If 10 people witness a crime, how many different accounts will there be? Undoubtedly, there will be 10 unique eyewitness accounts. There might be similarities between the 10 stories, but there will most definitely be distinctions between the accounts, possibly even with contradictory details.
Why is this?
Each of us has a unique experience of the world. We can’t help but view the world through our own unique lens. It also means that we interpret the world around us through that same lens, and pass judgement or draw conclusions based on our experience and our perspective.
The same is true for those who have dementia. They are viewing the world through their own unique lens and filtering it based on experience and perspective. They have a massive additional challenge because—their brain is significantly affected by a disease that interferes with how they can process information.
They cannot rely on memory to recall past experience or to logically process information. For example, if someone with dementia sees a blue towel crumpled on the floor, they could ask if it’s a dolphin. At that moment, their brain did not process that dolphins can only survive in water and they do not live in people’s homes. Their brain is unable to recall past information about dolphins or access memory to know that their home does not have any pets. At that moment, they see something that looks like it could be a dolphin and their brain interprets that data to conclude that must be what they are seeing since there is no other information to explain it.
Another example is, if an elderly woman with advanced dementia says she needs to pick her children up from school, she sincerely believes this to be the case. She is not aware that she is 86 years old and has not had school-age children in over 50 years. She is not aware that you are her daughter and you are the schoolgirl she is concerned about. At that moment, her brain is accessing long-term memory for information that has changed drastically over the years, but she is unable to recall more recent memory that would put her long-term memory in context.
Her reality is that she has school children to pick up and she cannot leave them alone. She is an attentive mother and needs to get to her children. Your reality is that your 86-year old mother is determined to pick up a school child, and you have not been that school child in nearly 50 years. In fact, you have grandchildren now who are starting in school.
Your realities are different in that moment. While your reality may be more factually correct, it is nearly impossible to have someone with dementia adjust their reality to match yours. It is far more effective to understand their reality and match them in theirs. Focusing on facts is rarely useful. Focusing on emotions is the most effective way to handle differing realities.
Focusing on facts would be reorienting your mother to your reality: “No Mom, you don’ have to pick children up from school. I’m your daughter and I haven’t gone to school in nearly 50 years; even your grandchildren have finished school. You’ve got great-grand-children starting in school now. You don’t need to pick up anyone. You’re staying here with me.”
The comments are all factually correct, but they are not helpful to the person with dementia. The pieces don’t fit together; she is unable to access the memory and process that would allow all the information to make sense. Instead, try to join her in her world.
“Oh, you have children! Tell me about your children.” Get your mother talking to understand her mindset. An emotion will likely surface, and you’re looking to understand what her emotional state is in the moment and ideally address her emotional concern.
You’re matching your mother’s reality and joining her in her world for a few moments, rather than trying to force her to join you in your version of reality. Keep the conversation going and create that emotional connection.
Don’t fight different versions of reality; learn to join your loved one in their version of reality by focusing less upon the facts, and more upon the emotions.
Dementia and Communication: What to Expect in the Late Stages
Tuesday, July 2, 2019
In the late stages of dementia, or in severe Alzheimer’s, communication is significantly impacted. By this stage, both speech and language can be affected. The person with advanced dementia is not aware of their communication deficits; they may not be able to think beyond their own needs to notice the perception challenges of the family caregiver with whom they are communicating.
Understanding the limitations of late-stage dementia is critical to communication. Knowing the challenges that will exist and the ability level of your loved one makes all the difference for successful communication.
Here are 7 elements of communication that will have become difficult, directly impacting the expectations we should set for late-stage dementia communication:
1. Highly Variable
Your loved one is going to fluctuate in ability level—by the day, by the hour, even within a minute. Just because a person with dementia can clearly articulate a concept one minute, does not mean that she is able to do so the next minute. There can be islands of fluent and coherent language where she can express herself with impressive clarity. Understand that her ability to express herself will fluctuate drastically, and a moment of inability is not laziness or faking, or manipulation.
Perseveration is a focus or preoccupation with a particular concept. It is often expressed as worry or concern. In the later stages of dementia, perseveration is quite common and is often expressed through repeated questions or a repeated focus on certain words/topics.
3. Reduced Vocabulary
The mental dictionary of vocabulary is not only shuffled as it is in the early stages, but there are also now entire sections of the dictionary that are missing. Vocabulary may be reduced to simple words, or your loved one may surprise you with complex words in one moment and lack of simple words the next moment.
4. Unrelated Utterances
Late-stage dementia causes disorganized thinking, resulting in a conversation that jumps around frequently. Where there might be some linkage between concepts in the mid-stages, in the late stages, words or ideas may be expressed that are entirely unrelated. The reduced vocabulary causes your loved one to grasp at other, unrelated words to fill the gap.
5. Word order and Agreement
One of the hallmarks of language is the correct arrangement of words—words need to be used in the correct order and in agreement with each other. In the later stages of dementia, words become easily entangled, sentences are mixed up, and correct grammar may be lost.
6. Speech Disturbances
Throughout the earlier stages of dementia or milder Alzheimer’s, language is affected. In the late stages of dementia, speech may also be affected. Someone may have trouble pronouncing words, forget how to pronounce certain syllables, or begin to stutter. In the very late stages, speech may be significantly impacted so that words are no longer discernable.
7. Non-Verbal Cues Paramount
When your loved one can no longer understand the meaning of the words you are saying, he/she will rely upon understanding your intonation, your body language, the tone of your voice, and your approach.
Your words could be pleasant and clear, but if you appear to be upset or hurried, your words will be lost. Only your upset nature or hurried and flustered sense is being conveyed to your loved one. The person with dementia may then respond to your perceived emotion, completely separate from the words that you are saying.
As someone with dementia progresses through the illness, their ability to analyze their own communication dwindles. By the late stages, they are not able to self-assess their communication at all.
As a family caregiver communicating with your loved one, or as a health care professional communicating with clients, it is our responsibility to anticipate the above 7 challenges and accommodate accordingly.
4 Reasons to Get Elders Out of the Hospital Quickly!
Your mom just had surgery and you thought she’d be in the hospital for weeks, but she’s being discharged today! You may feel as though your mother is being pushed out of the hospital door just to make space for the next patient, but there’s a lot more to it than that.
Here are four reasons why you don’t want an elderly relative to remain in hospital any longer than necessary:
1. Bedrest is TERRIBLE!
When someone is sick or recovering after surgery, it is tempting to pamper them while they remain in bed all day long, but that is actually the worst thing for recovery. For every day of bed rest, the frail elderly lose approximately 5% of their mobility. After only a week of bedrest, they could be down by 35% of their mobility—and they may not have started with 100% prior to surgery. Getting up and out of bed is crucial to retain mobility and strength. Encouraging someone to get up periodically throughout the day will prevent the 5% mobility loss that comes with complete bedrest.
2. Hospitals make you sick!
The risk of contracting an additional illness while in hospital increases the longer you remain in hospital. Those with weakened immune systems are most likely to contract superbugs such as MRSA or C-difficile which are antibiotic resistant.
These illnesses can cause severe diarrhea which often leads to dehydration, which increases the risk of delirium—the next item on the list.
3. Delirium, Dementia or Despair?
Delirium is a state of confusion that can be mistaken for a sudden case of Alzheimer’s Disease. It is NOT a form of dementia, but it can mimic dementia. The frail elderly are at high risk of developing delirium in the hospital.
Here are some of the risk factors:
Medication changes—their regular medication routine may be changed to help with diagnosis
Interrupted sleep—injections in the middle of the night, a nurse checking in, etc.
Day/night reversal—orientation to time of day becomes difficult when lights are on all night and circadian rhythm is interrupted.
Lack of social interaction—while nurses and doctors may conduct a test or provide care, they cannot remain at a patient’s bedside for hours at a time. The loneliness and sense of isolation can cause the elderly to despair. With a sense of time interrupted, someone may believe they have been abandoned for days.
4. Get back on the john!
If an elderly person is at risk of falling or they need assistance, they won’t be permitted to toilet independently. They can press the buzzer to request help, but hospital staff may not be immediately available. In many cases, it is easier to catheterize a patient to ensure that they are not attempting to get out of bed and risk falling on their way to the bathroom.
The longer someone is catheterized, the greater the risk that they will become incontinent. The catheter holds open the muscles that usually contract to block the bladder. Those muscles will essentially become lazy. The catheter might be removed, but the muscles may have lost their ability to retract and no longer be able to contract sufficiently to contain urine.
Losing the ability to hold one’s bladder has enormous ramifications. Beyond the increased care needs, someone’s confidence and quality of life can be negatively impacted by incontinence.
The hospital is the right spot for someone who is acutely ill or injured, but it’s a terrible place to recover! Returning home as soon as possible will prevent these four risks of a prolonged hospital stay. We can help your loved one remain healthy and well!
You grow attached to your residents and you hate to see them move on from your residence into Long Term Care. You wish you could keep them with you even longer! You may even feel a little torn because on one hand, you have grown fond of each resident and you want them to remain in your home, but you also see the toll it takes on your staff when care needs suddenly increase.
Warm Embrace can help you to have the best of both worlds! Your residents can remain living with you much longer, without placing an increased burden on your staff.
One of our greatest success stories was with a gentleman at a retirement home in Kitchener. When he moved into the retirement home, he had occasional nighttime urinary incontinence due to prostate issues. After prostate surgery, he became entirely incontinent and he wasn’t able to self-manage. Because of this, he was self-isolating, remaining in his room and not attending any activities or events.
He had AM/PM care from the LHIN, but many days he wasn’t ready to get out of bed when the PSW from the LHIN arrived. That left the retirement home staff to attend to his needs at the busiest time of day—the morning rush. He needed assistance numerous times throughout the day as well and it was taking quite a toll on the staff.
Warm Embrace was brought in to help support this gentleman so he could remain living in retirement and not move into long term care. We intentionally scheduled our service at the time of day that was heaviest for the retirement home team. That way, their efforts could be focused on other residents, knowing this gentleman was well-cared for.
Our caregivers attended to his personal care needs in the morning—on his schedule when he was ready to get up. Our caregivers ensured that he was bathed and dressed in fresh clothes. Each day, they changed the bedsheets and laundered them, along with any other soiled laundry. While this gentleman had weekly laundry included in his package, our team was responsible to immediately launder soiled items so they didn’t remain in his suite until laundry day.
Once he was dressed and ready for the day, we’d get him to breakfast and then take him on an outing. With a caregiver’s reassurance, he began leaving his room to attend events and activities. When he required assistance, we’d be right there to provide it. His confidence began to return!
Our morning visits thoroughly covered the busiest time of day, and the retirement home staff was able to provide the coverage for this gentleman required in the afternoon. Working together as a team, we supported this gentleman in remaining in his retirement home of choice for an additional three and a half years.
We are pleased to partner with you and your team to provide the same support to any of your residents who require it. We intentionally schedule our services at your highest need times of day to reduce the strain on your staff.
Our Warm Embrace caregivers can support your highest-needs residents on a one-to-one basis, freeing your staff to attend to all the other residents in their care. Together, we can help your residents to remain with you for many more years to come!
In the world of homecare, terms like ‘minimum’, ‘maximum’, and ‘eligibility’ frequently arise.
When arranging publicly-funded homecare through the LHIN, the first concern will be eligibility—is your loved one eligible for LHIN homecare? If they are, the next question will be “for how much homecare?” Publicly-funded homecare is all about eligibility and maximums—the maximum amount of service that can be provided based on eligibility.
Privatehomecare is exactly the opposite. There are no eligibility criteria, and there is no maximum amount of service. We gladly provide as much service as a client needs or wants. In fact, to ensure that clients truly are well-served, we have minimum service provisions rather than maximums.
Why do we have minimum service provisions?
Here at Warm Embrace Elder Care, we have service minimums as a way of ensuring that we always provide service in line with our philosophy of care. Here are a few important ways that minimum service provisions contribute to the fulfillment of our mission and our philosophy of care:
Our philosophy of care is about promoting abilities and never doing for a client what he or she can manage independently. It takes significantly longer to support someone in doing a task slowly, at their ability level, than having caregivers just rush through a task on a client’s behalf. What is best for the client though? If caregivers always just do the task because it’s faster, eventually, the client will lose the ability to manage that task independently. Promoting abilities—even though it may take much longer and requires more support—is better for clients, so we allow enough time to support independence and not just do tasks ourselves.
Part of dignified care is ensuring that we match each client’s individual pace. Being rushed through your daily routine, especially with something as intimate as personal care, can feel very dehumanizing. Our clients deserve the dignity of taking time and lingering over their personal routines and not being rushed by an artificial deadline imposed by a one-hour visit.
Companionship is an essential element of our service. Our clients and caregivers establish a special bond, and this bond is developed by sharing quality time together. If caregivers simply rush in the door hurrying to complete a specified task in less than an hour and rush back out the door, it is difficult for rapport to develop. Slowing down and getting to know each other as human beings first, before jumping into tasks or personal care, puts the focus where it should be—on the people first and not on the tasks alone.
When a caregiver is paired with your loved one, that caregiver is prepared to assist in numerous ways. Caregivers are able to help with numerous tasks in the time they are present—they might do some laundry, wash dishes, make dinner, help your loved one to shower and get dressed, and then run errands. The benefit of this model is that you don’t need a separate person for each task—you don’t need a driver who only does errands, and someone else who only assists with personal care, and someone else who only does laundry, etc. It’s a more comprehensive approach where all the different elements of daily life can be seamlessly woven together—the same as you weave numerous elements throughout your day. Because we’re aiming to assist with so many different elements of daily living it takes more than an hour or two to effectively assist with each.
Living and serving by our mission and our philosophy of care is what makes our service exceptional. Minimum service is the first step to abiding by our mission. Beyond the minimum, the sky is the limit! Clients don’t need to worry about exceeding the maximum or being capped at a certain level. Instead of feeling limited by caps, maximums or restraints, clients can know that we’ll be there to assist as needed.
You have a resident, Henry, who insists on “going home”. Henry is adamant that he is “getting out of here” and that you can’t stop him. As the afternoon progresses, he becomes increasingly agitated and more insistent. Henry’s agitation is contagious; other residents are upset that he is upset.
Of course, logic won’t be helpful at this point. Reminding Henry that this is his home and he has lived here for months now is not effective. In fact, the more you try to reason with him and explain that this is his home, the more upset he becomes and the more he wants to leave.
“Going home” is not about the location. It’s moreabout the feeling Henry is experiencing. Henry is trying to communicate how he feels. He wants to go home because home is a place that represents feeling safe and secure, feeling in charge, feeling productive and knowing what to do. He wants to “get out of here” because he isn’t feeling safe, in charge or productive. He’s not sure what to do, so he figures he should go home where everything will make more sense.
Answering Henry’s emotional plea with logical answers won’t work. Explaining how long he’s lived there or which city he’s in, or the fact that he chose this home when he toured with his son—none of these explanations will be helpful. Instead, he needs someone to address his emotional needs.
The challenging part is that it takes a lot of time, a lot of patience, and a lot of one-on-one focused attention to effectively help Henry. It may take more individual time than your staffing allows, and other residents may have more pressing needs. This is where Warm Embrace comes in. Our caregivers provide one-on-one support to help redirect Henry when he wants to go home.
Better yet, our caregivers proactively address Henry’s needs. Since we know that Henry is more likely to want to go home as the afternoon progresses, we schedule an afternoon visit that starts before he typically becomes agitated. We keep Henry engaged in activities and provide positive reinforcement that confirms for Henry that he’s in the right place and he belongs. When Henry is busy working on a puzzle with his caregiver, or he’s in the courtyard enjoying the sunshine, or he’s joining in the sing-a-long in a chapel, he is less likely to focus on going home.
One-on-one companionship meets Henry’s needs in a non-pharmacological way. We can help to reduce his agitation and no medication is required. Other residents are also relieved when Henry is content and not agitated. Your staff is then free to attend to the needs of all the other residents in their care, knowing that Henry is in good hands.
Which of your residents would benefit from the same support as Henry?
You’re always encouraged when your residents have visitors. It brightens their spirits and gives them something to look forward to.
You have a fairly new resident who moved in last month and her daughter has been visiting daily. Initially, you thought it was to help ease the transition, but after a month, the daily routine is still in place. You’ve noticed that the daughter is looking increasingly strained herself. While the mother certainly seems to appreciate the daily visits, it seems to be taking a toll on the daughter.
This daughter needs a Warm Embrace caregiver! She needs a reliable visitor who will befriend her mother and visit consistently on set days of the week. We certainly can’t replace family, but we can supplement family visits. Maintaining a daily visiting routine is not sustainable for most families, and this daughter could be relieved to know that a reliable caregiver will cover set days of the week.
We can protect the daughter from burnout by alleviating her before she hits a breaking point with an unsustainable routine. If she reaches the point of burnout, there’s a risk she will no longer be able to visit at all. If she stretches herself too thin, she may become susceptible to illness herself, catching every cold or flu that circulates. If she becomes contagiously ill, she won’t be able to visit and then her mother will be left with no visitor at all.
Our wonderful caregivers create balance. We can supplement family visits by coordinating to match each family’s routine and schedule. Perhaps the daughter would like to maintain visits three days a week; we can provide a caregiver to visit on the other four days of the week. When the daughter would like to go on holidays, we can provide additional visits to cover the days when she would usually have visited.
By recommending a Warm Embrace caregiver for this new resident, you are supporting this family when they need it most. Which residents—or family members—do you see who are most in need right now?
10 Life Choices You Can Make to Protect Your Heart
Wednesday, February 13, 2019
February is all about hearts. . . but not just the cupid and chocolate kind of hearts. It’s also heart awareness month as the Heart and Stroke Foundation promote heart health and disease prevention.
Did you know that every seven minutes someone in Canada dies from heart disease or stroke? And 32% of all deaths are attributed to heart disease or stroke? With heart disease this rampant, it is bound to affect you personally through someone that you know.
Here are the Top 10 healthy living choices you can make to help prevent heart disease:
1. If you smoke, become smoke-free.
2. Be aware of your cholesterol, blood pressure and blood sugar levels and keep them in the healthy range.
3. Engage in regular physical activity for a minimum of 150 minutes weekly– choose activities you find fun so you’ll stick with them. Bouts of 10 minutes of exercise at a time count toward your 150 weekly minutes.
How Essential is Exercise?
Research conducted by Dr. Poulin with women over 65 demonstrated that active women have 10% lower blood pressure and 10% higher brain function on cognitive tests. The active women were engaged in aerobic activity, such as walking, for at least 150 minutes per week.
4. Achieve and maintain a healthy weight. Weight loss of 5-10% of your current weight can have significant health benefits.
5. Consume at least five servings of vegetables and fruits per day by including vegetables with every meal and fruit for dessert. Boomers are notorious for failing to eat enough fruit and veggies; 80% of all boomers do not eat the recommended five veggies daily.
6. Develop and maintain personal relationships to help reduce any stress that can lead to unhealthy habits such as overeating and lack of physical activity.
7. Choose lean meat, fish, poultry and meat alternatives such as beans along with low-fat milk.
8. Include a small amount of soft non-hydrogenated margarine, vegetable oils and nuts each day.
9. Make at least half of your grain products whole grain each day.
10. Choose foods that are lower in sodium and limit the amount of salt you add in cooking or at the table. Begin using fresh herbs or spices to flavour your food, rather than depending on salt.
Starting and sticking to new habits can be difficult - especially when done alone. However, you don't have to do it alone! We are fabulous caregivers who will encourage and guide you - or your elderly loved one – in staying on track. Your heart health is important, it’s never too late to introduce new living choices, start today!
You’re worried about your parents and you think they could use more help. You suggested homecare, but they wouldn’t hear of it. They told you: “we’ve managed just fine on our own this long, we don’t need any help.”
What they’re really saying is that they don’t want to face change.
That’s because change is scary.
Change is scary for all of us, at some level. Each person has a different tolerance for change, and it might take a lot more change to scare some people than others. But if you introduce a drastic enough change, eventually, any of us would feel trepidation about that change.
It’s little wonder then, that for seniors in their 80’s or 90’s, the thought of even a small change can be quite scary. After eight or nine decades, they are likely pretty set in their ways. They want things done a certain way; they want to keep their environment the same. As long as everything remains the same, it feels more manageable. It might help your parents to understand that homecare is all about reducing the amount of change that your parents will experience.
Warm Embrace Caregivers are trained to match each client’s specific preferences.
Caregivers DO NOT barge into a client’s home and just take over. Caregivers DO wait to be invited in, and they ASK permission to proceed. They ask how that particular client prefers the laundry or housekeeping to be done. They cook from the client’s recipes or directions to match their particular tastes. They help to keep clients’ lives consistent.
Homecare is one of the best prevention strategies to one of the biggest possible life changes: admission to a long term care home. Moving to long term care is a HUGE change—absolutely every single element of someone’s routine is changed. From the time they get out of bed, to when they eat, and whether they wear pyjamas to breakfast—everything is adjusted to match the schedule of the long term care home.
Homecare ensures that individual clients maintain their own personal routine, they maintain their home, they maintain familiar comforts. Caregivers match clients, rather than clients matching caregivers. It reduces the amount of change they must experience.
Since homecare is completely client-focused, each client calls the shots. The client decides what they’re doing each day and how they want things done and in which order. It is very empowering for seniors to get to make all the decisions that impact their own day-to-day living. Homecare grants this level of autonomy and independence.
Help your parents to see that homecare will ensure the least amount of change and help them to maintain the lifestyle that they know and love.
In 2014, a number of organizations across Canada came together to promote a campaign called Fall Prevention Month. During the month of November, this campaign encourages organizations and individuals to come together to coordinate fall prevention efforts for a larger impact. The goal is to collectively raise awareness about fall prevention strategies and to help everyone see their role in keeping older adults safe, active, independent and healthy.
What are the impacts of falls?
Unintentional falls are the leading cause of injury for Ontarians aged 65 and over.
Recovering from a fall can be very difficult and with an increasing number of falls, it is important we take measures to prevent them.
How can we prevent falls?
The good news is that falls are preventable injuries! There are five key factors that caregivers and seniors should consider in order to prevent falls.
1) Eyesight – vision is an important part of balance and good vision helps to prevent falls. Everyone who is over the age of 65 should have their vision checked every year.
2) Your home – if you have clutter on your floors or stairs, it increases the chance of tripping and/or slipping. Make sure cords, scattered rugs, pet toys, books, etc. are in their proper place. Also, if your home is dark it increases the chance of falling, especially on stairs. Make sure to create a space that is well-lit!
3) Exercise – the most important thing you can do to prevent falls is to stay and remain strong! Walking, fishing, gardening, tai chi. Light yoga – whatever you enjoy! – do it to increase activity levels.
4) Medication – some medications cause dizziness on their own, or when mixed with others. It’s important to properly manage your health! Always take medication as directed and ask your pharmacist to review them if you are taking more than 2 medications.
5) Eating a healthy diet – Vitamin D and calcium help to keep strong bones. A diet to include more greens, lean protein, and less sugar will help you in remaining strong. You may want to talk to your doctor about supplements or other alternatives.
Most of all, don’t do it alone! It takes a community to prevent a fall and we all have a role to play. Here at Warm Embrace, we have a wonderful team of caregivers who can help you and your loved one to remain safe at home.