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How does Dementia affect Personal Space?

 

Have you ever been in line at the checkout and the guy behind you is getting too close….awkwardly close? How do you react? What is your body language like? What is your facial expression?

 

I’ll bet your expression is a cross between curiosity and suspicion.  Your eyes are watching carefully; you’re on high alert.  Your body language is likely standoffish and you’re tense; you’re ready to react or even defend yourself if necessary.

 

 

Is that normal?  Perhaps it’s a bit stronger than necessary for a checkout lineup, but your natural instinct is to protect yourself.  You interpreted the intrusion of your personal space a possible threat, and you’re on high alert until the threat subsides.

 

This human instinct to protect yourself and your personal space is a normal human reaction, and it doesn’t disappear just because someone has dementia.

 

In fact, this instinct to protect oneself may become even stronger in the face of dementia.

 

This self-protection instinct comes from the Amygdala, a small area deep within your brain.  The Amygdala continues to send out survival instincts even when other portions of the brain are affected by dementia.

 

The part of the brain that houses reason and logic—the prefrontal cortex—is often first affected by dementia.  It is this part of the brain that allows you to think through a situation and respond appropriately.

 

When the guy at the grocery store gets too close, your Amygdala sends out a threat alert, but your Prefrontal Cortex uses logic to asses and notices that the store is crowded.  You then realize that the guy moved into your personal space because he was bumped from behind.  There is no threat after all, and your prefrontal cortex sends a message to the Amygdala that all is safe and secure.

 

For someone who’s prefrontal cortex is affected by dementia, their ability to assess the situation for danger diminishes.  Their Amygdala is still sending out the danger warning, but they do not have the ability to use logic or reason to understand the situation and reduce their sense of risk.

 

Think back to your initial reaction to the guy in the checkout line—your facial reaction and body language were not friendly or welcoming, were they?  That’s because you were feeling at risk for just a second.  Now think about someone with dementia who may have a concerned or suspicious expression on their face or their body language is reactive.  Perhaps they are feeling threatened and they are on high-alert.

 

That person with dementia may not be able to use logic or reason to reassure themselves that there is no threat.  If someone is in their personal space, and they feel threatened, they will react exactly like you did—defensively.  They will not be able to contextualize and say “oh, that person is wearing scrubs. It must be a doctor or a nurse who is in my personal space to treat me medically.” 

 

They may not recognize a family member, friend, care provider, or fellow resident. If they don’t recognize the person who is entering their personal space, then that person may feel as strange as the guy in the checkout line.  If so, the reaction—even to a family member or friend—will be the same defensive reaction as a stranger intruding on space.

 

What can you do?

 

 

When you’re interacting with someone who has dementia, be on the lookout for defensive body language.  If you notice a defensive stance or a suspicious facial expression, recognize that the person with dementia may be feeling threatened or at risk and help them to feel reassured.  Be kind, and help them to contextualize. Fill in the missing details that their brain may not be able to supply.  Help them to recognize relationships or connections and do not enter their personal space until you are sure they welcome you.

 

A beloved family member with dementia may not recognize your face, but they will recognize how you make them feel. Focus on helping them to feel safe and reassured, and the defensive behaviour will melt away.

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Hallucinations and Vision Loss

 

Your grandmother has had macular degeneration for years and her vision is now quite limited. Lately, she’s mentioned seeing little people in the living room, especially in the evening. Does that mean that she now has dementia? Is she experiencing a mental illness or disconnect from reality?

 

Quite likely she is not! Hallucinations with severe vision loss are more common than you might expect, and there is a name for it: Charles Bonnet Syndrome. The condition is named after Charles Bonnet, a Swiss philosopher and writer who first described the condition in 1760 after witnessing his grandfather experience vision-loss hallucinations.

 

 

Charles Bonnet Syndrome (CBS) is a condition of temporary hallucinations in people with severe vision loss. The vision loss is usually due to one of the following three conditions:

 

  • Macular degeneration
  • Glaucoma
  • Diabetic retinopathy

The visual hallucinations are typically quite simple—-seeing people, animals, houses, or other everyday objects. In some cases, more complex visions are animated or dreamlike and continue for a longer duration. These visual hallucinations are almost like a mirage, and often contain greater detail than what someone can detect in their actual surroundings.

 

CBS is sometimes referred to as “phantom vision syndrome” because it is similar to “phantom leg” syndrome. After an amputation, someone may continue to “feel” sensation in a limb that is no longer present. The feeling is created and experienced in the brain; there are no stimuli to create the sensation. Likewise, with CBS, the retinal cells in the eye are no longer receiving the visual images (due to damage from macular degeneration, glaucoma, or diabetic retinopathy). The brain begins creating its own “phantom” images using images stored in memory to create new “vision”.

 

The eye is only creating general images and cannot provide detail due to damage from the illness, yet the brain is still seeking those details. The brain will compensate for the weakness of the optic nerves and retina. Sometimes, the brain will do this by completing an image (i.e.: adding details that are not present); at other times, the brain may create whole images that are not present.

 

The hallucinations with Charles Bonnet Syndrome are visual illusions and are distinct from delusions. Visual illusions are a misinterpretation of external visual stimuli (interpreting the sweater on the couch for a cat, and adding the details of whiskers and eyes). Visual illusions affect only vision, none of the other senses. A delusion is believing something that is not true but believing it wholeheartedly (believing oneself to be the messiah). A delusion may include any of the senses and often a delusion is supported by more than one sense (hearing voices and seeing things for which there are no external stimuli).

 

Someone who is experiencing a visual illusion will accept that they have misinterpreted an image; someone who is delusional will not. Those with CBS are often quite aware that their perceived illusions are not real—they are able to rationalize that there cannot be miniature people standing in their living room. Some visions are surreal—small people, dragons, exotic animals—and other visions are realistic, such as seeing cows in a field.

 

CBS is most likely to affect someone soon after vision loss. The brain is still trying to interpret visual stimuli, even though the optic nerve and retina are no longer producing the images. Often, the brain will adapt to the loss of the incoming stimuli and the hallucinations will dissipate after 12-18 months, though some people have experienced CBS for many years.

 

CBS often goes undetected and undiagnosed. There is limited awareness of CBS—not just in the general public, but also in medical communities as well. Patients are often hesitant to report the symptoms of CBS because they fear being labelled “crazy” or mentally unstable.

 

 

Most estimates suggest 10-30% of those with severe vision loss will experience CBS; the most recent study conducted by the CNIB (Canadian National Institute for the Blind) surveyed 2500 people with low vision and found 18.8% had experienced hallucinations.

 

Of those who experienced hallucinations:

  • Most common hallucinations were of people, animals, shapes or patterns
  • Most people hallucinated daily—but for just a few seconds or minutes at a time
  • 1/3 could get rid of hallucination by blinking
  • 1/2 hallucinated in dim light, darkness, or while falling asleep
  • 1/3 could not detect a pattern to their hallucinations
  • 2/3 did not find their hallucinations to be bothersome

 

For many people, just knowing about CBS is a huge relief—it reassures them that they are not disconnected from reality and that there is a real phenomenon to explain their experiences. Unfortunately, there is no cure or treatment for CBS, and there isn’t one simple test to diagnose CBS. It is important that the doctor is alerted to hallucinations because it can be a symptom of other conditions, all of which should be ruled out before settling on a diagnosis of CBS.

 

While there is no cure for CBS, there are coping strategies such as:

  • Closing your eyes or blinking rapidly
  • Shifting eyes left to right every second for half a minute
  • Adjusting lighting—some people need more light to reduce hallucinations; others find bright light causes hallucinations
  • Watching TV or moving locations
  • Explain to family and friends what you are experiencing
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Dementia and Communication: 4 Points of Awareness

 

When someone is in the early stages of dementia, they are aware that they’re having trouble communicating.  They know that they can’t find the words to use and they perceive others’ confusion. Their ability to talk remains strong, but their language is beginning to be affected.

 

It is important that we understand and know how to communicate with seniors experiencing dementia because they are still members of our society. If you are communicating with someone who is in the early stages of dementia, or someone who has mild Alzheimer’s, be sure you’re aware of these items:

 

1. Nouns

 

Nouns are the first words to escape with dementia.  Nouns are specific—people, places, things—and when you attempt to find a specific noun, it evaporates.  Someone with dementia may have trouble naming specific items, even everyday items.  Instead of naming exactly what or who they are talking about, they will talk around the item/person, describing it in detail until someone else can guess the correct word. 

 

 

Verbs, adjectives, and adverbs remain strong, and the description can become quite vivid.  The person with dementia is searching through their mental dictionary of words and cannot locate the exact word they are looking for, but they are in the right area—they’re in the right arena, the right section, the right row, but they’re not in the right seat.

 

The person with dementia is not playing guessing games with you! His/her vocabulary with descriptive words is so strong, you might assume that he/she must remember such basic nouns, but that is not the case.  Understand that naming items, people, and places will be the most challenging words to locate.

 

2. Clichés

 

Clichés and stereotypes become very useful to people with dementia.  They can rely on a safe conversation that is predictable by using memorized responses.  Social pleasantries are usually dependent on clichés, and continuing to use those clichés allows someone with dementia to maintain social appearances.  When we say that someone “presents well socially” that often translates to “they use socially acceptable clichés in polite conversation”.  As dementia progresses, people will increasingly rely on clichés when they’re in social settings.

 

3. Comprehension Challenges

 

Comprehension will become increasingly literal.  It will be difficult for someone with dementia to understand sarcasm and other forms of humour.  Analogies or metaphors are difficult to discern, and abstract expressions no longer make sense.  In the middle of a conversation, you express “don’t throw the baby out with the bathwater.”  Someone in the early stages of dementia may be confused and wondering how the conversation switched to bathing a baby.  Abstract expressions begin to lose their meanings and are interpreted literally.

 

4. Redundancy Helpful

 

It is helpful to build redundancy into your conversation as a means of continually reaffirming the context of the conversation.  Pronouns can be difficult to follow (he, she, they, etc.); naming the person about whom you are speaking ensures that the person with dementia can follow the conversation.  It can be helpful to build other redundancies into the conversation as well. 

 

 

A sentence such as: “Susan called last night, she’s coming to visit and bringing Evan,” could easily cause confusion for someone with dementia.  Re-wording that concept into a series of simple sentences, with built-in redundancies makes the meaning much clearer: “Susan, your sister called last night.  Susan is coming to visit.  Susan is bringing Evan, her grandson, with her.

 

As we practice these 4 points of awareness, we are including our seniors into meaningful discussions! Don’t forget that our seniors are active members of society.

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Isn’t it tough when clients pass away?

 

I get asked this question a lot.  And the answer is yes, without a doubt, yes.  It certainly is sad when a client passes away.  We have many long-standing clients whom we have served for years. We have seen them through major life transformations, journeyed with them as their health and abilities fluctuate, and have been at their side in their final moments. 

 

These are people for whom we have provided intimate personal care. These are people who entrusted us with even more than their physical needs; we are often their listening ear, the ones who reassure them when they voice fears or concerns, the ones who acknowledge and validate their current reality.

 

Our clients are more than clients.  They are an extended family with whom we share deeply meaningful moments. So the answer is absolutely yes—when a client passes away it certainly does impact us.

 

 

The next question that usually follows is: “how do you keep doing it? If losing clients is tough, how do you not get depressed by it all?”

 

That is a tougher question to answer, but finding the answer to this question makes all the difference in the world. It is always important to step back and consider the impact that we have made in the client’s life and the lives of their family.

 

Impact in the Client’s Life

 

We had a long-term client who passed away just last week.  Over ten months ago, she was deemed palliative and initially was told she may only have a few weeks left to live.  She proved everyone wrong!  Every day our fabulous caregivers arrived to spend quality time together, with hopes of drawing out her charming smile.  Many have suggested that she lived for our daily visits; it is possible that the companionship of our team contributed to her surviving months longer than doctors predicted.

 

We impact our client’s lives each and every day.  We arrive at each client visit with the viewpoint of: “how can I make today a better day for this client?”  We have countless heartwarming moments that will make you laugh or cry—or both!  We share these Heartfelt Moments so others can feel the joy and deep meaning that we experience.  We aim to make every day special for clients—whether it’s our first visit with them, or it’s within their final days. 

 

Impact in the Family’s Lives

 

Recently, we were asked to provide palliative care to a client who had stage four cancer that was rapidly progressing.  Although we did not have years of history with this client, we quickly grew to love her too.  It was her family’s wish that she remain in her apartment until the very end—they desperately did not want their mother to pass away in hospital.  Our attendant care granted this family their final wish for their mother. She passed away in her own bed, at peace, with someone holding her hand.

 

We cannot doubt that the family was impacted.  The family had peace of mind knowing that someone was with their mother around the clock at times that they could not be present. They knew she had the tender and loving care that she deserved. They were granted their wish to have their mother pass away in her own bed at home.

 

 

In moments when we are tempted to feel sad and depressed because clients have passed away, I stop to consider—what impact did we make?  If we were brought in specifically to provide palliative care to someone in need, and we successfully enabled them to remain at home and experience the passing they had envisioned, what more could I ask?  When I realize that without our care, the family’s wish and the client’s wishes might not have been granted, then I realize that it would be selfish of me NOT to provide the care and support that they request.

 

When I recognize that our clients received a higher quality of life for the final months or years of their life, I realize that it is all worth it.  I am a better person for each of the clients I have met. They each leave a lasting touch.  What a blessing that I get to meet so many incredible people who touch my life, and who have entrusted me with the great honour of impacting their lives too.

 

So is it tough to lose clients? Yes, it most certainly is.  Is it depressing though? I would say no, it is not depressing.  Instead, it is a blessing to have been invited into the client’s life at such an important time. I am honoured, I am blessed, and I am touched.

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4 Survival Tips for all Family Caregivers

 

When you think of family caregiving which words come to mind? 

 

 

Burden

Stressful

Sad

Depressing

Exhausting

Frustrating

Honour/devotion

Meaningful

Blessing

Joyful

Humour

Fulfilling

   

 

What creates the difference between the first column experience and the second column?  How can family caregiving be both frustrating but joyful, a burden and a blessing?

 

Here are 4 survival tips to take your family caregiving experience away from the first column and into the second column.

 

1. Take care of yourself

 

 

It may sound trite, but self-care is crucial.  If you don’t care for yourself, you’ll have nothing left over to give to anyone else.  You need to allow yourself time to refuel. How you re-energize will be unique to you; there is no right or wrong answer.  Maybe you exercise, or enjoy dinner out, or attend a rock concert, or read a book, or travel.  It doesn’t matter what you choose to do; it matters that you take time for yourself and prioritize your own self-care.

 

2. Allow yourself to be “off-duty”

 

It is not reasonable to expect yourself—or anyone else for that matter—to work or be on-call 24/7. And yet, when in the midst of family caregiving, people often hold themselves to an unrealistic standard of doing it all, all of the time. You need time when you are not “on-call”.

 

This includes elderly spouses who have assumed the caregiver role and who live together. It can be tough for the caregiving partner to feel “off-duty” when they are at home together with their partner who requires care. Respite care is critical to help both halves of a couple remain healthy—both physically and mentally. 

 

Feeling “off-duty” also applies to family members who are receiving constant phone calls from their elderly loved one.  They need time when they can turn off the ringer and not field any phone calls—a timeframe when they are “off-duty” from repeated calls.

 

3. Enlist support before a crisis emerges

 

 

All too often people will say: “Dad won’t accept help from anyone else, so I have no choice!”  Then a crisis occurs and it is Dad who has no choice—he must accept help from another source because you, the family caregiver, are now experiencing your own health issue related to burn out.  Sure enough, Dad does accept the help, although it might have been a smoother introduction to care had it not been a crisis situation.

 

It will be a kinder transition for your father to accept outside support in a graduated care plan, rather than abruptly. With advance notice and the luxury of time, caregivers can be selected to match your father’s personality and preferences. In a crisis situation, you might have no choice but to get a caregiver—any caregiver—in place the same day.  A more ideal match could have been made with advance planning.

 

Best of all, your burnout can be prevented in the first place! It is far easier to prevent burnout by providing support early on than it is to recover after burnout has occurred. 

 

4. Protect Family Roles and Relationships

 

Caregiving can upset the long-ingrained roles and family dynamics.  A husband who is suddenly thrust into the position of caring for his wife may feel ill-equipped for the role of the family caregiver. He doesn’t feel like a husband. . . he feels like a caregiver.  And she doesn’t feel like a wife. . . she feels like a patient. Their interaction as husband and wife has been interrupted and they begin to interact as patient and caregiver, which may start to stress their marriage.

 

 

It is important that key family roles and relationships are preserved. That couple needs to continue to feel like a married couple.  A parent and child need to preserve their mother-son relationship.  It may be best to let certain elements be provided by a professional caregiver so the family relationships can remain intact. 

 

Family caregivers are SO important to the health and well-being of their loved ones.  It is crucial that their health and sanity is protected.  If the family caregiver burns out, then there are two people requiring care! 

 

The only way to survive family caregiving and find the positive is to take care of yourself, have time that you are “off-duty”, get help in place before it’s too late, and aim to protect family roles and relationships for as long as possible.

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4 Reasons to Leave the Hospital Quickly

 

They’re discharging mom...TODAY?!

 

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!

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Your Role in Creating an Inclusive Community

 

Inclusion is a hot topic and a very important one for our elderly population. It emphasizes the importance of inviting the active participation of all citizens, including our elderly population, into our social fabric. 

 

The Canadian Network for the Prevention of Elder Abuse (CNPEA) has reported that:

  • Being socially isolated is a common affliction among older adults. More than 30% of Canadian seniors are at risk of becoming socially isolated.

  • Isolation and loneliness are as bad for your health as smoking 15 cigarettes a day.

  • And, social isolation can put seniors at increased risk for elder abuse.

Inviting the elderly population into social spaces is the first step, the second next step is creating an age-friendly community.

 

What exactly is an age-friendly community?

 

Being age-friendly means that there are no barriers to accessing services in the community, regardless of age or ability. A city that is designed to include and be accessible for its elderly residents is automatically factoring in the needs of its younger population.

 

 

For example, if a community is accessible for someone using a walker or wheelchair, it is also accessible to a parent pushing a stroller. The examples that we think of quickly are usually about physical accommodation such as ramps, wider doorways, longer crosswalk signals, etc. These accessibility features are certainly important, but a truly age-friendly community is about far more than just physical accessibility.

 

Dr. John Lewis, professor at the University of Waterloo, points out that currently, one-quarter of Waterloo Region’s population is age 55 plus. That number is only going to increase in the next few decades. It is not acceptable that there are ageist prejudices towards 1/4 of our population! If we want to have a community that is inclusive to all members, it needs to be designed to suit those who are age 55 and older.

 

Age-friendly communities are about inclusion and a sense of belonging. It is about receiving the respect and dignity that all citizens deserve, regardless of ability or age.

 

Often, these issues relate directly to coping with ageism. Ageism is the stereotyping of and prejudices against someone because of their age. It might include automatically treating someone in a certain way, just because they appear to be a senior.

 

For example, assuming someone is hard of hearing because they have gray hair is an ageist stereotype. Another example is the way that professionals often speak about a senior to their family members, as though the senior is not even in the room! The conversation should be directed to the relevant person, regardless of age.

 

In addition to physical challenges, some people experience cognitive changes. These people deserve the same level of respect and inclusion as all other members of society. Brenda Hounam, dementia advocate and spokesperson, highly advises communicating about dementia itself. Rather than hiding her challenges with dementia, she has decided to be very public and make others aware of her disease.

 

 

Hounam suggests that people “open the doors for communication—just ask”. She feels that it is much better to ask for clarification and to communicate clearly with someone who has dementia; do not just make assumptions. She asks that people do more than just listen; she wants people to truly hear and validate what she is saying. Hounam’s overarching message is that “we are all unique, and we all have something to contribute until the last breath.”

 

Being inclusive and respectful of all citizens—regardless of age, ability, or illness—better allows us to fully acknowledge and appreciate the contributions of all members of society.

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Warning Signs to watch when driving with Dementia

 

Warm sunny weather brings more summer driving!

 

Driving is a very personal issue that involves strong emotions. For many seniors, driving is a privilege they’ve had for decades, and their personal sense of identity and independence is often linked to their ability to drive. When driving seems so second nature, it can be difficult for people to remember that driving is truly a privilege, not a right.

So, when is it time to give up the privilege of driving?

 

Oftentimes, the person who is suffering from dementia is the least aware that anything is wrong. They may not notice that their reaction time has changed, or that their judgment is off. The family are often the first ones to be concerned about driving, and rightfully so, as research shows that someone with dementia is eight times more likely to be in an accident than the average population.

 

Some warning signs to watch for if you have an elderly who is driving with dementia:

  • Damage to the car
  • Traffic tickets
  • Difficulty navigating familiar routes
  • Simple errands taking hours longer than necessary with no explanation
  • Mixing up the gas and brake pedals
  • Missing stop signs or traffic lights
  • Problems with lane changes and merging
  • Passenger input is required
  • Family refuse to get into the car

Consider the “grandchild question”: do you feel comfortable allowing the grandchildren to ride with their grandparent behind the wheel? If your answer is no, there are likely significant concerns about your loved ones’ driving ability.

 

If you are concerned about your loved ones’ driving, you need to speak to their doctor. It is ideal to attend a doctor’s visit with your loved one; you may also write letters to inform the doctor of the changes your loved one is experiencing.

 

The family doctor is required to notify the Ministry of Transportation, and it is the MTO who will revoke the licence (not the family doctor). After being notified by the family doctor, the MTO will send a letter directly to your loved one (not to the family doctor). The letter will state whether they may continue to drive, they need an assessment, more medical evidence is required, or the licence is revoked.

 

What happens when their licence is revoked?

 

If the licence is revoked, it is HIGHLY advised that your loved one’s car be removed from the property. Someone with dementia may no longer remember that they are not allowed to drive. Disabling the vehicle is an option, though it is remarkable how handy and mechanically-minded many seniors from that generation can be, so the simple options of unplugging the spark plugs or draining the battery may be insufficient. The most ideal solution is to have the vehicle removed from the property altogether to ensure that your loved one is safe, and to ensure that others are safe as well.

 

It is important to understand how devastating the loss of a licence can be for many seniors. It can result in loss of independence, reduced social interaction, loneliness, lowered self-esteem, depression, and increased stress on family and friends. For all of these reasons, family doctors do not just send letters to the MTO easily; they must have concrete evidence of imminent safety concerns. To minimize the negative impact of losing a licence, family and friends can assist by providing alternate means of transportation and socialization.

There are volunteer driving services that can be accessed through your local community centres or the Alzheimer’s Society. Taxi companies are often able to offer discounts to “frequent riders”. If your loved one drives less than 4000—5000km per year, then it is cheaper to take a taxi everywhere than it is to maintain the car. From a purely economic standpoint, driving may simply be too expensive compared to alternate options! Appealing to your loved one’s financial sense may be more effective than having them agree that their driving is no longer safe.

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Standing up to Ageism

 

Just the other day, one of our caregivers had a question for us.  She wanted to know what she should do when she is out in public with a client, and the clerk or receptionist directs all their questions to the caregiver and not to the client.  She was particularly disturbed; the client she was serving that day needed physical assistance but is completely capable of making her own decisions.  The receptionist was asking questions about the gentleman’s health—no one would know the answers to those questions better than the man himself!

 

 

It is unfortunate that this question even needed to be raised.  Since when is it acceptable to speak about a person right in front of their face, without addressing them directly?  Doesn’t this break all social norms?  

 

What this client experienced and this caregiver witnessed is a case of ageism.  Sadly, it is all too common.  Ageism is assuming someone’s capabilities, preferences, tastes, etc. based solely on their perceived age.  It is a form of discrimination or stereotyping. 

 

 

It can happen to young people who might be told that only two young people are allowed to shop in the store at a time; more often though, ageism is experienced by those who are perceived to be elderly or infirm. Just because someone is using a walker doesn’t mean he can’t answer personal care questions; just because someone is in a wheelchair doesn’t mean she can’t make her own decisions.

 

How do we combat prevalent ageism? 

 

We start by ensuring that we always address the adult to whom we are speaking—not their son or daughter, their caregiver, their spouse.  We address the person directly, and speak to them in the same manner with which we’d speak to any other adult (ie: not using ‘elder speak’ which is akin to baby talk). 

 

 

What do we do in a case such as our caregiver presented? We, ourselves, might be respectful and addressing elders directly, but someone else in the general public isn’t offering the same respect.  How do we graciously handle that situation? 

 

My recommendation is to set a good example by redirecting the conversation to the appropriate person.  When asked a question that should have been directed to my client, I will respond with: “oh, I believe that question is for Mrs. Weber. Let’s ask her.”  It may seem small and simple, but at this moment, we can afford dignity to the elder who deserves it and hopefully set a positive example to someone who is inadvertently being ageist.

 

 

Next time you are out in public, and you notice someone speaking past a senior or ignoring a senior, please speak up and encourage the respect and dignity that the senior deserves. 
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It Takes a Team to Provide Dignified Care

 

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!

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