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Change is scary but it doesn’t have to be

 

You’re worried about your parents and you think they could use more help.  You suggested homecare, but they wouldn’t hear of it.  They told you: “we’ve managed just fine on our own this long, we don’t need any help.” What they're really saying is that they don't want to face change. That's because change is scary.

 

older lady looking worried as she stares

 

Change is scary for all of us, at some level. Each person has a different tolerance for change, and it might take a lot more change to scare some people than others. But if you introduce a drastic enough change, eventually, any of us would feel trepidation about that change.

 

It’s little wonder then, that for seniors in their 80’s or 90’s, the thought of even a small change can be quite scary. After eight or nine decades, they are likely pretty set in their ways. They want things done a certain way; they want to keep their environment the same. As long as everything remains the same, it feels more manageable. It might help your parents to understand that home care is all about reducing the amount of change that your parents will experience. 

 

Warm Embrace caregivers are trained to match each client's specific preferences. 

 

Caregivers DO NOT barge into a client’s home and just take over. Caregivers DO wait to be invited in, and they ASK permission to proceed. They ask how that particular client prefers the laundry or housekeeping to be done. They cook from the client’s recipes or directions to match their particular tastes.   They help to keep clients’ lives consistent.

 

caregiver helping elderly lady from the couch

 

Homecare is one of the best prevention strategies for one of the biggest possible life changes: admission to a long-term care home.  Moving to long term care is a HUGE change—absolutely every single element of someone’s routine is changed. From the time they get out of bed, to when they eat, and whether they wear pyjamas to breakfast—everything is adjusted to match the schedule of the long-term care home.

 

Homecare ensures that individual clients maintain their own personal routine, they maintain their home, they maintain familiar comforts.  Caregivers match clients, rather than clients matching caregivers.  It reduces the amount of change they must experience.

 

Since home care is completely client-focused, each client calls the shots. The client decides what they’re doing each day and how they want things done and in which order.  It is very empowering for seniors to get to make all the decisions that impact their own day-to-day living.  Homecare grants this level of autonomy and independence.

 

Help your parents see that home care will ensure the least amount of change and help to maintain the lifestyle that they know and love. 

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A Picture is Worth 1000 Words

 

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?

 

Older lady looking at a photo album

 

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.

 

Elderly father and adult daughter looking at family photo album

 

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.

 

Wall of old timey photos in vintage frames

 

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.

 

Wall decor and art in vintage frames and styleAnother 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.

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Exploring Responsive Behaviours

 

Someone who is experiencing dementia may exhibit behaviours that we do not understand.  These behaviours have been labelled ‘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. 

 

Photo side by side. First photo, older woman wearing a blue sweater is looking very sad and confused. Second photo, older woman covering her face with her hands.

 

The newer understanding of dementia is that the changes in someone’s brain result 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. 

 

Black old married couple walking arm and arm.

 

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

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

 

The Four Steps:

 

1. Show you care

 

2. Show you want to help

 

3. Redirect

 

4. Distract

 

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

 

older woman wearing a light scarf smiling

 

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.

 

If you have questions about dementia or dementia care, contact our office today to speak to one of our experts. 

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Dementia and Communication: 5 Typical Mid-Stage Challenges

 

Mid-stage dementia or moderate Alzheimer’s is marked by increased communication challenges.  Language is increasingly affected; though speech remains quite clear.

 

 

In the mid-stages of dementia, the affected person is less self-aware of their communication challenges.  In the early stages, the person is highly aware that they cannot find the words they are seeking; but in the mid-stages, they don’t perceive their communication as problematic.  They may be inclined to blame others for not comprehending what they are saying.

 

Here is a list of 5 communication challenges

 

Circumlocution

 

This is your new word of the day!  Circumlocution is the fancy way of saying “talking around what you are trying to articulate.”  In the early stages, precise noun naming is difficult, in the mid-stages, nouns are frequently substituted with pronouns such as ‘he’, ‘she’, and ‘they’.  Instead of identifying an item, you might hear ‘thingy’ or ‘thingamajig’.  Sometimes, the person with dementia becomes frustrated when you don’t know what the ‘thingamajig’ is, and they become mad at you for not knowing.

 

Disinhibited

 

Your sweet little granny who never so much as uttered “darn” her entire life is now swearing like a trooper.  She can’t tell you what she wants, but she can tell you off just fine!  She may be inclined to tell someone “I don’t like your hair. You should have left it the way it was before.” The part of her brain that tells her what is socially acceptable has been affected by dementia, and the language she is using reflects that. 

 

An elderly lady wearing blue and smiling

 

Repetition

 

In mid-stage you will hear more repetition.  The person with dementia may become set on a few words and repeats those words frequently, or they may be focused on a particular idea/question/worry and continue repeating those ideas incessantly. If repetition deters you from engaging in conversation with your loved one, try out our 5 conversation starter tips

 

Digress & Ramble

 

The conversation becomes more conceptually linked rather than following a linear pattern.  For someone with dementia, his conversation may not follow a specific ‘train of thought’.  Especially when word-finding becomes difficult, he may be inclined to substitute an unrelated word for the one he cannot find; he then rambles about the new word he has substituted.  The conversation can take a sudden leap in a different direction complete with a long rabbit trail rambling.

 

Multi-person conversations

 

Group settings become increasingly difficult, and multi-person conversations are hard to follow for someone who has dementia. The mental stimulation of various conversations happening simultaneously can be too much to handle for someone with dementia.  You may notice that your loved one with dementia tends to sneak off during family visits or larger events, self-excusing from the crowd. 

 

Group of seniors engaging in happy conversation

 

Understanding the limitations of communication for someone with moderate Alzheimer’s or mid-stage dementia is important.  It is easier to set reasonable expectations and plan to be supportive.

 

Interested in learning more about Dementia and communication? Read our blog on the difference between speech and language.

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How Does Dementia Impact Incontinence?

 

Your mother hasn’t been going out as much lately. She even declined a few outings with you recently, which is unlike her. Then you noticed a pair of soiled underwear shoved behind the toilet…and another soiled pair under the bathroom sink.

 

 

What she may be hiding is trouble with urinary continence.  She may be feeling embarrassed and is trying to hide it, or if she has dementia, she may be confused about how to cope with this new change.

 

There are many possible reasons and treatments for urinary incontinence.  Ensure your mother sees her doctor and speaks openly about what she is experiencing.  Many causes of incontinence can be addressed medically, and those should be addressed immediately.

 

You may be able to suggest some lifestyle adjustments that will help to support your mother’s bladder, rather than irritate it. Read our other blog that addresses natural ways to support the bladder. If your mother has dementia though, the source of her challenge may be related more to her functional abilities than to her bladder directly.

 

As your mother’s dementia advances, she may not be as responsive to the signals her body is sending.  By the time she realizes that her bladder needs relief, it may be too late to respond and she may not be making it to the washroom in time.

 

 

Another challenge can be complicated clothing. Buttons, snaps, zippers or belts may be proving a challenge in the washroom. The more barriers there are to quick washroom use, the more likely your mother is to be slowed down and not make it in time. Be especially aware of skirts or dresses with back closures since it may not be self-evident how to undo the zipper. Modified and accessible clothing may make it easier for your mother to be quick and self-sufficient in the washroom. Drawstring or elastic-waistbands are often the easiest to manage.

 

If your mother’s dementia is advanced, it is possible she is confused about where to find the washroom.  Washrooms are not always easy to find, especially for someone with dementia.  Often, washroom doors remain closed, even when unoccupied.  Someone with dementia may not think to open closed doors to see what is behind the door. They may not have an intuitive sense of where a bathroom is likely to be located within a home or apartment. Although she may have lived in the same home for years, or decades even, dementia can cloud her memory and obscure what was once familiar. If she cannot easily find the washroom, she will not make it in time when nature calls.

 

 

Once she is able to locate the washroom, she may be confused about what to do once she’s in there.  For some people with advanced dementia, the washroom can feel very confusing and overwhelming.  If the toilet seat lid is down, the toilet may not look familiar. A white toilet and white sink may look very similar and can be confusing.  A wastepaper basket may seem more familiar and is often mistaken for the toilet itself.

 

Sometimes people attempt to sit down facing the toilet, rather than with their back to the toilet tank, as it is typically used. Because it feels so unusual when facing backwards, there is no long-term memory to cue what to do next.  It can also be dangerous since balance is impacted and there is a risk of falling.

 

If someone needs cueing through each step of toileting, their apparent challenges with incontinence may be more related to functional abilities and less so to their bladder or bowel function. They may be able to hold their bladder or bowel and may even be aware of when they need a washroom, but the confusion sets in with how to use the washroom.  If someone is experiencing functional decline, various support measures can be implemented to promote independent washroom use.

 

 

Cue cards can be helpful for those who can read and interpret directions. If your mother is inclined to read instructions and follow the directions, a cue card in the washroom to cue each step may be helpful.  In some cases, colour coding the toilet seat vs. the sink can be helpful. Contrasting colours can make it easier to see which item is which. If cue cards and colour coding are insufficient, your mother may need a caregiver to cue her through each step of the toileting process. 

 

When functional ability is preventing someone from toileting successfully, look for which step is causing the confusion, or which component of mobility is posing the challenge

 

By solving that specific component, you can help support someone to toilet as independently as possible.  Engaging the support of a professional caregiver may also help in identifying precisely where the needs exist. For more ideas on supporting independent toileting and continence, contact us at Warm Embrace Elder Care.

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What is Doll Therapy?

 

When someone has advanced dementia, their ability to complete tasks may become impaired, but their desire to have an important role and care for others often remains strong. While they may require quite a bit of assistance themselves, they are keen to offer assistance in return.

 

 

Caring for others is a deeply rooted desire for many people that persists throughout the journey with dementia. Simply trying to tell someone “you’re retired and you don’t have to worry about anything!” often produces more agitation. Instead, figure out how to tap into that desire to help for even better results.

 

One option is to provide doll therapy. 

 

Doll therapy allows someone with dementia to care for a doll as though it were a baby.  For some people, this can be highly effective and meaningful since it connects with identify—someone’s identity as a parent or a caregiver.

 

In some cases, a regular doll is sufficient. In other cases, a true therapy doll is more effective. A therapy doll is designed to be as life-like as possible. The doll is weighted so it feels similar to holding an actual baby.  Most are designed to look like a peacefully sleeping infant.

 

The ways that people interact with their own personal therapy doll can vary significantly.  We served two different clients, Mildred and Betty who each resided in long term care and had a therapy doll, but their forms of interaction with their dolls differed.  In each case, we let the client initiate the interaction with the doll and we matched their interaction.

 

 

Mildred treated her therapy doll as though it were a real child. She held the baby properly and laid it down to nap peacefully.  In this case, we mimicked Mildred’s interactions and also treated the doll as though it were real.  Often, Mildred wanted to put the baby’s needs above her own—she would decline to go to the dining room for dinner since the baby was sleeping and she didn’t want to disturb a sleeping baby. In this case, we offered to hold the baby during dinner so Mildred could eat.  We went together with Mildred to the dining room and sat by her table, holding the doll where she could keep an eye on her baby during mealtime.

 

Betty had quite a different interaction with her doll. Betty always wanted to have her doll nearby, but she didn’t always hold it the way one would hold a child. Sometimes she’d pick the doll up by its head, or carry the doll around in a plastic grocery bag.  She was comforted by having the doll nearby, but she didn’t interact with it as though it were real.  Out of respect for Betty, we handled the doll carefully, but rocking the doll throughout dinner wasn’t necessary for Betty’s peace of mind.

 

When interacting with someone who is soothed by doll therapy, always ensure that you act as though the doll is a real baby.  Offer to hold the baby, and hold it correctly as you would a real child.  If someone is upset their therapy doll is not within sight, provide an explanation that would make sense if it were a real baby.

 

 

Saying “it doesn’t matter where the baby is—it’s just a doll!” can be quite upsetting. Instead, saying “oh, your baby is having a nap and the nurses are keeping an eye on her. Best to let the sleeping baby sleep.”  Your reassurance with an explanation that fits the scenario will provide more peace of mind.

 

Therapy dolls can meet someone’s need to nurture and care for others. It isn’t only women who have a need to nurture. Many elderly men with dementia do very well with a therapy doll as well.  One gentleman we met, Dyck, was rather despondent. He wasn’t interested in joining any of the activities in the long term care home he had just moved into. He was even trying to avoid some mealtimes. 

 

The introduction of a therapy doll completely changed his demeanour. He was proud of his new role and was keen to show off his baby to others. When staff and visitors would say: “Good morning Dyck, how is your baby today?” he would proudly respond “she slept through the night again!”  The tactile comfort of carrying the baby, joined with the sense of purpose and newfound caregiving role helped Dyck with his transition into long term care.

 

 

Doll therapy does not have universal appeal. Many people are not at all interested in carrying a doll; others are very well aware it is a doll and not a real baby; others still become so preoccupied with the doll that it can become problematic. Some people become concerned that the baby is sleeping all the time and they’re concerned when they cannot wake the doll. The inverse can happen too if the doll is designed to look like it’s awake—a concern that the doll never sleeps.  If someone is distressed in any way by the details, then doll therapy may not be ideal for them.

 

The next time you’re in a long term care home and you see someone carrying a baby doll, remember that it could be a therapy doll and you should treat it as though it’s a real child.  Ask the person holding the doll about their baby—you will likely see them perk right up and be very proud to tell you more.  While doll therapy certainly isn’t for everyone, it can be a great comfort and benefit to those seeing a nurturing role.

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Why Bed rest isn't always a good thing

 

Avoid bed rest at all costs!

 

No one gets excited at the idea of being on bed rest. We can all agree it’s not something we would necessarily want to experience. What we may not realize is just how risky bedrest can be, especially for the elderly.

 

Bed rest most commonly occurs within the hospital, but can definitely happen at home as well.  When an elderly person is admitted to the hospital, they typically remain in bed. While they may not have been “put on bedrest” by doctor’s orders, the outcome is that they tend to remain in bed. Our hospital system is set up in such a way that those who are admitted to the hospital largely remain in bed all day long.

 

 

The problem is that remaining in bed all day long is one of the worst ways to recover from almost anything!

 

Bed rest limits someone’s physical activity to little more than a few steps to and from the washroom, a few times daily. That is not enough physical activity to maintain muscle mass.

 

The data proves that with an alarming statistic:

 

For every day of bed rest, the frail elderly lose 5% of their mobility.

 

Consider how long an elderly person tends to be in a hospital. Once admitted, most elderly patients are hospitalized for at least a number of days, but upwards of a week or ten days wouldn’t be uncommon. After a week of bed rest, 35% of mobility is lost! If someone is unfortunate enough to be in the hospital for two weeks—which is all too common—on average they would lose 70% of their mobility. 

 

That's a very high risk!

 

 

That could mean that prior to hospitalization, someone was living independently and walking without any aides. After two weeks in the hospital, that same person now requires a walker and struggles to get out of bed or out of a chair.  That’s a drastic change in their ability level and independence. It will significantly impact the quality of daily life.

 

With such a high risk of losing mobility on each day of bed rest, you can see why it is critical to keep people up and moving as much as possible (unless expressly prohibited by doctor’s orders).  Seniors should be encouraged to sit up and get out of bed and into a chair, stand up and sit down numerous times to keep leg muscles strong and do exercises either seated in a chair or passive exercises in the bed.

 

Even just sitting up straight in a chair is beneficial since it is typically easier for people to breathe deeply or cough and expel when they’re upright versus lying down.  Many elderly patients are at high risk of developing pneumonia while in hospital, and failing to sit up, breathe deeply, cough and expel can increase that risk. Developing pneumonia will lengthen a hospital stay, which increases the likely number of days on bedrest—meaning more days of losing 5% mobility each day!

 

 

Unless a medical condition or injury specifically requires immobilized bed rest, remaining active in any possible way is absolutely essential to recovery and long-term maintenance of mobility and muscle mass.

 

Next time you’re visiting a senior in the hospital, have them sit up or get out of bed and into the chair.

 

You just might be helping to save their mobility and prevent the 5% daily loss!

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A Love Story: Violet and Lawrence

 

Violet and Lawrence have been married for 68 years. After a lifetime of hard work, travelling through early retirement and most recently relaxing in retirement living together, they are now separated.  Lawrence’s dementia progressed and he began wandering at night. He could no longer be safely cared for in retirement, and he moved to long term care.

 

Violet had been very physically healthy and she had been caring for Lawrence for years within the retirement home where, together with staff, she could handle his needs. But once he began exit seeking and leaving in the night, even Violet had to admit she couldn’t manage his needs safely. 

 

It ripped her heart out to have him move to another location across town.

 

Now, Violet attempts to visit most days.  She wasn’t a confident driver, to begin with, but she is attempting to drive across town every day and stay with Lawrence throughout the afternoon and dinner.

 

She fears that he won’t eat unless she is at his side, so she remains for both lunch and dinner. She worries about how she will visit every day when the winter weather begins. She never drove in the winter and at 89, she isn’t keen to start winter driving.

 

You can see the toll it is taking on Violet. She appears to be withering before your eyes. She has lost weight and she looks exhausted. She suddenly strikes you as rather frail. She is probably stretching herself too thin, but she wants someone to be with Lawrence through lunch and dinner.

 

Violet needs Warm Embrace to provide a caregiver for Lawrence.  A Warm Embrace caregiver could visit Lawrence through lunch and dinner and keep him engaged in activities throughout the afternoon.  Of course, we can’t replace Violet’s visits, but we can supplement her visits.

 

We can provide a regular schedule so that Violet does not feel obliged to visit every day. She can take some much-needed time to relax and rejuvenate herself.

 

Warm Embrace caregivers can visit Lawrence on set days of the week, and on those days, Violet can remain at the retirement residence, eating her meals in the dining room with her friends.

 

She can rejoin the social activities and events that she participated in for all those years and not become disconnected from her peer group. But she can do so with the reassurance that Lawrence is not alone. He is with a dedicated caregiver who will ensure that he has the best afternoon possible.

 

By recommending additional support for Lawrence, you may actually be saving Violet’s health. She needs the support—possibly more than Lawrence does—and your recommendation to alleviate her stress could make the difference for Violet.

 

We’d be happy to improve the quality of life for each of them by providing a dedicated caregiver when they need it most. Reach out to us today!

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Dementia Care: 5 Conversation Starters

 

When a loved one has dementia or Alzheimer’s disease, it can be difficult to know what to talk about. Sometimes, family members will even say “I didn’t know what to talk about and it felt awkward, so I just stopped visiting.”

 

Rest assured, your visits mean the world to your loved one!  It’s almost guaranteed that any awkwardness was felt by you, more than it was felt by them.  Sometimes, just being present is enough. Just being together in the same room conveys love and caring and appreciation.

 

When you do try to strike up a conversation, here are a few tips that may ease the conversation.

 

1. Talk about right now

 

 

Comment on your surroundings—are the flowers just poking through the ground outside? Is it warm or cold out? Is it a bright sunny day or dreary and overcast?  When you comment on the environment around you, you are welcoming the person with dementia to experience the environment equally. They too can comment on the weather or the temperature. They too can appreciate the view out the window of the garden or the trees or the sky.  Commenting on this very moment does not require memory or complex executive functioning.  Simply noticing and commenting on your five senses is a great way to stay focused on the moment at hand and invite your loved one to join you on equal footing.

 

2. I thought of you the other day when…

 

This is a great way to draw your loved one in and help them to feel connected to you and your everyday life.  This simple line conveys ongoing love and caring.  It gives you the opportunity to share more about what is happening in your life.  You can cue your loved one with some information and it may spark a memory that otherwise may not have surfaced.  When you say “I thought of you when I was driving Liam to school the other day…” you might be surprised that your loved one suddenly asks about their grandson Liam and a whole new conversation starts.

 

3. I was remembering the time you…

 

 

Get the storytelling rolling without asking a question.  If you ask “do you remember the story you used to tell about….” It puts pressure on your loved one to remember something specific. Instead, you start the story by saying “I was remembering the story you told about…”  If you see the spark of recognition, then step back and let your loved one fill in all the blanks. If they can’t recall that story in the moment, you can tell it however you best remember it and share that family moment together. Either way, you’re sharing your family history together without it feeling like a “test” that someone has to remember.

 

4. What is your favourite…? Do you prefer…?

 

If you’re going to ask a question, be sure it’s an opinion-based question.  Opinions can’t be wrong! If you ask an opinion-based question of someone who has Alzheimer’s disease, you may be amazed at the robust answer you receive.  Asking “did you attend bingo yesterday afternoon?” is a fact-based question. The answer is either correct or incorrect and the person with dementia can sense it. If they’re unsure of the answer, the question suddenly feels like a test.  Instead say, “I see both bingo and euchre are on the schedule this week. Which do you prefer?The opinion-based question invites your loved one to provide a personal opinion as a response. If they actually did attend bingo yesterday, you may cue their memory of attending bingo by providing information before you ask the opinion question.

 

5. What do you think about…?

 

 

Again, this question is an opinion based question.  Ask “what do you think about…?” of things that are in the moment and do not depend upon memory or complex reasoning.  Asking “what do you think about the upcoming election?” is probably not a fair question unless your loved one is a long-standing political junkie who has been following the news.  Asking “what do you think about this guest on Ellen DeGeneres?” while you’re watching the show together is probably a better question. It is current and based on information from that moment only. Because it is an opinion question, it allows for a response of “I don’t know” or “nothing” and that’s perfectly fine. You may just be surprised at what does pop out though!

 

Don’t be afraid of having a conversation with loved ones who have dementia or Alzheimer’s disease.

 

There may be times when you need to carry more of the conversation or times when you are simply sharing comfortable silence together, but there will also be times when your loved one will surprise you by sharing more opinions or memories than you expected!  If you follow the 5 tips above and stay completely in the moment, provide some information to cue your loved one, and only ask opinion-based questions, you just may have more engaging conversations.

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What happens after a hospital discharge?

 

One of your long-standing residents, Jean, has just been discharged after a ten-day stay in hospital.  She has been discharged back to your residence, but she has declined considerably in the past 10 days.

 

She lost quite a bit of her strength from being in bed all day at the hospital, and since she was catheterized, she’s struggling with incontinence now as well. Previously she was independent with personal care and was able to get to the dining room on her own.  Now, she’s needing help with toileting and sometimes she’s not even a one-person transfer.

 

Your care team were already stretched thin across residents with high needs.  There are key times of day when you simply don’t have enough staff available all at the same time.

 

That’s where Warm Embrace comes in

 

Jean needs a dedicated caregiver who can attend to her increased needs as she recovers from her hospital stay.  If she requires a two-person transfer assist, our caregiver can be one of the two required people.  Jean’s caregiver can attend to her toileting needs and assist her in getting to and from the dining room at a time when your staff have many other residents who need help getting to meals. 

 

 

Jean’s caregiver can work together with her on some strengthening exercises to help her return to a greater state of independence.  Of course, the goal is to help Jean remain independent enough to remain in your residence much longer.

 

If, however, Jean’s medical condition deteriorated while in the hospital to the point that she now qualifies for long term care placement, Jean’s caregiver will provide the assistance she needs while she remains in your residence awaiting placement.  With her increased needs, Jean may require more than your staff have the capacity to provide, especially when other residents also have many complex needs. 

 

If you have a resident like Jean who is returning from hospital, you can recommend that they implement a dedicated caregiver from Warm Embrace to help them as they recover.  We recognize that our role might vary depending on the goals of the resident and their health. Any combination of the following are possible:

 

 

  • Temporary assistance as your resident recovers from hospitalization/surgery/recent illness until they regain their strength and abilities and no longer need our help
  • Ongoing support to match your resident’s new ability level and needs, allowing them to remain living in your residence even though their needs have increased.
  • Crises support if your resident is awaiting long term care placement and their needs have drastically increased.

Our support ensures the resident has all the care they need after returning from the hospital, while also reducing strain on your staff. 

 

The next time you have a resident with a pending hospital discharge, remember to make Warm Embrace part of the planning process and have care in place for a smooth return to your residence.

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