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Exploring Responsive Behaviours

 

Someone who is experiencing dementia may exhibit behaviours that we do not understand.  These behaviours have been labeled ‘difficult’ or ‘disruptive’ or ‘challenging’, but is that really a fair assessment of these behaviours?

 

In caring for people with dementia, the focus often ends up being on the disease itself, rather than on the person who is experiencing the disease.  Thus, their behaviours are often automatically assumed to be associated with the disease. 

 

Sharon Stap, a Psychogeriatric Resource Consultant, contrasts older understandings of dementia with more updated approaches.  In the past, it was understood that dementia was altering someone’s brain, resulting in different behaviour. All behaviour was assumed to be a result of the disease. 

 

 

The newer understanding of dementia is that the changes in someone’s brain results in a different perception of the world around them, creating anxiety, fear and other emotions which then lead to different behaviours.  Understanding that someone with dementia is experiencing a change in perception which causes behaviour should fundamentally alter how we interact with those who have dementia.

 

Dr. Sherry Dupuis, former director of MAREP (the Murray Alzheimer Research Education Project), feels that we need to reframe our view of these behaviours.  Instead of merely seeing the ‘challenge’ or ‘difficulty’ that these behaviours cause for us, or assuming that all behaviour is attributed to disease, we need to reframe these behaviours as a form of communication.  Dr. Dupuis views behaviours as a form of personal expression, a unique way of communicating needs.  We should then seek to understand the meaning behind the personal expression.


We must remember that people who have dementia were all unique individuals prior to the onset of their illness. They continue to be unique individuals with different personalities, communication styles, interests, life histories, etc.  Dr. Dupuis charges us to never lose sight of the fact that a person with dementia is first and foremost a person who requires love, care, and understanding, not just a disease or a ‘case’ that needs to be managed.

 

One of the greatest gifts that we can offer to someone with dementia is the gift of truly relating to that person—validating their personal experiences and feelings.  Someone with dementia is experiencing the world around them differently than they previously experienced the world, and differently than you might be experiencing the world around you. 

 

 

This experience may be frightening, overwhelming, or worrisome, and the feelings that are generated and their emotional response is fully valid. We cannot be dismissive of someone’s feelings or emotional responses just because we do not deem a situation to be frightening to ourselves.  The kindest thing we can do is try to understand the emotional response and validate the feelings that someone else is experiencing.  Only then can we attempt to change someone’s experience into something more positive.
 

If someone is distressed or having a negative experience, distraction can be helpful, but it is not the first step in the process.  Stap emphasizes that you cannot jump immediately to distraction, otherwise you risk being dismissive of someone’s feelings. Stap proposes a four-step process where distraction is the final step, not the first option. 

 
The Four Steps:

 

1. Show you care

 

2. Show you want to help

 

3. Redirect

 

4. Distract

 

For example, Agnes has dementia, and she is upset and focused on wanting to return home. The first step is to acknowledge how Agnes is feeling.  You might say: “You need to get home, Agnes? I can understand why you’re so upset.”  Attempting to inform Agnes that she is already at home—known as reality orientation—is not helpful and only causes more distress; Dupuis and Stap agree that there is rarely, if ever, a good time for reality orientation.

 

 

After acknowledging and validating Agnes’ feelings, you want to show that you want to help.  You might suggest: “let’s go see if we can find someone who can help us, Agnes”.  While on the hunt for someone who can help, you have the opportunity to redirect, the third step.  You could say, “I’m tired. Before we look for someone else who can help, do you mind if we rest here by the piano?”.  After this, you have the opportunity for distraction, the fourth step.  You could then say: “You play the piano, don’t you, Agnes?  Would you play me a tune?” 

 

If you had jumped immediately to distraction via the piano when Agnes first approached you, she likely would have felt even more frustrated that her needs were not being addressed. Acknowledging Agnes’ feelings and needs, then assisting her to focus on something that is more comforting, allows for a positive experience overall.

 

Interpreting all behaviour as a form of personal expression shifts the focus off of the disease of dementia, and refocuses attention on the individual person.  Suddenly, behaviours are imbued with meaning and purpose, a form of communication. It is then our responsibility to enable the best possible form of communication and understanding, setting people up for success, regardless of dementia or other illnesses.

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Why are there Private Caregivers in Nursing Homes?

 

People are often shocked to realize that Warm Embrace provides service within long-term care homes (previously known as nursing homes).  We have numerous clients who live in long-term care homes all across the region—in Kitchener, Waterloo, Cambridge, Guelph, Elmira, even all the way out to Palmerston!

 

If people move into nursing homes to have everything taken care of, then why do they need a Warm Embrace Caregiver?

 

One-on-one undivided attention

 

You might think “there are tons of staff at the nursing home, why would we bring in another caregiver?”  You’re absolutely right—there are many staff within long-term care.  There are nurses and PSWs, housekeeping staff and maintenance staff, administrative staff and social workers—the list goes on and on!  Sure there are many people buzzing around, but none of them are there exclusively for your parent.

 

 

People know when a visitor is there just for them, versus someone who is there for the whole group.  Staff must pay attention to all the residents; even hired entertainers must try to engage the whole audience.  The residents inherently know that those visitors are for everyone. It is no different than attending an event at Centre in the Square—the performance isn’t for you personally, it is for the whole audience.

 

A personal, private caregiver, by contrast, is there for your parent exclusively. They are not rushing out of the room to assist anyone else; they are not turning away from your parent to converse with someone else.  They are there to provide undivided, one-on-one attention. It is amazing to see how people KNOW the difference.  Someone with advanced dementia who can no longer speak will absolutely light up when her caregiver arrives—she knows the difference between her personal caregiver and any other visitor who is there for the group.

 

Matching Individual Needs

 

Residents in long-term care centres have a huge range of needs.  Some people are there because of cognitive needs—their brain has been affected by an illness such as dementia.  Others are there due to physical needs such as incontinence or requiring a Hoyer lift for transfer.  Others may have a combination of both physical and cognitive needs such as those with Parkinson’s or stroke survivors.

 

 

The Activity Director has the very challenging job of trying to find group activities that match as many needs as possible. Naturally, the activity director has to cater to the average so that as many people as possible can participate.  However, residents on either end of the spectrum may feel left out. Those who are very sharp mentally may feel that activities are too basic or childish.  Those with advanced dementia may find activities too complicated or frustrating.

 

A caregiver matches the individual needs of the resident whom they are helping.  The activity can be scaled to suit the ability of their client so that the client never feels frustrated while also ensuring that the client is not bored or under-challenged. Maintaining just the right level of mental stimulation is a delicate balancing act—one that can be managed by a caregiver who is assigned to meet the needs of just one client at a time.

 

Managing Behaviours (expressive communication)

 

Moving into long-term care can be a frightening experience for someone with dementia. Suddenly, everything is different. Routines have changed, the environment has changed, and everything seems to be moving so quickly.  Someone with dementia may not be able to articulate how they are feeling. Instead of saying: “I feel frustrated and overwhelmed right now” they may instead act in a way that you’ve never seen before.

 

 

Their new behaviour is a form of communication.  They are trying to tell you something. . . the hard part is to figure out what they’re trying to say. Nursing home staff who are rushing from resident to resident may not have the time or undivided focus to figure out what your loved one is communicating.

 

Instead of just seeing “challenging behaviour” we see a form of communication. We consider ourselves to be detectives—we are looking for clues to decode what your parent is attempting to tell us. If we can start to pieces together the clues, we might be able to decode a legend of sorts—a legend that will help interpret future communication.

 

Nursing homes are large facilities with tons of staff coming and going. Warm Embrace Caregivers work alongside long-term care staff to provide the best possible care for your loved one! As a team, we work to ensure all your parent’s needs are being met. Long-term Care staff may focus on their immediate physical needs but our caregivers will take the extra mile to provide your loved one social and emotional support.

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Exercise!


When asked “how much do you exercise?” the answer is invariably “not enough!”  We know that we should exercise more, but do we know what the consequences are if we fail to exercise regularly?


Lack of physical activity is a risk factor for heart disease and stroke (as well as other many other illnesses such as diabetes and even dementia).  It is a risk factor that we have control over, so we should reduce our risk!

 

How much exercise do we really need?



The official guidelines from the Canadian Society for Exercise Physiology recommend a minimum of 150 minutes per week of aerobic physical activity. That’s it!  That’s an attainable goal—within reach, even for people who aren’t accustomed to exercise.  Even 10 minute increments of activity count toward the total of 150 minutes.

Of course, 150 minutes doesn’t need to be a limit.  More activity is even better.  The guideline is a base limit for how much activity adults (middle age, baby boomers, seniors, and even the frail elderly) require each week.

Which activities count toward your 150 minutes? 

The good news is that going to the gym is not your only option! Walking is a simple and easy heart-healthy activity, and counts toward your minutes.  Even household activities can count—vigorous cleaning, gardening and yard work all elevate your heart rate and get your blood pumping, and that’s the goal of physical activity!

 



I find it encouraging to measure exercise in terms of 150 minutes weekly because it allows for flexibility.  In contrast, if you measure exercise as ’30 minutes most days of the week’, the focus is on 30 minute intervals, and missing a few days in a week can feel like overall failure.

For the frail seniors who are utilizing our Triple Vitality program, they appreciate the flexibility in measuring total minutes over the course of a week.  Ten-minute increments feel very accessible.  Frail seniors can manage 10 minutes of light exercise!  Thirty minutes may be out of reach when we first start, but 10-minute activity sessions throughout the day add up quickly!


Our clients are so encouraged by the progress that they experience.  You can feel the benefits of exercise very quickly.  Increased energy and stamina, renewed interest in activities, reduced stress, better sleeping and digestion, are all immediate benefits to exercise.  Knowing that you are contributing to improved overall health and reducing your risk factors for heart disease, stroke, diabetes, and other illnesses only increases the incentive to continue being active!



Be sure to track your minutes of activity this week and see how close you are to the recommended minimum of 150 minutes.  Remember that 10 minutes of activity at a time can count toward your total!

If you know someone who is elderly and they are unsure about how to become active, be sure to contact Warm Embrace.  Our Triple Vitality program is specifically designed for the frail elderly who need assistance to become active.  We love to make a healthy, proactive difference in people’s lives, regardless of age!

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