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.
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
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.
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.
You care deeply about each of your residents but sometimes it can be difficult to meet their varying needs simultaneously. It can be especially tough when a resident with dementia progresses, and other residents are perturbed by the new symptoms. Sometimes other residents inadvertently exclude or even ostracize residents with dementia, which only increase agitation and confusion.
Our caregivers can help remedy this situation!
One of our favourite client success stories was with Lydia, who lived in a Waterloo retirement home. Lydia was quite spry physically and she was keen to “assist” other residents. However, her advancing dementia impaired her judgement and her ability to assess the situation. In some cases, Lydia was moving walkers out of reach or rearranging chairs as others were about to sit down, placing others at serious risk of falling.
This presented a challenge for retirement home staff. Of course, the safety of all residents needs to be a top priority, and managing Lydia’s need to be active and assist is also important. The BSO team was brought in to help problem-solve the situation and they determined that the best non-pharmacological option would be attendant care. Since Warm Embrace offers extensive dementia training to our caregivers, our team is particularly well-suited to support residents whose dementia is advancing.
Warm Embrace caregivers were paired with Lydia and found her to be delightful! When redirected to positive and constructive activities, Lydia stopped interfering with other residents. Her need to feel helpful, involved and productive could be met in ways that protected the safety of other residents.
Within a week, the other upset residents had stopped complaining about interferences and they became contented residents again. The staff could return to their regular responsibilities since they no longer had to be completely preoccupied with just one resident. Lydia herself was so much more content and happy; all traces of agitation evaporated.
Attendant care made all the difference in this situation. Retirement home staff were pulled in many directions attempting to meet everyone’s needs at once. By providing one-on-one support to Lydia, everyone’s needs could be met simultaneously, which also relieved the strain and stress on staff.
Which resident in your home could use the same support?
Do you ever find the holidays overwhelming? There are lights and music, decorations and crowds, shopping and cooking, parties and dinners, rich food and alcohol, late nights and busy days— sometimes it feels like you need a holiday to recover from the Christmas season!
If we feel overwhelmed during this season—and we are cognitively well, our brain is fully working—then imagine how overwhelming the holidays may be for someone who has dementia. Someone with dementia may not remember what “Christmas” or “the holidays” mean because they become abstract terms.
Here are some holiday tips to help a loved one with dementia through the holidays!
Beware of Decorations
You see an impressively life-like St. Nicholas welcoming people to your front hallway, but what does your loved one with dementia see? Is she concerned about “the man in the hallway who isn’t having dinner?” Life-like or oversized decorations can be confusing or even scary to someone with dementia. Consider from their perspective how the decorations could be misinterpreted.
Flashing lights draw a mixed response. Some people with dementia are mesmerized by flashing lights; others become alarmed or agitated. Keep consistent bright lighting in all rooms. Dark rooms with candlelight or just the tree lights may be fearful for someone with dementia.
Remove all ornaments that are not edible but look like real food. Fake gingerbread men or houses, fake candy canes or apple ornaments should all be avoided. Someone with dementia may not realize that it is just an ornament and may attempt to eat the decoration.
Have a Quiet Room
You want to include your loved one who has dementia, but you also need to provide a space where they can retreat and have some peace and quiet. People with dementia typically interact best in small groups or one-on-one. If a loved one with dementia is attending a large family gathering, set up a separate room—well lit with comfortable furniture—and recommend that family take turns visiting that person, one at a time. This allows for quality interaction in a way that best matches your loved one’s needs.
Routine is often the first casualty of the holiday season. We stay up late at night, we don’t eat meals at the usual time and we often stray from our usual, healthy diet. Remember how you felt last January after eating heavily and having your routine interrupted? Now imagine someone with dementia. The person with dementia cannot rationalize why they feel different, all they know is that something doesn’t feel right.
As much as possible, keep routine familiar and consistent. Try to maintain regular meal times (even if that means eating separately from the party), and try to limit intake of rich, sugary foods or excessive alcohol. Respect nap times and bedtimes—sleep is as important as ever! By maintaining routine as much as possible, your loved one may be able to better handle the surprises that come with the season
If family members live at a distance, they may be visiting for the first time since the last holiday season. Your loved one may have changed significantly since last holiday season. Advise family and friends in advance so that they know what to expect. Request their assistance in making the holidays easier for your loved one, and outline exactly what you need them to do. Here are some suggestions:
Please do not ask “do you know who I am?” this causes undue stress. While she may not be able to name you, grandma knows you are an important person whom she loves.
Please be aware of the fact that mom now needs to take some time away from the crowd. She finds noise and groups over-whelming. We will have a Quiet Room set up and we invite you to visit mom one at a time in the quiet room.
Please do not encourage alcohol consumption by saying “it’s only one drink!". Dad is now on a medication that does not react well to alcohol and he will not enjoy the event as much when he is trying to process the alcohol.
Set Realistic Expectations
Set realistic expectations for your loved one by limiting the number of events they attend. No more than one event or activity in a given day; only a few in a week with recovery time between events. Step back and try to asses what is realistic for your loved one. Maybe a dinner with 50 people will not be a successful event, but attending a hymn sing would better match your loved one’s preferences and current abilities.
Your loved one will not be able to suddenly do more or handle more because it is the holiday season. If anything, their coping abilities may be taxed and they may become agitated or stressed more easily than usual. Be realistic when scheduling the season.
Select the Top Priority
What is more important—that your loved one attend every event and every tradition is followed in detail, or that your loved one has a merry Christmas feeling loved and happy?
If the top priority is your loved one having a wonderful Christmas season, then focus on the elements that create that sense of joy, peace, and love for them. If you really analyze it, you’ll realize it has nothing to do with decorations or traditions. It has everything to do with family and interaction.
If you are stressed because of holiday prep, your loved one will feel that stress and not enjoy the season. A person with dementia would rather have you slow down, match their pace, and be patient than present a tray with 15 varieties of home-baked cookies that stressed you out!
Your loved one with dementia might enjoy singing a few familiar Christmas carols (because the words of those favourite tunes tend to stick), rather than feel the pressure of keeping up with an animated conversation at a cocktail event.
What will make your loved one smile? When will they seem most at peace? What will have them feeling safe, secure, and loved? Aim to focus on those elements and your loved one will have a truly blessed Christmas.
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
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.
Why are there Private Caregivers in Nursing Homes?
Friday, August 10, 2018
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.
I remember working in a facility and wishing I had more time even just to talk with residents who had stories to share. We just couldn't spread ourselves any thinner. Your service would fill some of that gap.
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!
thank you for the email.. it has been quite some time since I received your emails. I found this exercise information interesting. I just started the wellness program for diabetics at the Y and am slowly getting more active again.