to sleep in? I knew a man that was so hard to get going in the morning, till the family said their Dad always had a cup of coffee in the morning before he got out of bed. Adding the cup of coffee in bed to his routine made all the difference to him.
- Does the person you care for like to take a nap in the afternoon, if so for how long and where – in bed or on the couch? Makes a difference.
- If the person you care for is a man – does he like to shave with a straight razor or electric?
- What kind of music does the person like?
- What kind of personal products do they like to use? I know my mother always used LUX soap, most people don’t even know that soap – but for my Mom LUX is important. So whether it is soap, shampoo, deodorant, shaving cream – whatever the product- person centered care means knowing the favorite product and using that person’s favorite product.
- Is the person they care for a sports enthusiast? If so what sports, what is their favorite team. If they are one of those die hard Cubs fans, does the caregiver make sure when the Cubs are playing that the TV is on?
All you need to provide person centered care, is to care enough to get it right!
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 May 24, 2010 - by Nurse Virginia
AGEISM – DEATH BY INVISIBILITY
Some how we never think we will get “there,” old age. (where ever “there” is) Old age is relative to how old you are presently. When the Beatles belted out “Will you still need me? Will you still feed me, when I’m 64?” It was 1967 and sixty-four seemed a long way off to me, and yes seemed old. Not so much now.
To the early teen 16 seems old because you can drive. In your late teens the number is 21, because then you are old enough to drink. When I got married my brother-in-law was 30 which seemed ancient to me then. When I reached the other side of thirty, it appeared quite youthful.
The word “ageism” was coined in 1968 by Robert Butler. He said “Ageism allows the younger generations to see older people as different as themselves; thus they subtly cease to identify with their elders as human beings.”
How do the younger generations become so disconnected to the elderly? One way is through placement in a nursing home. When the elderly are taken out of the general society and grouped together in a facility they start to lose their individuality.
One day I was visiting my mother in a nursing facility and as her nurse was encouraging mom to take her medication. Mom looked up at the nurse and said “Sometimes I feel invisible.” There it was, no one prompted her. I certainly didn’t know that was coming. But she had the nurse’s attention for the briefest of moments and she told her how she felt. (those four words were the foundation for what would become my book: Please Get To Know Me – Aging with Dignity and Relevance)
It’s over 40 years ago that Robert Butler coined the word ageism, and gave us his definition. But the definition seems even truer today than in 1968. There now seems to be an even greater disconnect between the generations. Maybe because so many families have had to relocate for financial reasons and moved away from the folks. Maybe it’s because we have become so busy, just trying to stay current and keep our heads above water. In 1968 two income families weren’t as common place as they are today.
Death by invisibility? What ever the reason, this is an “ism” that is someday going to affect us all. As the saying goes,” old age isn’t so bad when you think of the 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 May 19, 2010 - by Nurse Virginia
NURSING HOME WEEK 2010 ***** JAIL – OR NURSING HOME?
As we end our annual celebration of Nursing Home Week, I received this email I would like to pass along.
Jail vs. Nursing Home? – Food for thought.
Let’s put the seniors in jail, and the criminals in a nursing home.
This way the seniors would have access to showers, hobbies, walks, and they would receive unlimited free prescriptions, dental, medical treatment, wheelchairs etc. and they would receive money instead of paying it out.
They would have constant video monitoring, so they could be helped instantly, if they fell, or needed assistance.
Bedding would be washed twice a week, and all clothing would be ironed and returned to them.
A guard would check on them every 20 minutes, and bring their meals and snacks to their cells. They would have family visits in a suite built for that purpose.
They would have access to a library, weight room, spiritual counseling, pool and education.
Simple clothing, shoes, slippers, P.J.’s and legal aid would be free, on request.
Private, secure rooms for all, with an outdoor exercise yard, with gardens.
Each senior could have a P.C., a T.V., a radio and daily phone calls.
There would be a board of directors to hear complaints and the guards would have a code of conduct that would be strictly adhered to.
The “criminals” would get cold food, be left all alone, and unsupervised.
Lights off at 8pm, and showers once a week.
Live in a tiny room, and pay $5,000 per month from their savings and have no hope of ever getting out.
Justice for all.
Virginia Garberding R.N.
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on May 18, 2010 - by Nurse Virginia
THE BED BATH – GOOD FOR THE ELDERLY, THOSE WITH DEMENTIA, THE BED-RIDDEN, THE CONVALESCING ……
I first addressed the issue of bathing a year ago after speaking to Sheila Wilson on the radio in Raleigh, North Carolina. (Sheila is now with Curtis Media Group) Sheila told me of a friend whose mother Mary, had dementia. Mary lived in a nursing home, and due to Mary’s combative behavior the nursing home staff was asking her daughter to come on a regular basis and bathe her mother.
Instead of spending her time visiting with her mother, the staff had given the daughter a” task” and a difficult one at that. This staff had probably never heard of the benefits of a “Bed Bath.”
The Old Fashion Bed Bath – everything old is new again.
When I was in nursing school, one of the first things they taught you was how to give a bed bath. Times have changed, and while then we were all about being fast and efficient, because everyone was getting a bed bath those days. Today we are about what is the best thing for the elder and causing less trauma especially to the confused.
THE BED BATH:
- Assemble all of your supplies, large soft towels, two wash cloths, soap less soap (available on the internet), a wash basin for water, or a pitcher of very warm water (years ago we always used a standard wash basin, but the water became cold very fast and we had to keep changing the water for warm water, the goal here is not to let the elder get cold, and certainly not have to walk away – a better solution is to have a plastic bag large enough to hold the bath towels and wash cloths – pour warm soapy water over the towels in the bag, and take one warm moist towel out at a time)
- Tell the elder what is going to happen, and explain every step of the way what you will be doing next
- Make sure the room is warm and lights not shining in the elder’s face, soft music if possible
- Put a large towel under the elder
- Start undressing the elder, still covering them with blankets
- Take one warm moist towel out of the bag with the no-rinse soap, lay it over the elder and gently “wash” using circular motions, from the shoulders working down (change towels as necessary)
- If the elder is able, hand them a wash cloth to wash their face and hands with, then giving them a dry wash cloth to dry their face
- The last area to be washed after the legs and feet is the private areas, cleaning well front to back, once again if the person is able to this for themselves, encourage them to do so
Keeping the elder covered at all times is so important for their privacy and dignity.
See also blogs:
Elderly with Alzheimer’s disease don’t want to get undressed, get wet and really don’t want to take a bath. July 3, 2009
Bathing a senior with Alzheimer’s disease, or when bathing becomes a challenge.
February 12, 2009
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 May 17, 2010 - by Nurse Virginia
MAKING THE NURSING HOME A PLACE – “TO GO TO” – NOT A PLACE “TO END UP” AT
A family member came up to me at a conference and shared her greatest concern in her mother’s recent Nursing Home placement, “I don’t want my Mom to ever feel abandoned,” she said. What would cause feelings of having been abandoned? Never being touched, never being spoken to, being ignored, and feeling forgotten.
The five senses
Touch: If you are never touched, how do you know your body still exists? The elderly in general suffer from lack of being touched and elderly in Nursing Homes even more so. Sometimes due to frailty or fragile skin, touching the elder may be limited. Or it might be that their caregiver just isn’t a touching type of person.
Maybe it was the elder who wasn’t much of a touchy – feely person themselves. But now they really need that human connection of touch to know that they are still here. Studies have shown that increasing touching by holding, hugging, hand massage, back massage, holding hands etc, will increase level of socialization and decrease confusion and agitation.
Smell: The sense of smell when added to the art of touching, as during a hand massage, incorporates the use of two senses. If the caregiver uses fragrant oil, the combination of the two senses increases the elder’s responsiveness. Think of familiar and comforting smells. Everyone knows what just baked bread smells and tastes like. Cooking and baking are wonderful opportunities for familiar smells as well as opportunities to do something together.
Taste: As the person ages, they often lose their sense of taste. Sometimes it is related to medications the elder is taking; sometimes it is just the aging process. But the last taste ability the elder will have is for sweet things. So often a family member will say, “Mom, never really liked sweet things.” Yet there she is eating almost everything after it has a little sweetener added to stimulate eating. Because the taste buds for “sweet” are usually the last that the elder still experiences.
Hearing: Music is universal, it makes us move, relax, remember, feel energized. Music can be such a stimulant and healer all at the same time. Even though music is so wonderful, the sound of the human voice is still the most comforting sound. Talking to a baby can comfort them and talking or reading to the elderly can be just as comforting.
Vision: As the elder ages, vision is of course one of the most obvious loses. Having regular vision test as well as hearing helps the elder to better understand their environment. Vision and hearing especially help the confused elder, giving them cues as to what is going on around them. Anything that helps the elder still enjoy seeing nature, their family members, their pets, their pictures, and their life – is so worth preserving.
The world around us includes many sensations, not just the normal five senses we think of. We also experience change in temperature, the pull of gravity, where we are in space and so on. The options of incorporating more senses into your elder’s day are only limited by your imagination.
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 May 13, 2010 - by Nurse Virginia
PAIN – THE MOST UNDERREPORTED PROBLEM IN NURSING HOMES
Pain is the most underreported problem in nursing communities. This applies to the general population and even more so for those with dementia. Sometimes the elders can’t express their pain with words, so those who know them need to be alert and able to read their body language. Signs of pain in elders with dementia may be increased restlessness, holding a body part, or a sad facial expression. Or it may be a language issue.
One day I walked through a unit for people with dementia. A patient named Edna moved around all the time, so we sat her in a rocker. She rocked for hours at a time, and yelled at anyone who came near her.
We heard her words but we couldn’t understand her language. We didn’t even know what language she spoke. During the first two weeks after her arrival, we asked bilingual people to help us. We asked all through the building and we also asked visitors to listen and see if they could identify her language. No one could understand her. Edna had no family to help us communicate.
One day as I walked through the unit, an elderly gentleman, a neighbor of Edna’s, had come to visit. He walked over to the nearest nurse and asked, “Don’t you know Edna is in pain?” The nurse said no one understood her words.
“She’s from Yugoslavia and she is calling out in Serbian, the language of her childhood.”
Just to know that information helped us to give her better care. Even more important, we were able to do something to control her pain. Her neighbor came by often, and he also gave us a list of Serbian words she used to express her pain. If only someone on the staff had been able to communicate with her, Edna could have been given something to relieve her pain. That’s an isolated case, but it reminds us that we have to learn the language of pain, especially when we deal with those with dementia.
Book excerpt from: Please Get To Know Me – Aging with Dignity and Relevance
By: Virginia Garberding, R.N. and New York Times Best Selling Author Cecil Murphey
www.pleasegettoknowme.com
Posted on May 12, 2010 - by Nurse Virginia
SURVIVE ALZHEIMER’S DISEASE? – JUST A DREAM FOR NOW
“Let’s see a show of hands, how many of you know someone who has survived cancer?” Hands flew up all over the conference room, as the speaker addressed the 800 plus people gathered there. “How many know someone who has survived a heart attack?” again the hands flew up and so it went till he came to Alzheimer’s disease.
When the question was asked, no hands flew up this time as people looked around the room at each other. No one knew anyone who had beat Alzheimer’s disease. Alzheimer’s disease is a terminal illness, progressing through stages of losses until death. There are no “survivors” living to tell their story of therapy and recovery.
Death usually comes in the form of pneumonia due to the fact that the late stage individual has difficulty swallowing and inhales their food.
Then the question is what does the doctor put on the death certificate? Not often is the cause of death Alzheimer’s disease. More often than not, the cause of death becomes one of the side effects of the real disease and the real cause of death, Alzheimer’s.
It almost seems as though after the shock of the diagnosis and the changes. Everyone gets used to the confusion of the elder and they don’t really expect that much from them anymore. Even the physician becomes desensitized to the loss of the individual. And so when the end comes we tend not to look back over those years and remember the person we lost years ago. We just see the debilitated elder in front of us and tell people they died of pneumonia, heart failure, an infection, kidney failure or whatever the final insult was.
Unless doctors start putting Alzheimer’s disease on death certificates, we won’t really know how many people are now dying from this disease.
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 May 6, 2010 - by Nurse Virginia
INSOMNIA LEADS TO NURSING HOME FOR ELDERLY WITH ALZHEIMER’S DISEASE
Most people have experienced the fatigue, confusion and insomnia connected with “jet lag.” When the family caregiver is no longer able (night after night), to get good nights sleep, they suffer those same symptoms of jet lag. Eventually they may have to consider nursing home placement for their loved one. The loss of sleep plus the strain of caregiving will prove too much for the caregiver. Knowing a person’s natural biological rhythm can help the caregiver encourage a better sleep-wake cycle.
When the weather is good is the time to develop good sleep habits.
- Take a thirty minute walk every day – outside where you can benefit from the sun light. Spending time outside in the sun will re-enforce their natural reaction to a light/dark cycle.
- Get other opportunities for sun by sitting on a porch or deck, working in a garden. Plant some flowers or vegetables just for the opportunity to get outside to take care of them.
- Don’t spend the day in front of the TV – the elderly with Alzheimer’s need work to do also – fold clothes even if they are the same clothes you folded already
- Have a regular schedule – eat at regular times – have a evening routine
- Read to the elder in the evening instead of watching TV
- Don’t let the elder nap during the day – if they really need to lay down – no more than thirty minutes. Studies have shown that a short, “power-nap” doesn’t have any negative impact on a person’s natural sleep/wake cycle.
- If the elder is incontinent, use a twelve-hour incontinent product during the night
- Make sure the elder’s room is totally dark, windows with blinds or shades to make sure there is no reflection off the glass
- Have night lights in the elder’s room, so if they need be to attended to – you are using the smallest amount of light so as not to arouse the sleeping elder.
- Elderly people usually suffer from some stiffness whether they have been diagnosed with Arthritis or not. Pain or stiffness will cause the elderly person to wake up, when they become uncomfortable. Most likely that time will be between 4:30 am and 5 am when a person has a normal dip in body temperature. Make sure the elder is warm and pain free, in order to enjoy a full nights sleep.
(See blog: WHEN CARING FOR THE ELDERLY THE 5TH VITAL SIGN SHOULD ALWAYS BE “PAIN” March 11, 2009)
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
- Help your elder find comfort, relevance and respect no matter how frail he or she is.
Find out why the quality of life depends so much on the family no matter who the direct caregiver may be.
Find out how to have a meaningful visit with your parent when they have dementia.
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