What is the difference between curing and healing? When we seek medical attention, are we hoping to be cured or hoping to be healed?
Dr. Mark Greenberg grapples with the issue of being cured versus being healed on a daily basis. Dr. Greenberg is a pediatric oncologist at The Hospital for Sick Children and has received the Order of Canada (2011) for his work.
In his TEDx address, Dr. Greenberg outlined the difference between being cured and being healed. When we seek medical intervention, we are looking to be cured of whatever ailment sent us to the doctor in the first place. We believe that we (or at least the doctors) have some semblance of control over the health care being provided. If we follow doctors’ orders, we expect to be cured.
Healing, however, is an entirely different issue. When someone suffers from a life-threatening illness, being physically cured is only the beginning. Life-threatening illness requires healing. Healing is more than just a physical process; it is also a psychological, social, and societal issue. It includes the patient directly, as well as the patient’s family, social network, and support system. Healing involves adapting to the new physical state of the patient and may include coping with emotional scarring.
Dr. Greenberg explains that coping with a life-threatening illness is the ultimate loss of control. It defies our Western mythology that if we work hard enough and are good people, then all will be fine. Grappling with this loss of control in the face of life-threatening illness plays out in family interactions and in dealing with doctors. Far too often, patients are physically cured, but they never fully heal. Dr. Greenberg asserts that compassion for the individual, rather than a focus on control of outcomes, leads to more comprehensive healing.
Healing is a psychological, social, and societal issue with implications beyond the individual, reaching to the health care system as a whole. Therefore, your family physician alone cannot help your loved one through the healing process; what your loved one needs is a team of people.
Adapting to a new physical state can be difficult that is why your loved one needs a team comprising of you, their doctor(s), nurses and caregivers. Wherever your loved one might be living, the help of a professional caregiver can provide them with social and physical support.
You don't have to go through the curing or healing process alone.
How does Daylight Savings impact those with Dementia?
Monday, October 7, 2019
It’s almost that time of year again—time to change the clocks!
Did you think the same thing I did: “Thank goodness I get an extra hour of sleep”? The autumn time change feels easier on the system since we gain extra sleep…but then the darker evenings are a tougher adjustment. The darkness creeping in earlier day by day, and then leaping earlier by an hour can be a tough adjustment.
If adjusting to the time change can take a toll on those of us who can cognitively process it, how much harder is it for someone with dementia?
Someone with advanced dementia may not be able to tell time anymore. Some days, it may seem as if they don’t have much routine if they are waking at odd hours and sleeping during the day. But even if their routine has shifted from what it was years ago, they still have an internal sense of the passing of time. Suddenly adding an hour throws off that internal sense, and it can feel disorienting and confusing.
The toughest part of the autumn time change is the earlier time for sunset. Dusk can be a challenging time of day for those with dementia, and dusk happening earlier in the day can exacerbate those challenges. For those who experience elements of “sundowning”—where dementia symptoms worsen and agitation increases at sunset—the autumn time change can be a tough transition.
What can you do to ease the transition?
To ease the transition of the time change, turn on all the lights in the late afternoon. Instead of waiting until it is dark and you need the lights to see, turn on all the lights before you truly need them on. Keep the environment well-lit, bright and welcoming. For the person with dementia, it is helpful to be in a well-lit environment that is not confusing with the long shadows that accompany dusk. In many cases, it is also helpful to close all the curtains before sunset, before the streetlights turn on.
In preparation for the autumn time change, you can start turning the lights on earlier in the days and even weeks leading up to the time change. If you start the routine of turning all the lights on by 4 pm, then that routine can remain constant, even when the time changes and dusk are imminent at 4 pm.
When caring for someone with moderate or advanced dementia, just knowing what to expect can make a difference. Recognize that the time change is just like dealing with jet-lag and it will be an adjustment for your loved one. Expect that they may exhibit some unusual behaviour or feel agitated and anxious the week following the time change.
Prepare as much as possible by gradually backing up the time when you turn on all the lights and close the curtains. Once the time change occurs, ensure that you do keep the environment brightly-lit before dusk even arrives.
In a few months, your parents will be celebrating their 62nd wedding anniversary. After more than six decades together, they’re practically inseparable. Their staunch European background has rendered them rather emotionally reserved, but of course, they love each other in their own quiet way.
Your mother was the queen of the domestic domain, cooking and cleaning and raising children and managing the household. Your father worked hard to provide for the family and took care of the yard and cars and the handyman jobs. His way of demonstrating love to his family was to work hard and provide well. These roles worked well for your parents for decades of marriage and through countless life challenges.
But now your mother has Parkinson’s Disease. It has been progressing over the past few years and what started as a minor tremor in her left arm, has now become debilitating. She struggles with tasks that require dexterity because her tremor is so pronounced. Her walking gait is halting and unsteady and she has fallen numerous times. She has trouble keeping track of the medications she is supposed to be taking every four hours to help manage her symptoms. Basic daily tasks such as getting dressed are now proving to be a challenge. More complex tasks such as cooking or baking are pretty much out of the question.
Your father dearly loves your mother, but he is entirely ill-equipped to provide the help that she needs. He proudly declares that he can’t even boil water; he has never cooked a day in his life. He has been depending on ordering in takeout food, but your parents are already tired of fast food. When it comes to helping your mother get dressed, he is flummoxed by her undergarments and embarrassed about helping her to dress. His no-nonsense, high-efficiency mentality made him an excellent businessman, but those same traits are not helpful when trying to assist his wife to get dressed. It’s not a stellar start to their day when getting dressed becomes a major mission and sets the tone for the day.
Although your parents insist that they’ve gotten this far by weathering life’s storms together, it’s time for some expert assistance. While your father has many great talents and skills, providing personal care and household assistance are not his specialties. Your mother deserves the care and attention that a trained caregiver can provide.
Someone who can not only support her physical needs but someone who can also set her up for success each day. Someone who can make the morning routine feel like daily pampering instead of a chore. Someone who can linger overdoing her hair and her makeup and helping her to select her outfit and jewelry for the day so she can maintain the poised appearance that she always prided herself in.
Your father wants this outcome for your mother—he wants her to feel well each day, to look her best and take pride in her appearance and start each day strong. He may just need help in recognizing that he isn’t the best one to provide this support. His heart is in the right place, but he has limited life experience in this department and for your mother’s sake, it is worth it to enlist a professional who can make an enormous difference.
It is okay to acknowledge that everyone has different skills and strengths and life experiences. Your father has many valuable skills that made him an excellent businessman. He continues to use those skills to manage household finances and continually monitor their stock portfolio. But he is ill-equipped to manage the nuances that come with personal care and supporting his wife through her Parkinson’s journey.
Enlisting additional support does not mean that he does not love his wife sufficiently to help her; it means he loves her enough to ensure that she has the professional and experienced care that she deserves.
Let your father play to his strengths and let us demonstrate our caregiving strengths to support your mother in her journey.
If a picture is worth a thousand words, then what does the photo selection on our walls say about us? When you look around your home, what photos do you have prominently displayed?
Photos are one of the ways to personalize your living space, be reminded of your closest friends and family, or commemorate a favourite event. What if the photos on your wall no longer triggered happy memories? What if you didn’t recognize the people or places in the photos on your walls? How would you feel?
If you didn’t recognize any of the photos, you might feel like you’re out of place, that it can’t possibly be your home. You might feel disconnected, or perhaps even a little lost. You might wish to go home, to a place that’s familiar and recognizable.
That is exactly how someone with advanced dementia can feel. For some people with dementia, they will have a tough time recognizing photos of family members or even photos of themselves. In the early stages of dementia, it can be helpful to have recent photos of grandchildren available so they are more recognizable when they visit, especially because they grow up and change so quickly. But as someone’s dementia advances, keeping up with updated photos can be challenging.
For someone with advanced dementia, it can be quite abstract to look at a photo of a baby or a child and connect to that person as being your great-grandchild. Having recent photos of the latest great-grandchildren may not provide an anchor-point for identity. It may just be a nice photo of a cute baby, but no greater connection than that. In fact, I’ve had clients with advanced dementia tell me that the cute baby photo—which is indeed their newest great-grandchild—is just the sample photo that came with the picture frame and since they liked the photo, they never changed it out!
Photos of unrecognizable family members may be pretty photos, but if someone with advanced dementia does not realize it’s a family member, then the photo does not have much significance. It does not signal “you are home” or “you belong here”. It does not spark memories of happy times, it doesn’t connect to a sense of identity.
Instead, it can be helpful to understand what and who your loved one is thinking about most these days. Oftentimes, people with advanced dementia are thinking and talking about times that they can more clearly remember and understand. Since long-term memory is stronger, people often revert back to childhood or young adulthood memories. If that is the timeframe that is clearest, then provide photos to match the era that your loved one can remember.
If your loved one is talking about their parents, see if you can unearth an old photograph of their parents from decades ago—a photo of what their parents would have looked like when they were a child or teen. If your loved one is talking about their siblings, find old photos of the siblings together as children. You may have a recent photo from the latest family reunion, but if your father is remembering his brother as an 8-year-old child, he may not be connecting with the photo of the 87-year-old man who is his brother today.
Many elderly women have strong memories of having children. Their strongest memories are of their children as babies, toddlers or young children. Finding the old baby photos that might have adorned the walls over 60 years ago can be helpful. The photos will be familiar and will likely spark a smile and perhaps even some fond memories.
Another option, though much tougher to implement, is to adorn the walls with photos, pictures, or wall hangings that were in your loved one’s childhood home, or even their first home when they moved out. Of course, many of those photos and prints may be long gone, but if you can find anything stashed away in the attic, it may be worth bringing them out to see what reaction you get.
For someone with advanced dementia, adjust their environment to match their internal reality. Have photos to match their strongest memories. Select pieces that bring comfort or joy and spark a memory.
Whether modifying someone’s home or decorating their new living space in a retirement home or long term care centre, provide photos that spark a sense of pride and identity for your loved one.
Family caregiving is an immense responsibility at the best of times. When a health crisis occurs, a family can feel that they’re in over their heads. Families need caregiving support during crisis more than ever.
At one time, it felt manageable to assist your mother in remaining in her own home. Sure, some weeks were a little more hectic than others, but on the whole, you were managing. Then she fell.
You’re not too sure how long she was on the floor before you discovered her; she was pretty disoriented and doesn’t recall the circumstances surrounding her fall. She was rushed to the hospital and you’ve been visiting her daily. She’s still quite confused and you’re not sure she’d eat anything at mealtime in the hospital without you there to unpackage the food and insist on every bite.
It was fine for the first few days, but your mother isn’t doing as well as you’d hoped and it’s evident she won’t be discharged any time soon. The daily visiting routine you started just isn’t sustainable—especially if your mother goes to Freeport for rehab as the discharge planners are now talking about.
Visiting daily in the hospital is certainly not sustainable long term, and even more overwhelming is the question of how much assistance your mother will need when she does return home, whenever that might be.
Warm Embrace caregivers serve clients wherever they need us most, including in the hospital. Our caregivers can provide daily visits that cover meal times to ensure your mother eats her meals. Between meals we’ll visit with her, enjoying conversation and keeping her mind active and engaged.
If her next move is to Freeport, our Caregivers can continue visiting her there while she recovers. Best of all, when it comes time for discharge, you won’t have to panic. You’ll already have the care in place and ready to go.
The caregivers who have already met your mother and grown to love her can now help her to transition home. The crisis situation of a fall and a fractured hip is much less stressful when you have reliable care that will help you through each stage of the journey.
Instead of feeling like you’re in over your head, you can feel relaxed and at ease knowing that experienced professionals have everything under control.
Do you know a senior who has suffered a serious fall? Likely you do, since approximately 30% of seniors who live in the community suffer a fall each year. The consequences of a fall can be quite serious—injury, hospitalization, even death from complications.
Did you know that falls are the cause of 90% of all hip fractures, 50% of all injury-relatedhospitalizations in seniors, and the 5th leading cause of death in the elderly?! These numbers also double when a senior has dementia. So, it is extremely vital in keeping seniors strong and steady on their feet.
Why do seniors fall in the first place?
“Falling isn’t as much about slips and trips. It’s about the failure to recover. Slips and trips happen at all ages” (Dr. George Fernie). There are various external factors at play that contribute to slips and trips; such as:
Poor footwear (e.g. slippers)
While some falls can be attributed to tripping—such as tripping over floor mats, pets or curbs—other falls seem mysterious. The person will report that they just went down and we're not sure why. In many of those mysterious cases, the fall is due to internal factors such as:
Visual and hearing deficits
Neuropathy (abnormal sensory feedback)
Low blood pressure
Pain and foot drop
Weakness and tightness
Slowed reflexes and balance disorders
What can we do to prevent falls?
1. Get rid of all the external factors that cause slips and trips!
Ensure that your living space has no loose carpets or rugs, the lighting is bright for increased visibility, all chairs are sturdy with armrests, everything needed is on the main floor (no stairs), and that proper footwear is worn in the house.
2. Improve balance and stability!
“She says she wants to keep living in her home. We say it starts by keeping her on her feet” (American Academy of Orthopedic Surgeons). The number one key to fall prevention is staying active! Physical activity has shown to mitigate the deathly consequences of falls – just walking, gardening or housework is enough for an elderly loved one.
However, when your elderly loved one refuses to do regular exercise the best option is to increase their base of support.
To remain balanced, there must be a stable base of support—the wider the base of support the more stable it becomes. The base of support is the invisible box that can be drawn around your feet when you are standing. Added to this is our centre of mass—which is approximately where our belly button is located.
When someone’s centre of mass is in the middle of their base of support, they are perfectly balanced. When their centre of mass begins to reach the outer edge of their base of support, they are more prone to falling.
For example, a ballerina narrows her base of support to be only one square inch when she is en pointe. Her balance is quite precarious because her base of support has been reduced. The only way that she remains upright is by perfectly hovering her centre of mass over her base of support. She is constantly adjusting to ensure that her centre of mass doesn't sway too far aware from her base of support.
In contrast, a football player crouches low and spreads his feet wide so that he has a wider base of support than he normally would. He may even put one hand to the ground adding a third point of contact and expanding his base of support further. He has a stable base of support, and his centre of mass is positioned in the middle of his base.
In the case of a frail senior, their feet may ache or have bunions, causing that person to only walk on the edges of their feet, which reduces their base of support and their balance. Instead of using the full surface of their foot, they have reduced their base of support more like a ballerina. As well, the senior’s posture may be more forward-leaning, pushing the centre of mass to the outer edge of the base of support, causing instability. A senior will not likely be crouching down to touch the ground for support, the way a football player does.
The best way to create a strong base of support is to use a walker. The four wheels of the walker expand someone’s base and provide the necessary support. Much like a football player, a well-balanced senior using a walker is less likely to fall than a senior who is precariously balancing on sore feet. If their posture is forward leaning then the walker extends the base of support ensuring that the centre of mass remains in the middle of the base of support.
Encourage the seniors in your life to carefully assess their centre of mass and base of support to ensure that they are as safely balanced as possible. Every fall that is prevented is a great success and ensures a longer and healthier life for that senior!
Don’t be discouraged and let the cabin fever get to you—instead, speed up spring!
One of the best ways to bring spring to you is to start your gardening early—indoors! Rather than waiting on mother nature to cooperate for a display of spring colours, get things started yourself by forcing bulbs.
Indoor gardening is a very accessible way to garden. There is no need to bend over or kneel on the hard ground. Bulbs require very little maintenance or effort. Indoor gardening is a great way to connect with an elderly loved one’s passion and hobby without being overwhelming or too physically demanding. It can also be a great intergenerational activity, drawing children and grandparents—or even great grandparents—together over a common task.
Forcing bulbs indoors mimic the outdoor environment that causes a bulb to grow and bloom. Unlike large, potted house plants, bulbs do not need big pots. A small, shallow dish is sufficient. Many bulbs are easily forced using only water and pebbles, rather than soil, resulting in much easier clean up when gardening indoors. It is also more fun to watch the roots develop and see the bulb change as it grows. New growth development is exciting to see—at any age!
Using your shallow container, fill it half full of pebbles or marbles, then place the bulbs on top of the pebble layer. Gently fill the rest of the container with pebbles or marbles to secure the bulbs in place, but do not completely bury the bulbs. Put enough water in the dish so that the water touches the bottom of the bulb, but do not submerge the bulb in water or it will begin to rot.
The step that is most often overlooked when forcing bulbs is the chilling step. Your freshly “planted” bulbs need to be chilled in a cellar or in the fridge to mimic the winter season. Some bulbs only need a few days of chilling, and others need a much more extended chilling period of several weeks. Be sure to check the specifications on the bulbs that you purchase.
NOTE: Please do NOT store bulbs in an elderly person’s fridge. If that person has dementia or mild cognitive impairment, the bulbs (or pebbles) could be mistaken for other produce. Likewise, if your loved one has impaired vision, the bulbs could appear similar to onions. Senses such as taste and smell become dulled for many people as they age; the smell or bitter taste that might alert you to food being harmful may not alert an elderly loved one.
When roots begin to show you will know that your bulbs are ready to begin their growth cycle and it is time to remove them from the chilling stage. With roots now showing, your bulbs are ready to be moved into warmth and sunlight. You need to introduce them to sunlight slowly, just the way that the spring sunlight is soft at first and then gradually gets warmer. Place your bulbs in a cooler area of your home, away from direct sunlight. When your plants begin to grow and the stems take on a healthy green colour, then it is time to move them to a sunny windowsill to watch the beauty unfold!
In theory, any bulb can be forced to grow indoors, but some varieties are easier to force than others. Paperwhite narcissus grows well indoors and does not require a very long chilling period. They grow well in water and pebbles and are quite fragrant. Amaryllis are very easy to force and the blooms are giant and colourful. They grow so quickly that you can see growth daily.
The warmer the environment, the faster the amaryllis will grow. Once it blooms, it is best to move the plant to a cooler, shaded area for the blooms to last longer, as they can remain for up to a month.
Hyacinth and crocus can also be forced and take eight to ten weeks to grow. Although tulips are a favourite spring bloom, they are probably best enjoyed out in the garden as they can be trickier to force and require a long chilling period of sixteen weeks.
Enjoy your head start on spring by forcing your favourite bulbs indoors, and use this easy, timeless, and ageless activity to connect various members of your family. You will have spring beauty unfolding in your own living room—no matter how much snow remains on the ground outside!
Homecare can be defined pretty broadly and mean different things to different people. To some, it might mean dropping in to check on someone for 5 or 10 mins, for someone else it could be 24/7 care in someone’s home. It could be just about anything in between!
To ensure that our clients receive the best possible service, we have placed parameters around the type of service we can offer to ensure top quality. Here at Warm Embrace, the minimum visit length we offer is three hours. We have set this minimum to ensure that we are fulfilling our mission and our philosophy of care.
Within the context of homecare, where an elderly client is living in their own home, apartment or condo, there are some additional reasons why the three-hour minimum is necessary.
Have you ever dropped by your elderly parents’ home with the intent of staying for a half hour visit? How did that turn out? I’m willing to bet that you stayed much longer than just 30 minutes! Why is that?
I’m guessing that by the time you got in the door and settled, got caught up with some friendly chit-chat and had a coffee, you were already at the 30-minute mark. Just as you were thinking you would head out the door, your mother mentioned a new symptom that’s bothering her. You discussed that and tried to track down whether a doctor’s appointment had been made since your mother couldn’t remember. Then your father mentioned that the microwave wasn’t working properly so they weren’t sure what they were going to have for dinner. The next thing you know, you’re busy making dinner for them and your quick 30-minute drop-in lasted a few hours.
Of course, your parents tend to stock-pile all the issues until you arrive. Then it takes longer to address everything. The same is true for our visits. Clients may save up the dishes and the housekeeping and laundry pile up. The items you plan in advance that you figure might take an hour or so end up taking much longer when the list keeps growing!
It’s not just about tasks; it’s also about pacing.
If you personally have a doctor’s appointment at 11 am, how much time do you allow yourself to get showered, dressed, ready and out the door? Now, what if your parents have a doctor’s appointment at 11 am? It takes a lot more time since every step in the process needs to be adjusted to allow the extra time they may require or prefer.
It likely takes much longer for them to manage to get in and out of the shower. Selecting an outfit and dressing likely takes longer, as does personal grooming and other morning routines. Physically getting into and out of the car may take longer, and your parents may prefer to be at the appointment 20 minutes early instead of arriving just on time. . .despite the fact that the doctor is always behind schedule and you know you’ll end up waiting anyway!
Out of respect for your parents, we allow significant time for outings to ensure that we can match their preferred pace, not our preferred pace. We know that each stage will take much longer and that we need to allow lots of extra time should something unexpected arise. If we’re just getting your parents settled in the car and your mother suddenly needs the washroom once more before leaving, we need to have allowed lots of extra time to deal with the (somewhat) unexpected. For your parents’ sake, we would never attempt to accomplish an outing in only an hour long shift. Part of providing dignified care is allowing sufficient time for outings and errands and matching your parents’ pace, not necessarily just focusing on fastest efficiency. It takes time to do things well and the minimum time we need to ensure top quality is three hours.
Granting your parents the dignity of matching their preferred pace, ensuring that we have extra time built in for the unexpected, and knowing that they may have a stockpiled list ready for our arrival are all part of how we plan in advance to meet your parents’ needs.
Relationships are about so much more than speed and efficiency; your parents will thrive from the attention they receive from a wonderful caregiver who takes the time to appreciate them for who they are and who gets to know them on a personal level without rushing.
You know your mother needs assistance, but she refuses to even consider it. She insists that she doesn’t want to lose her independence. You’re frustrated because you’re trying to be proactive and prevent a crisis, but your mother won’t hear of it.
Be reassured! You are not alone! Your mother is not the first senior to bristle at the notion of receiving help. In fact, most of our homecareclients here at Warm Embrace started out exactly like your mother—Estelle sure did. Estelle started out adamantly insisting that she didn’t need or want any help at all.
I can hardly blame Estelle for resisting help. Very few people are quick to put up their hand and say “yes, I need help”—and that is true at any age. Our North American culture places a high value on independence, and many people tend to define that as “doing everything myself.”
Estelle rejected homecare because she was afraid that if she can’t do it all herself, then she won’t be considered independent. In her mind, that would mean being one step away from a dreaded nursing home.
We define independence differently. We believe that independence doesn’t mean that you do it all yourself; instead, independence means that you get to choose how everything is done. Independence means that you’re the boss. You make your own decisions. It doesn’t mean you physically do everything; it means you have control in how it is done.
Homecare doesn’t take away a senior’s independence. In fact, it often does the opposite. It often grants senior more independence.
Estelle did not lose her independence, and that’s probably why she now adores her two favourite caregivers. Estelle did not lose anything; she gained.
Estelle benefited from:
Gaining two new best friends
Enjoying stimulating conversation
Eating healthy meals and having more energy
Re-establishing her social connections because her caregivers can drive her to events
More physical activity by keeping up with her caregivers—instead of just sitting watching TV
Improved sleeping patterns since she’s no longer napping all day out of boredom
Your mother could benefit from homecare just as much as Estelle. Your mother can go from just barely surviving to actually thrive.
What NOT To Do:
When you mention the idea of homecare or introducing a caregiver, don’t highlight what your mother can’t do. Don’t point out all the activities she’s no longer managing, even though it may seem obvious and glaring to you.
Do NOT point out that:
She has lost her licence and no longer drives
The only healthy meals she eats are the leftovers you bring
She hasn’t been to a social event in six months
Her housekeeping standards are slipping
What To DO:
Highlight all of the gains your mother will benefit from when she has a wonderful new caregiver in her life. Point out how her life will be even better.
DO point out that:
She can now go anywhere she likes without worrying about calling a cab
She can go to social events and visit friends she hasn’t seen lately
Her caregiver will be a new friend with whom to play scrabble
She will enjoy having a visitor in the lonely winter months when she doesn’t usually get out
Even when you’re out of town, she’ll still have a consistent visitor
She will be the boss and SHE gets to decide what she does, together with her caregiver
When seniors see that they are not giving anything up, they are not losing anything, they are more receptive. Seniors are often keen to accept new friends and live life more fully.
Help your mother to see all that she stands to gain, and the conversation may be easier. We’ve helped countless families through the exact same struggle you’re experiencing, and we can make suggestions specific to your situation. Call us for more ideas!
A senior benefits from homecare by suddenly eating better meals and that senior now has more energy to independently manage more tasks. Another senior might benefit from our accompanied transportation and now that senior can attend all the activities and functions she once enjoyed. She is regaining her life back; she is not losing independence!
When seniors recognize what they can gain from homecare, they are more receptive. They are gaining a new friend who will ensure that they enjoy each day and live it to the fullest.
The good news is, we managed to win them over and now they are clients who absolutely adore their caregivers and can hardly imagine life without Warm Embrace.