Family Caregiver Blog

Category Archives: Guest Blogs

Tips for Communicating with a Person Who Has Dementia

Written on August 15, 2011 by homewatchcaregivers in Caregivers in Crisis, Caregiving Advice, Guest Blogs

We often think of communication in the context of words or other sounds (singing or shouts for example) and we assume that the goal of communication is to share a particular message. But in fact, there are two types of communication: verbal and nonverbal. Nonverbal communication — the use of body language – is conveyed with our eyes, touch, facial expressions, gestures, hand movements, body posture and position. What’s more, the actual message, or content of our communication plays a lesser role in overall communication.

According to research, nonverbal (body language) comprises 55% of overall communication, compared to vocal tone, which comprises 38% of communication and content, which comprises only 7% of communication. Keep this in mind when interacting with your loved one. Just because they may have trouble understanding the content of your message, does not mean that they can’t pick up on frustration, fear, happiness, sadness, anger and other communication through body language.

Tip 1: Effective Non-Verbal Communication

Maintain a calm pleasant approach. The person with dementia will mirror your mood. If you act rushed or tense the dementia person may react by becoming more anxious or agitated. Approach the person from the front to minimize the startle effect. Always establish eye contact. Speak at eye level whenever this can be done. Point or demonstrate what you are trying to get across.

Tip 2: Effective Verbal Communication

Use a calm gentle voice. Use short simple sentences. Speak slowly. Call the person by name and introduce yourself if necessary. Answer a frequently asked question like it was the first time they have asked it. Eliminate distracting noises. Give one instruction at a time. Do not overwhelm them. Remember you are speaking to an adult. Allow enough time for the person to respond and repeat yourself if necessary. Use words that are familiar to them.

Tip 3: Things Not to Say

Do not try to argue with someone who has dementia, talk louder when they do not understand you, use a demanding tone or ask questions that rely on the use of memory if they are experiencing a disoriented moment. You should treat them the way you would want to be treated under the same circumstances. Basically, try to put yourself in their shoes.

Tip 4: Alleviating Barriers

Be a good listener. Encourage nonverbal types of communication and be patient and supportive. Show interest in what they are saying and do not criticize. Focus on feelings and not the facts and offer comfort and reassurance. Limit distractions, offer a guess when they can’t find the word and give them time to express their thoughts. Use cue cards to help with communication barriers. Do not make fun of their lack of abilities or tease them at any time.

Tip 5: Coping with Reality

Communication with someone with Alzheimer’s can be a difficult task. Alzheimer’s disease damages parts of the brain that control communication and it may be difficult for your loved one to find the right words. They may have difficulty following conversations or they may be able to still read but not comprehend what they are reading. Memory loss may cause the person to repeat himself or herself or to develop “automatic speech”, where a simple phrase like “thank you” is repeated. Curse words may be used more frequently due to the disease process. Keep in mind when communicating to enter their reality instead of bringing them into yours.

As you learn to communicate with some who has dementia, stay flexible. Remember that it is a trial and error process and what works today may not work tomorrow. Use your own skills and implement your own ideas

Deanna Lueckenotte experienced Alzheimer’s at a personal level with her grandmother who is now no longer with us. She has spent almost 13 years working in geriatric healthcare with an emphasis on Alzheimer’s. She is the author of Alzheimer’s Days Gone By: For Those Caring For Their Loved Ones.

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Two Easy Steps to Developing a Care Plan

Written on August 8, 2011 by homewatchcaregivers in Caregivers in Crisis, Caregiving Advice, Guest Blogs, Research and News, Wellness

Help to ensure continued good health for your aging loved one by creating a geriatric care plan. Taking the time to go through these quick and easy steps to creating a plan will help your loved one avoid hospitalization, enable them to live independently, and improve their overall quality of life. Putting a care plan in place enables family caregivers, aging loved ones and health care professionals to be on the same page regarding health care and living arrangements. This also ensures that each person knows their role in managing the needs of the patient or loved one.

Step One: The Geriatric Assessment

A geriatric assessment is performed by a geriatric care manager or licensed social worker. The goal of the geriatric assessment is to evaluate the current and future medical, social and emotional needs of the aging individual. A geriatric assessment should include:

A complete physical, mental and psycho-social evaluation

An assessment of the individual’s personal care competencies, known as actvities of daily living (ADLs)

An evaluation of current living arrangements and access to support services

Identification of existing problems

Listing of anticipated problems

Step Two: Developing a Care Plan

The geriatric assessment should give families and caregivers all of the information needed to develop a solid, comprehensive care plan for their loved one. According to the American Association of Retired Persons (AARP), a care plan “assesses an individual’s medical and social service needs, and then coordinates assistance from paid service providers and unpaid help from family and friends to enable persons with disabilities to live with as much independence as possible.” Such a plan should include:

Help managing personal care responsibilities, medication delivery, and general physical, mental and psycho-social issues. For some families, a home health aide or an assisted living environment addresses these issues.

Anticipate changes needed in living arrangements developed to ensure the continued safety and health of the aging individual. Sometimes, simple attention to geriatric home safety is all that a family needs to ensure the continued health and safety of their loved one. Other times it may be necessary for the older individual to be moved to a smaller housing unit, apartment or other one-level living arrangement (including assisted living options and/or nursing homes).

Managing the connections between support services, healthcare providers and the aging individual to ensure that the loved one receives the necessary care and monitoring.

A plan for ongoing monitoring and reassessment. Families, especially those who don’t live nearby their aging parents, should make sure that they receive periodic reports about their loved ones. Regular reassessments should be scheduled to address any changes in the older person’s physical, mental or psycho-social needs. Special attention should be paid to the need for immediate modification in the event of a drastic change in the older person’s health.

Republished with permission from Parent Giving. Parentgiving.com was created to help time-starved caregivers provide better care for their aging parents by providing in-depth information and helpful checklists about a variety of caregiving topics.

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Helping to Make Each Other Better

Written on July 18, 2011 by homewatchcaregivers in Caregivers in Crisis, Caregiving Advice, Family Caregiver Profiles, Franchise Partners, Guest Blogs, Wellness

I’m a grandmother embarking on my third career – becoming a professional caregiver. Before I decided to try my hand at caregiving, I taught English overseas and helped Native American adult students prepare for their high school equivalency exams. After that, I drove big rigs cross-country for a number of years. I like stepping into a completely different occupational world every few years. It keeps me on my toes.

My very first regular client, whom I’ll call Ralph (though that’s not his real name), is a talented teacher, juggler and cyclist who is now confined to a wheelchair at age 82 with Parkinson’s Disease. Before I met Ralph, my knowledge of Parkinson’s was minimal. For me, as for many Arizonans, it was “the thing that Mo Udall had.” Spending several days every week helping Ralph with his daily activities has taught me a lot.

I often think of one of my favorite poems by English writer Thomas Hardy, author of Tess of the D’Urbervilles, which conveys the vital force within each of us that refuses to surrender to the physical disability that inevitably comes with age or disease.

We all have donned disguises for a few hours, for fun. At a party, we can take on the identity of a devil, an angel or a giant squid, then lightly cast it off again. Parkinson’s is a disguise that a person does not choose and cannot cast off. It hides a graceful, capable person behind a mask of tremors, painfully slow movement and halting speech.

The first time I met Ralph, it was immediately obvious to me that he wanted to be recognized for who he is behind the mask of his disability.

Along with his two other new caregivers, I was ushered into the small apartment where Ralph sat in the reclining chair where he spends much of his time. The chair faces a large screen T.V. set and a window with a lovely view of the desert landscape. The first thing Ralph did was open up a scrapbook he was holding. We leafed through maps of parts of Canada, of Civil War battle sites in the Southern United States. It turned out he’d not merely visited these places on vacations; he had pedaled through them perched on the seat of a bicycle.

That one scrapbook was just the tip of the iceberg. Each day — sandwiched in between the mundane routine of meals, meds, and personal hygiene — there are new revelations about Ralph’s amazing talents and experiences. He’s fond of thrusting sheets of paper into my hands with a twinkle in his eye and the gruff command “Read that!”.

Once it was a long list of very exotic faraway countries. Yup, he’d cycled through all of them, thousands of miles. He asked for help organizing five or six white banker’s boxes of tattered manila folders. I couldn’t believe the scope of the man’s interests. One folder’s tab said “Diving.” Had he done it himself? Of course. A handful of black and white snapshots showed a young Ralph poised in perfect form above a diving board. What about scuba diving? Yeah, that too. He’s also been a baseball player and a master juggler who has attended juggling conferences all over the world. He taught middle school social studies for many years.

And then out of the blue, Ralph will ask, “What day is it? Did we already go down to lunch?”. Short-term memory loss is an effect of Parkinson’s. I am struck by the grand irony of this question, coming from someone like Ralph.

As a caregiver, I often wonder how I would react if I had led an extraordinary life of high adventure and achievement like Ralph, and then found myself needing support with daily tasks of living. Would I be able to explain patiently to a stranger, as Ralph has done for me, how I wanted my teeth brushed, how I wanted to be assisted with ambulation so I’d feel unafraid of falling, which objects I needed near me and how to place them so I could pick them up easily?

Ralph — who speaks lucidly, though softly and with great effort — is a great teacher.

Like all great teachers, his first concern is always for others. He hates to bother people and is never rude. Ralph tires easily and is often overtaken by the shaking that comes with Parkinson’s. He once told me that he probably wouldn’t sit at the dinner table so long, but he makes the effort so that his tablemate, Ernie, will have somebody to talk to. I don’t know too many younger, more able-bodied people who would be willing to make that kind of effort for the sake of another person’s comfort.

The poet Gil Scott-Heron, who died this month at the young age of 62, said that here on earth “we’re just going to meet other humans and help to make each other better.” Ralph, while living with Parkinson’s Disease, is also living those words.

Kim Mathews grew up in Michigan but has been a resident of Tucson, Arizona for most of the past 33 years. Her recent professional life includes teaching GED classes for the Tohono O’odham Nation west of Tucson for 11 years and long-haul truck driving for nine years. She is eagerly exploring the mysterious universe of caregiving. She shares her life with her two daughters, grandaughter, 91-year-old mother, cat, dog, three horses and many friends. She has been writing all her life.

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Homewatch CareGivers is a premier caregiver agency, providing home care for all ages. We invite you to visit www.homewatchcaregivers.com, where you can read articles related to home health, Dementia Care Tips and home care news; or download PDF home care resources. From health care coordination and hospital discharge planning to home care transportation and daily living assistance, let our family of caregivers care for yours.

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Difficult Decisions: Guilt and Caring for Alzheimer’s

Written on July 11, 2011 by homewatchcaregivers in Caregivers in Crisis, Caregiving Advice, Guest Blogs, Wellness

Recently, my friend Sarah had to put her mother in a nursing home. I use the word “put” because Sarah’s mother did not want to go. It was heart-breaking for everyone. Sarah overcome with guilt. Her mother, not having any insight about the Alzheimer’s disease that caused this situation, wrote a very nasty letter disowning Sarah.

Although Sarah’s mother suffers from memory deficits that have literally resulted in near-death events, she has not forgotten that her daughter put her in that nursing home! It is very strange and sad how our loved-ones seem to remember things we wish they would forget, yet they forget very important pieces of information that are critical for their own safety. Sarah’s mother sometimes even forgets who Sarah is, but oddly she still remembers the emotions of betrayal and anger during those distressing visits.

The decision to get legal guardianship and then move her mother into an assisted living facility was a long process. Over a year earlier, Dixie (Sarah’s mother) had nearly killed a bicyclist when she was driving against her doctor’s orders. A few months after that, she left the stove on and the kitchen was badly damaged. Dixie would have probably been injured herself in that fire if she had not strolled outside and walked to a nearby café for lunch. Luckily a neighbor saw the smoke and called 911. Difficulty remembering very crucial medication overlapped with the lack of insight about the need to take those meds (and also, I suspect, with some paranoia about the doctors).

There were many other close calls leading up to the eventual edict to move Sarah’s mother into that nursing home. This year of deliberation took its toll on my friend. She had a breakdown a few weeks after her mother relocated. It was a few days after she received a letter from Dixie stating that this transgression was unforgivable and that the betrayal would never be forgotten. As far as Dixie was concerned, Sarah “was dead to [her mother].”

Why had this impacted Sarah so devastatingly? Hadn’t she made the only logical choices? Dixie would surely have come to some terrible harm if Sarah had not intervened. But my friend still was overcome by guilt and remorse. Had Sarah really done anything wrong? I’ve seen similar {though not nearly as devastating} scenarios in the dynamics of many of my clients’ and their families. It seems that the adult children go through an almost predictable pattern of emotional turmoil when their parent develops dementia.

I think it may be the reversal of the roles of authority at the foundation of this phenomenon. After a lifetime of being subordinate (to some degree) to our parents, Alzheimer’s or some other neurologic disease robs them of critical abilities and leaves them in a vulnerable condition. Then, as their loving and caring family member(s), we step in to protect them. Sadly, they seldom see it that way.

But it is a neurologic disease that causes them to change. Why is it so difficult not to take their hurtful words personally? Perhaps it is because after a lifetime, we all have stockpiled psychological baggage and issues that have never fully been resolved. My friend has struggled to get past the fear that her mother always had hidden contempt for Sarah. Perhaps some of us feel fear that we are “punishing” that parent who was abusive somewhere along the way. I almost always hear something along the lines of “I don’t know, I just don’t think Dad [or Mom] needs to be ‘put away’ yet.” I have not yet witnessed a family “put away” a loved-one too early. In fact, it is usually when it was too late—after someone actually gets hurt (broken hip, auto accident, fire, medication overdose, etc.).

Watching Sarah go through this with her mother has made me wonder if the next generation will go through this pathologic guilt. I wonder if we adult children will remember how difficult these decisions were. As our life expectancy continues to climb, we are facing new social challenges like Sarah’s. It’s almost certain that we will have to deal with this dilemma today—over half of people at age 85 suffer from Alzheimer’s disease. Maybe this aspect of being an adult child will influence our relationships with our own children in a way that helps them go through this kind of transition more easily in the future.

Dr. Roderick Shields O’Brien is from Wisconsin. He attended undergrad at Notre Dame and med school at Indiana University, so he also considers himself part “Hoosier.” He completed two residencies, also at IU, in Psychiatry and Neurology and then served in the US Air Force. His combination of Neurology and Psychiatry backgrounds was a natural path to his current passion for dementia care. As the Director of Care for the Colorado Springs branch of Homewatch CareGivers, Rod enjoys the change of perspective that his current responsibilities offer. When practicing Neurology in the military, time was short and there was a culture of medicating problems as a “Band-Aid” solution. He now spends his spare time teaching, writing, and volunteering. He frequently gives lectures for the Alzheimer’s Association of Colorado Springs and is dedicated to raising awareness of the growing epidemic of dementia and other elder care needs.

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How Grandma Got Her Groove Back

Written on June 20, 2011 by homewatchcaregivers in Caregiving Advice, Contests!!, Guest Blogs, Wellness

This week we are thrilled to feature Sue Chen, founder of Nova Medical Products as she discusses the importance of considering aesthetics when selecting mobility equipment for your aging loved one.

Carson, CA – While going around the country giving mobility makeovers, I noticed a pattern – someone would put their hands on a new, colorful walker, decked out with stylish accessories and they would make a little wiggle motion with their hips. Though not as showy as a football player in the end zone, it reflected the same celebratory sense. A person would touch their new wheels and spontaneously start to groove.

All of us want to look good — and feel good — no matter our age or circumstance, and nothing is more important to one’s sense of dignity and independence than personal mobility. When selecting mobility equipment — whether it be a walker, wheelchair or cane — I encourage family care givers to consider the aesthetic as carefully as they consider functionality and comfort. Let’s face it: grey metal is not particularly life affirming. Nor does it reflect the vibrant spirits of the people who might need a little extra help getting around.

Without a little flair, mobility devices can be depressing, and make the people using them seem depressing, which makes other people not want to look at or acknowledge them for fear that they one day might BE them. It leads us, as a culture, to basically ignore and sometimes shun the members of our society that have the most to teach us about life. Our seniors and survivors deserve to be treated with greater dignity.

We carefully select designer shoes, ties and dresses — why not designer canes, colorful walkers and stylish accessories? When people like their equipment, they use it more, allowing them to regain independence, excitement about life and the desire to participate in the world. They are also more full of joy, adventure and, yes, even sex appeal. We have heard some amazing stories — from an ALS client that was able to photograph penguins in Antarctica to clients who use their fire-engine red walkers to meet for a late night tryst at the hot tub or electric blue to traipse around Paris.

This summer, I invite you to learn more about our amazing customers and their incredible life journeys – which we know are still going on. Visit www.zoomgroovecruise.com to learn how you can win up to $6,000 and visit a forum for everyone to see what we see: a world in which those facing mobility challenges are people with full, exciting lives.

NOVA specializes in brightly colored and patterned walkers, canes and wheelchairs along with all the accessories needed to lead an active life. By designing equipment that is both stylish and functional, NOVA is changing the way people face mobility challenges every day.

Sue Chen founded Nova Medical Products in 1993 when she was just 23 years old. Today, Nova has grown to become an industry leader in Mobility and Bathroom Safety products providing greater independence and personal well being to people at all stages of life. Sue and Nova are changing the look and perception of medical equipment and improving the lives of millions of Americans reliant on assistive devices by incorporating style, fashion, and function to products such as designer canes and colorful walkers. Nova’s mission is strong and simple: take care of our people, take care of our customers, and take care of our community. Sue and her team at Nova are working to educate people about the hope and possibilities of life – regardless of physical challenges – and to empower their customers to live life fully. Through her trademark “Mobility Makeover”, Sue works with individual customers to help them assert their style and pursue an active lifestyle with the help of their mobility equipment.

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