My Dad had Alzheimer’s. While I was lamenting his decline, pieces of the “old” Dad would show through. I would hear him say, “I am losing a piece of my mind every day.” Heartbreaking!! This, from a man that owned his own architectural company, could do math in his head, and was a brilliant artist.
It took a long time, but our family accepted Dad for what he was each day. He loved taking drives, and loved going out to eat. He people-watched all the time. I remember one time when he was resting on a concrete seat outside of his doctor’s office. A woman doctor came out of the door, dressed impeccably, and had a very nice figure. My Dad’s eyes lit on her immediately and followed her until she was out of sight. My Dad was not a womanizer, but he still appreciated a nice-looking woman.
Another side of this people-watching came through as well. He would always comment on people’s weight or men with facial hair. (Before he died, the men had started wearing goatees.) Dad would ask them, “Why do you like all that stuff on your face?”
The word “stuff” represented a change in language ability. If Dad couldn’t remember the word he was looking for, he would give a similar word that was more general. I could usually guess what he was asking for, but that was because I was with him almost every day.
We kept Dad active as long as we could. Even a few months before he died, we took him shopping for a new shirt and tie (which he picked out) to wear to my brother’s wedding. Dad was very happy that night. He loved the margaritas and danced with the bride!
Friday, June 25, 2010
Caregiving Maxim #2:
The patient is always 100% forgiven
Is your Mom or Dad grouchy? Does he/she pick at you and remind you of your childhood?? Does your Mom have a disease process going on? Is your Dad frustrated about his mental capabilities?
Being frustrated about having decreased abilities to manage one’s life or being in pain and not wanting to complain can cause grouchiness or anger at other parts of the day.
Does the patient regret having lost some of their independence? Is the patient now dependent upon a family member or caregiver to shop, cook, or take them to doctor’s appointments? Does this person no longer drive? Losing one’s independence is always very difficult and a hard pill to swallow!!!
STOP and THINK about why the patient is upset. It took me a while to understand this. My Mom had emphysema and was always short of breath. She used 200 pounds of oxygen each week and never complained about being in pain. But, she was always gasping for breath. She began using a walker, so she could sit down and rest. Then, we graduated to a battery-operated scooter, so she could take herself to the bathroom by herself (retaining some form of independence). But, she was grouchy sometimes.
Was her grouchiness due to her inability to breathe? Was it due to the loss of independence? Was she actually in pain and didn’t want to complain? It may not be possible to find out what the underlying cause of the complaining or grouchiness is.
The caregiver’s (whether a family member or professional) purpose is to help the patient get through each day as comfortably and as healthy as possible. The caregiver’s daily problems cannot be an issue. The caregiver is there for the patient. The patient is always 100% forgiven.
Being frustrated about having decreased abilities to manage one’s life or being in pain and not wanting to complain can cause grouchiness or anger at other parts of the day.
Does the patient regret having lost some of their independence? Is the patient now dependent upon a family member or caregiver to shop, cook, or take them to doctor’s appointments? Does this person no longer drive? Losing one’s independence is always very difficult and a hard pill to swallow!!!
STOP and THINK about why the patient is upset. It took me a while to understand this. My Mom had emphysema and was always short of breath. She used 200 pounds of oxygen each week and never complained about being in pain. But, she was always gasping for breath. She began using a walker, so she could sit down and rest. Then, we graduated to a battery-operated scooter, so she could take herself to the bathroom by herself (retaining some form of independence). But, she was grouchy sometimes.
Was her grouchiness due to her inability to breathe? Was it due to the loss of independence? Was she actually in pain and didn’t want to complain? It may not be possible to find out what the underlying cause of the complaining or grouchiness is.
The caregiver’s (whether a family member or professional) purpose is to help the patient get through each day as comfortably and as healthy as possible. The caregiver’s daily problems cannot be an issue. The caregiver is there for the patient. The patient is always 100% forgiven.
Thursday, June 24, 2010
Caregiving Maxim #3:
Applaud and praise the patient
Caregiving Maxim #4:
Always tell them they are beautiful
As a follow-on to the caregiving maxim – The patient is always 100% forgiven – these two maxims boost self-esteem in the patient.
An older person may look shrunken or decrepit; they may seem diminished in size. Older people are not always valued for what they have accomplished in their lives or for their life experiences. Think about what you, the caregiver, have accomplished over the last 25 years and multiply that by 2 or 3. The older person has accomplished much more in his/her life than you have. Value their life experience and value that person as a real person, not just as a patient.
Now, this patient is not so active, cannot accomplish as much with his/her life. This thought may be depressing to them – grouchy – here we come.
No matter how small the task is – applaud and praise the patient. This could be something simple like eating enough for breakfast. Nutrition in the older person is vital to their health. Perhaps, he/she was able to hold his/her toothbrush and brush his/her teeth by themselves. (Have a basin handy for them to rinse into, if reaching the sink is a problem)
Always tell the patient he/she is beautiful!! Don’t you like to hear that someone likes the shirt/blouse you wore that day?? Don’t you like compliments on your haircut? Or, how well you did on your last work project? The same theory applies to the patient. He/She doesn’t feel good in the first place. He/She is not able to be at their best when pain/disease is an issue. The best way to help them feel better is to compliment them. No matter how small the compliment is, the better the patient will feel.
An older person may look shrunken or decrepit; they may seem diminished in size. Older people are not always valued for what they have accomplished in their lives or for their life experiences. Think about what you, the caregiver, have accomplished over the last 25 years and multiply that by 2 or 3. The older person has accomplished much more in his/her life than you have. Value their life experience and value that person as a real person, not just as a patient.
Now, this patient is not so active, cannot accomplish as much with his/her life. This thought may be depressing to them – grouchy – here we come.
No matter how small the task is – applaud and praise the patient. This could be something simple like eating enough for breakfast. Nutrition in the older person is vital to their health. Perhaps, he/she was able to hold his/her toothbrush and brush his/her teeth by themselves. (Have a basin handy for them to rinse into, if reaching the sink is a problem)
Always tell the patient he/she is beautiful!! Don’t you like to hear that someone likes the shirt/blouse you wore that day?? Don’t you like compliments on your haircut? Or, how well you did on your last work project? The same theory applies to the patient. He/She doesn’t feel good in the first place. He/She is not able to be at their best when pain/disease is an issue. The best way to help them feel better is to compliment them. No matter how small the compliment is, the better the patient will feel.
Caregiving Maxim #5:
Give them a job and praise them for the job
Caregiving Maxim #6:
Tell them: I really need your help -- can you help me?
A job can be as simple as folding the towels or clothes from the laundry. Or, sitting at a table and cutting up ingredients to prepare the meal with. Ask the patient to help you. He/She will be glad to have something to do to occupy their time. The patient doesn’t want to be a burden (well, maybe some do) and wants to be helpful.
Make the job as easy as possible for them to do. For example, when Mom would help me cut up ingredients for a salad, I sat her at the kitchen table, and brought her the cutting board and knife. I washed the vegetables and gave them to her. When she was finished, I gave her a soapy paper towel to wash her hands with and another one to rinse or dry with. That way, she didn’t have to make the effort to travel to the sink and stand up to wash her hands. She really liked helping me.
I was amazed when Dad would actually help fold the laundry. But, Mom had trained him well – he always helped around the house. Folding the laundry was something he could do with his Alzheimer’s – maybe not the normal way we always did it – but it was folded. He also like helping pour juice or coffee in the morning, too. He always went out and picked up the newspaper in the morning. We might be afraid he would fall, but he insisted on doing so.
Jobs like these may be more rewarding to the patient than some craft or activity. One of our caregivers would bring in apples to paint or baskets to make. She did this more for Dad than Mom, after Mom died. He thought these activities were useless and a waste of time. He felt silly doing these activities. After all, he had been an architect (designed buildings) and painted watercolors as a hobby. Try and figure out what activities are good ones for each person.
Praise them for their help!! Praise makes the patient feel wanted and needed. Elders hate to lose their independence or their control over their own life.
Make the job as easy as possible for them to do. For example, when Mom would help me cut up ingredients for a salad, I sat her at the kitchen table, and brought her the cutting board and knife. I washed the vegetables and gave them to her. When she was finished, I gave her a soapy paper towel to wash her hands with and another one to rinse or dry with. That way, she didn’t have to make the effort to travel to the sink and stand up to wash her hands. She really liked helping me.
I was amazed when Dad would actually help fold the laundry. But, Mom had trained him well – he always helped around the house. Folding the laundry was something he could do with his Alzheimer’s – maybe not the normal way we always did it – but it was folded. He also like helping pour juice or coffee in the morning, too. He always went out and picked up the newspaper in the morning. We might be afraid he would fall, but he insisted on doing so.
Jobs like these may be more rewarding to the patient than some craft or activity. One of our caregivers would bring in apples to paint or baskets to make. She did this more for Dad than Mom, after Mom died. He thought these activities were useless and a waste of time. He felt silly doing these activities. After all, he had been an architect (designed buildings) and painted watercolors as a hobby. Try and figure out what activities are good ones for each person.
Praise them for their help!! Praise makes the patient feel wanted and needed. Elders hate to lose their independence or their control over their own life.
Caregiving Maxim #7:
Everyday is an adventure – don’t know who the patient is going to be from day to day
This maxim applies more to patients with Alzheimer’s or some other form of dementia (there are several types) than other patients. The patient with dementia may forget how to do some things or may not remember some or most of their past life, but the patient is still a person. This person has rights – the right to be treated nicely, the right to be kept clean, the right to be fed good food, the right to have entertainment (in what form is pleasing to the patient), etc. This person still has thoughts and can still tell right from wrong. The dementia patient may not have the strength to fight back, but can still gesture if something is not right.
But there are times each day when the dementia person will act like their old self and one can see the Mom or Dad we wished we still had. Sometimes it is a glimmer and sometimes more. The words may not be perfect, their balance may not be perfect, they may have different tastes (the taste for sweets or sugar does not go away), they may not know how to buckle their seat belts or get ice from the ice maker, but the patient is still your Mom or Dad.
Dad would eat green chili enchiladas or See’s candy right up until he died. If the grandkids came over, he would pretend to chase them around the living room and scare them with a “boo,” just as he has done for years. He called all the grandkids and great-grandkids “George,” no matter whether the child was a girl or a boy.
Some days the person with dementia may feel like being quiet, and that is OK. Try to engage them throughout the day to go with you to the store or listen to some music. Music is a great calmer and also very pleasing, especially if the music is from the era that the person grew up in. Dad loved to eat out, and wouldn’t mind going shopping, just to get out of the house. He picked out his own red shirt and tie to go with his suit to wear to my brother’s wedding!!
Overall, be patient with the person. Let them be who they are and in what era they are. They will change soon enough. If they get angry with you or cuss you out, they don’t mean it and will forget they did so in a few minutes. Just give them some peace.
Appreciate the person as he/she is at that moment.
But there are times each day when the dementia person will act like their old self and one can see the Mom or Dad we wished we still had. Sometimes it is a glimmer and sometimes more. The words may not be perfect, their balance may not be perfect, they may have different tastes (the taste for sweets or sugar does not go away), they may not know how to buckle their seat belts or get ice from the ice maker, but the patient is still your Mom or Dad.
Dad would eat green chili enchiladas or See’s candy right up until he died. If the grandkids came over, he would pretend to chase them around the living room and scare them with a “boo,” just as he has done for years. He called all the grandkids and great-grandkids “George,” no matter whether the child was a girl or a boy.
Some days the person with dementia may feel like being quiet, and that is OK. Try to engage them throughout the day to go with you to the store or listen to some music. Music is a great calmer and also very pleasing, especially if the music is from the era that the person grew up in. Dad loved to eat out, and wouldn’t mind going shopping, just to get out of the house. He picked out his own red shirt and tie to go with his suit to wear to my brother’s wedding!!
Overall, be patient with the person. Let them be who they are and in what era they are. They will change soon enough. If they get angry with you or cuss you out, they don’t mean it and will forget they did so in a few minutes. Just give them some peace.
Appreciate the person as he/she is at that moment.
Caregiving Maxim #8:
Go into their world – don’t bring them
into your world!
If the person you are caregiving for has dementia of any type, try to assess (for your own information) the different stages that this person goes through each day. Try and match the stage they are at. Dementia goes through many phases – sometimes the person may be alert, sometimes not. Other times, he/she might be living at a younger age or era of his/her life.
My Mom had transient ischemic attacks (TIAs), which eventually caused dementia and forgetfulness. One day, she was hurrying back to the bathroom with her walker, exclaiming that she had to pick up the boys from school. She was talking about my youngest two brothers, who were 10 and 11 years younger than I. At the time, they would have been in their late forties. I simply reassured her that they didn’t need a ride that day and I knew they were fine, so she didn’t need to worry.
It really doesn’t help to contradict or correct the person with dementia. Doing so will cause their anxiousness to spiral upward and possibly make them angry. If the patient becomes angry or argumentative, calming them down will be even more difficult.
It is better to agree with them, to divert them to another activity, or to simply reassure them that the person or activity they wanted to do didn’t need to be done until the next day.
If the patient asks a question about how something works, simply provide a gentle explanation. The person may become frustrated because he/she couldn’t remember. Reassure them that there is no problem, that you are there to help.
Agreement and redirection are keys to assisting the patient.
My Mom had transient ischemic attacks (TIAs), which eventually caused dementia and forgetfulness. One day, she was hurrying back to the bathroom with her walker, exclaiming that she had to pick up the boys from school. She was talking about my youngest two brothers, who were 10 and 11 years younger than I. At the time, they would have been in their late forties. I simply reassured her that they didn’t need a ride that day and I knew they were fine, so she didn’t need to worry.
It really doesn’t help to contradict or correct the person with dementia. Doing so will cause their anxiousness to spiral upward and possibly make them angry. If the patient becomes angry or argumentative, calming them down will be even more difficult.
It is better to agree with them, to divert them to another activity, or to simply reassure them that the person or activity they wanted to do didn’t need to be done until the next day.
If the patient asks a question about how something works, simply provide a gentle explanation. The person may become frustrated because he/she couldn’t remember. Reassure them that there is no problem, that you are there to help.
Agreement and redirection are keys to assisting the patient.
Caregiving Maxim #9:
Don't take offense when they get angry, cuss you out, or accuse you of lying – they won’t remember and don’t mean it
As Dad’s Alzheimer’s disease progressed, he could state that he was losing a piece of his mind each day. The initial loss was so profound, he lost his entire memory of their (Mom & Dad’s) financial status immediately. He wouldn’t know even what his profession had been or that he had owned his own company at one time.
A few times, Dad became angry with me and told me I was lying. He would unequivocally state that I had not said something or he had not said something. I would tell him, “Dad, why would I lie to you. There is no reason for me not to tell you the truth.” Then, I would take him step-by-step from the beginning of the issue to the end until he was able to understand. He would then calm down and I could offer him the solution or possibly two choices to pick from. This worked well.
After a period of anger, one might find five minutes later that the patient doesn’t even remember what the issue was or that they were even angry. Many times, the anger stems from their frustration to understand what is happening.
When Dad would ask me a question about his/Mom’s lives, I would summarize the information into a one-page statement or a couple of paragraphs. He would keep these statements by his chair and read them over and over, but it was easier for him to understand, rather than trying to remember what I had explained to him.
A few times, Dad became angry with me and told me I was lying. He would unequivocally state that I had not said something or he had not said something. I would tell him, “Dad, why would I lie to you. There is no reason for me not to tell you the truth.” Then, I would take him step-by-step from the beginning of the issue to the end until he was able to understand. He would then calm down and I could offer him the solution or possibly two choices to pick from. This worked well.
After a period of anger, one might find five minutes later that the patient doesn’t even remember what the issue was or that they were even angry. Many times, the anger stems from their frustration to understand what is happening.
When Dad would ask me a question about his/Mom’s lives, I would summarize the information into a one-page statement or a couple of paragraphs. He would keep these statements by his chair and read them over and over, but it was easier for him to understand, rather than trying to remember what I had explained to him.
Caregiving Maxim #10:
Tell them: When you are ready, just let me know or come and get me
Occasionally, and perhaps more often in a dementia patient, a person may not feel like getting dressed or eating their breakfast.
Give them a five-minute break and tell them you will be ready when they are ready. Check on them in five minutes and see if he/she is ready to finish the dressing process. Often, he/she will be calling you long before the five minutes is up. This process may go on for thirty minutes, but usually resolution is reached long before that time is up, simply because the patient won’t remember what the problem was.
The caregiver may never find out what the problem was, but it is much more important to have peace and calmer patients than to struggle for twenty-thirty minutes and have everyone upset.
Give them a five-minute break and tell them you will be ready when they are ready. Check on them in five minutes and see if he/she is ready to finish the dressing process. Often, he/she will be calling you long before the five minutes is up. This process may go on for thirty minutes, but usually resolution is reached long before that time is up, simply because the patient won’t remember what the problem was.
The caregiver may never find out what the problem was, but it is much more important to have peace and calmer patients than to struggle for twenty-thirty minutes and have everyone upset.
Caregiving Maxim #11:
There's no crime in getting old - the patient may be a prisoner in his/her own mind, but not in reality. Don't treat them like they are a criminal
Our elders need to be respected as people in their own right. They have lived just as busy and complicated lives as we have. And, they have seen wondrous inventions during this time – the automobile, the airplane, space adventure, television and all the communication devices developed since that time, and the depression, the World Wars, Korea, Vietnam, and the neverending strife in the Middle East. Life for them was much more difficult than it is for us – we have all heard the saying – “I walked two miles to school through rain and snow, etc.”
I never thought I would be the age that I am now. My parents lived to be 81 and 85, and before I know it, the time will go fleeting by and I will be that age. The saying “getting old is not for sissies” is very true. Over 1.7 million people aged 65 and over die in the United States each year. The 2009 Alzheimer’s Disease Facts and Figures estimate that 454,000 new cases will be diagnosed in 2010. By 2030, it is estimated that there will be 71 million people equal to or over the age of 65 in the United States (973 million worldwide). Everyone ages!! By the way, Alzheimer’s is not a normal aspect of aging.
I volunteer for Hospice and visit different retirement/nursing homes. It breaks my heart to see so many older people there, just existing. Many cannot feed themselves, and many are lonely. Their lives may now be as simple as worrying about whether or not the aide gets them to the bathroom, or changes their diaper, or whether or not their dinner is coming.
No matter what the state of the elder’s mind is, and many are very alert – they all have stories to tell and want to be valued for who they are and what they have experienced. It isn’t their fault they have gotten older and that their bodies have failed them. They are still a person.
I never thought I would be the age that I am now. My parents lived to be 81 and 85, and before I know it, the time will go fleeting by and I will be that age. The saying “getting old is not for sissies” is very true. Over 1.7 million people aged 65 and over die in the United States each year. The 2009 Alzheimer’s Disease Facts and Figures estimate that 454,000 new cases will be diagnosed in 2010. By 2030, it is estimated that there will be 71 million people equal to or over the age of 65 in the United States (973 million worldwide). Everyone ages!! By the way, Alzheimer’s is not a normal aspect of aging.
I volunteer for Hospice and visit different retirement/nursing homes. It breaks my heart to see so many older people there, just existing. Many cannot feed themselves, and many are lonely. Their lives may now be as simple as worrying about whether or not the aide gets them to the bathroom, or changes their diaper, or whether or not their dinner is coming.
No matter what the state of the elder’s mind is, and many are very alert – they all have stories to tell and want to be valued for who they are and what they have experienced. It isn’t their fault they have gotten older and that their bodies have failed them. They are still a person.
Caregiving Maxim #12:
Their world is whatever age they are at
This maxim can apply to two different aspects of one’s life.
The first aspect is for the patient having some form of dementia. These patients may not always live in the present time. Their short term memory has disappeared, but their long-term memory may be accurate.
My Dad (an Alzheimer’s patient) sometimes felt like he had to go to work. He would want paper and a pencil, so he could make notes, even though he could no longer even write his name. My Mom, toward the end of her life (she had an aspect of dementia due to mini-strokes (TIA’s)), wanted to hurry to the bathroom so she could go get my brothers from school. One day, I heard them trying to dial the telephone to call Iowa – they hadn’t lived there for over 50 years.
The best way to handle these situations is to try to redirect them to another activity or thought. Also, reassure them that whatever they were trying to do is settled or that you will call and find out the information they were looking for. Reassurance is a key aspect in handling many caregiving situations. Reassurance can calm the patient.
The second aspect may also apply to the end of life. The dying patient has work to do to settle their mind before they die. Many times, this patient will revisit his/her life and review what his/her life was like. This life review may cause them to act like they are that age (the time of the review).
Several times, I thought my Mother was talking to her Mother. I asked her if she had seen her Mother, and she said, “Yes.” I would ask her what they had talked about – she couldn’t answer that question, but I could tell that she was going through this life review.
Their world is whatever age they are at is an important statement. Respect this age, realize that he/she are involved in important work. Accept the stage, be reassuring, and query them if you are comfortable doing so. Do not reject or discourage them from this process.
The first aspect is for the patient having some form of dementia. These patients may not always live in the present time. Their short term memory has disappeared, but their long-term memory may be accurate.
My Dad (an Alzheimer’s patient) sometimes felt like he had to go to work. He would want paper and a pencil, so he could make notes, even though he could no longer even write his name. My Mom, toward the end of her life (she had an aspect of dementia due to mini-strokes (TIA’s)), wanted to hurry to the bathroom so she could go get my brothers from school. One day, I heard them trying to dial the telephone to call Iowa – they hadn’t lived there for over 50 years.
The best way to handle these situations is to try to redirect them to another activity or thought. Also, reassure them that whatever they were trying to do is settled or that you will call and find out the information they were looking for. Reassurance is a key aspect in handling many caregiving situations. Reassurance can calm the patient.
The second aspect may also apply to the end of life. The dying patient has work to do to settle their mind before they die. Many times, this patient will revisit his/her life and review what his/her life was like. This life review may cause them to act like they are that age (the time of the review).
Several times, I thought my Mother was talking to her Mother. I asked her if she had seen her Mother, and she said, “Yes.” I would ask her what they had talked about – she couldn’t answer that question, but I could tell that she was going through this life review.
Their world is whatever age they are at is an important statement. Respect this age, realize that he/she are involved in important work. Accept the stage, be reassuring, and query them if you are comfortable doing so. Do not reject or discourage them from this process.
Caregiving Maxim # 13:
Every day is a new day - the patient/caregiver won't know what the day is like until it is experienced
The patient with dementia may be a different person each day or several different people each day. He/she may be sleepy, may be alert and ready to go somewhere, may want to eat, may not want to eat, may want to talk, may want to be alone, may be restless, etc.
The caregiver needs to come to the caregiving situation with a new perspective each day and always be ready to see a new personality. The patient may also be their normal self for many days, and then change for a few days. Don’t take offense at these changes. The disease is causing these changes, and most likely, the patient does not want to be difficult to handle and would be embarrassed at being so.
The caregiver should adjust to the daily situation, become familiar with the patient’s personality, know what they like, and adjust the day to accommodate to the situation. Make a milk shake or some goodie that the patient likes. Serve a favorite food, or take them for a ride in the car to see the scenery. If the patient wants to sleep, that is OK too!
Adjust and accommodate!
The caregiver needs to come to the caregiving situation with a new perspective each day and always be ready to see a new personality. The patient may also be their normal self for many days, and then change for a few days. Don’t take offense at these changes. The disease is causing these changes, and most likely, the patient does not want to be difficult to handle and would be embarrassed at being so.
The caregiver should adjust to the daily situation, become familiar with the patient’s personality, know what they like, and adjust the day to accommodate to the situation. Make a milk shake or some goodie that the patient likes. Serve a favorite food, or take them for a ride in the car to see the scenery. If the patient wants to sleep, that is OK too!
Adjust and accommodate!
Caregiving Maxim #14:
Wait five minutes if patient doesn’t want to do something – their perspective will change and they won’t remember what happened
The patient may be grumpy on some days or not in the mood to get dressed or to eat.
It is very important for the caregiver to step back and let the patient settle down. Dressing or eating are important activities, but not urgent at a particular moment. If the caregiver is in the middle of cooking breakfast, lunch, or dinner and wants to hurry the patient into the kitchen, it is much easier on the caregiver if she lets the patient rest for a few minutes.
The patient’s perspective will change, as will the caregivers. Go back to the patient in five minutes and see if they are ready to finish dressing or to go to the kitchen (or whatever activity is desired). Most likely, the patient will be glad you have returned to the room and will be quite willing to comply.
Most important, the caregiver will have taken five minutes to take a deep breath, relax, and be able to go back in a calmer mood to deal with the patient.
It is very important for the caregiver to step back and let the patient settle down. Dressing or eating are important activities, but not urgent at a particular moment. If the caregiver is in the middle of cooking breakfast, lunch, or dinner and wants to hurry the patient into the kitchen, it is much easier on the caregiver if she lets the patient rest for a few minutes.
The patient’s perspective will change, as will the caregivers. Go back to the patient in five minutes and see if they are ready to finish dressing or to go to the kitchen (or whatever activity is desired). Most likely, the patient will be glad you have returned to the room and will be quite willing to comply.
Most important, the caregiver will have taken five minutes to take a deep breath, relax, and be able to go back in a calmer mood to deal with the patient.
Caregiving Maxim #15:
Using the words “Do you remember” is a pitfall. The patient may not remember and may feel badly that they can’t
During the first few months that I was caring for my Mom and Dad, I would ask Dad, “Do you remember about this or that” and he wouldn’t be able to remember. He would feel bad when I asked. He would tell me, “I feel like I am losing a piece of my mind every day.” This statement came from an engineer and architect who had owned his own company!! I would find hard back best seller books in the trash. When I asked Dad why he threw away the book, he would reply, “Nothing in there makes any sense! Why would someone write such trash!!"
When Dad was tested for Alzheimer’s disease using the Mini-Mental State Examination (MMSE), he would either look to me for the answers or look at me and say, “Boy, I am really dumb, aren’t I?” That was enough to make me cry!!
I eventually changed the way in which I approached him. I would prepare one or two simple graphs or a paragraph or two of explanation that he could read. I would then tell him the two main choices that we had to pick from. This way, Dad would feel comfortable that he was involved in the process of the decision making.
He might not remember that we had talked or what we had decided, but he could tell enough at the time to help out with the decision. This method of decision making made him feel more important.
When Dad was tested for Alzheimer’s disease using the Mini-Mental State Examination (MMSE), he would either look to me for the answers or look at me and say, “Boy, I am really dumb, aren’t I?” That was enough to make me cry!!
I eventually changed the way in which I approached him. I would prepare one or two simple graphs or a paragraph or two of explanation that he could read. I would then tell him the two main choices that we had to pick from. This way, Dad would feel comfortable that he was involved in the process of the decision making.
He might not remember that we had talked or what we had decided, but he could tell enough at the time to help out with the decision. This method of decision making made him feel more important.
Caregiving Maxim #16:
Try less – give in more!
Caregiving Maxim #17:
Accommodate, Accommodate, Accommodate
This maxim is especially important with a patient that has dementia, but applies to all caregiving situations. The caregiver’s agenda is not the important agenda. There are basic needs that should be adhered to each day – keeping the patient clean, making sure the patient eats healthily each day, and having the patient take the proper medications in a timely manner. Those three items should be the daily goals. Any thing else can be delayed or put off.
The caregiver can certainly apply his/her persuasion skills to getting the patient to help with daily housekeeping duties, or keeping the patient entertained. Some days will be more difficult than other days for perhaps no reason. People that are ill may not have energy that day or just may not feel good. Remember the caregiver is there to take care of the patient, and not to impose his/her needs on the patient.
Give in to the patient’s wants – if they only eat a few bites at breakfast, try to make those few bites count calorie-wise. Another tactic is to give them smaller meals or to split the food into two dishes – e.g., eggs on the plate and fruit in a bowl. If they finish the eggs, offer the fruit. If they want to take a nap, let them.
Accommodate the patient’s needs for the day – work around those needs, ensuring that the basic three tasks are performed throughout the day. Keeping the patient as healthy as possible can extend their life.
Two of the most important changes that I made when I came into my parents’ home were: I bought quart size plastic jars to keep the milk and juice in. Dad could no longer lift the half gallon size carton easily. But, he could lift the quart size jar and pour their juice or milk. This kept him feeling useful. The second change was to fill the water and coffee in the coffee pot the night before. Dad couldn’t remember how to make the coffee and we had several disasters. Having the pot ready to turn on allowed him to just “push” the button in the morning and Voila!, they had coffee in a few minutes. We still had a few disasters, but this was a great accommodation.
The caregiver can certainly apply his/her persuasion skills to getting the patient to help with daily housekeeping duties, or keeping the patient entertained. Some days will be more difficult than other days for perhaps no reason. People that are ill may not have energy that day or just may not feel good. Remember the caregiver is there to take care of the patient, and not to impose his/her needs on the patient.
Give in to the patient’s wants – if they only eat a few bites at breakfast, try to make those few bites count calorie-wise. Another tactic is to give them smaller meals or to split the food into two dishes – e.g., eggs on the plate and fruit in a bowl. If they finish the eggs, offer the fruit. If they want to take a nap, let them.
Accommodate the patient’s needs for the day – work around those needs, ensuring that the basic three tasks are performed throughout the day. Keeping the patient as healthy as possible can extend their life.
Two of the most important changes that I made when I came into my parents’ home were: I bought quart size plastic jars to keep the milk and juice in. Dad could no longer lift the half gallon size carton easily. But, he could lift the quart size jar and pour their juice or milk. This kept him feeling useful. The second change was to fill the water and coffee in the coffee pot the night before. Dad couldn’t remember how to make the coffee and we had several disasters. Having the pot ready to turn on allowed him to just “push” the button in the morning and Voila!, they had coffee in a few minutes. We still had a few disasters, but this was a great accommodation.
Caregiving Maxim #18:
Create a loving and healthy environment
This maxim is a very important concept. The patient has been a productive member of society before their illness. He/she may now feel like they no longer contribute to society or to the family. Their self-esteem may be suffering and the patient may feel useless and helpless.
Coming into a patient’s home is a challenge. The patient may not want to be cared for and may not want strangers in their home. The caregiver’s job is to be cheerful, to be loving and caring, to joke with the patient, and basically – to learn what the patient likes/dislikes and to create a caring atmosphere, while keeping the patient as healthy as possible.
There may be times when the patient is so testy that this is impossible. The patient may not want to be healthy and may refuse your efforts to keep up a proper diet (e.g., for diabetics or heart patients). The caregiver will have to assess whether or not this household will work with his/her personality. It may not. Accepting this and moving on to another caregiving assignment should be accepted.
Give the patient treats, like their favorite food, a milkshake, or dessert (if he/she can have them). My Dad loved cantaloupe, so I grew some in the backyard – the couple that actually grew turned out very sweet and he loved watching them grow. The patient with Alzheimer’s never loses their taste for sweets – both Dad and Mom loved See’s candies or Hershey’s. As they didn’t enjoy having a big meal at night, the candy actually supplemented their calories and allowed them to have small snacks in the late afternoon. Maybe not the healthiest outcome, but neither one had dietary restrictions.
Coming into a patient’s home is a challenge. The patient may not want to be cared for and may not want strangers in their home. The caregiver’s job is to be cheerful, to be loving and caring, to joke with the patient, and basically – to learn what the patient likes/dislikes and to create a caring atmosphere, while keeping the patient as healthy as possible.
There may be times when the patient is so testy that this is impossible. The patient may not want to be healthy and may refuse your efforts to keep up a proper diet (e.g., for diabetics or heart patients). The caregiver will have to assess whether or not this household will work with his/her personality. It may not. Accepting this and moving on to another caregiving assignment should be accepted.
Give the patient treats, like their favorite food, a milkshake, or dessert (if he/she can have them). My Dad loved cantaloupe, so I grew some in the backyard – the couple that actually grew turned out very sweet and he loved watching them grow. The patient with Alzheimer’s never loses their taste for sweets – both Dad and Mom loved See’s candies or Hershey’s. As they didn’t enjoy having a big meal at night, the candy actually supplemented their calories and allowed them to have small snacks in the late afternoon. Maybe not the healthiest outcome, but neither one had dietary restrictions.
Caregiving Maxim #19:
Use common sense, take deep breaths, and be cheerful
Think of yourself as a mother/father with a small child. The mother or father leads the child in the child’s activities throughout the day – feeding, potty training, play, safety. This concept can apply to caregiving as well. It is the responsibility of the caregiver to ensure that the patient is eating as well as possible, taking their medications, is clean, and stays safe.
Doing so may be taxing at times. The key is to take a few minutes, take deep breaths, and calm yourself. The patient may not be able to help being cranky. Redirect the patient to a new activity or room. Be as cheerful as possible. Think about the beauty of the day, of nature, the fact that you have a job, and that this person does not mean to be cranky.
Establish a rapport with the patient – come in each day cheerfully. Engage them in conversation, talk them through the next task, so he/she knows what to expect. Bribe them, if necessary.
I volunteer for Hospice. Last week, I was visiting my patient and feeding her dinner. The gentleman next to her refused to eat. The dietician eventually came over and reminded him he had promised her he would drink a milkshake for her. He nodded and she brought the milkshake. When he had finished about 2/3 of the shake, she came in a poured a few more ounces in it, reminding him that he had promised he would drink it. And drink it, he did. There is always a way to cajole or persuade the patient to do what you need them to do.
Common sense also applies to toileting. If the patient no longer makes it to the bathroom on his/her own, try using either pull-ups or a diaper kind of pull-up (easier to get on/off). Take the person to the bathroom every two hours, and ½ hour after meals. Doing so will ensure that accidents do not happen too often. Take extra clothes in the car, just in case.
Doing so may be taxing at times. The key is to take a few minutes, take deep breaths, and calm yourself. The patient may not be able to help being cranky. Redirect the patient to a new activity or room. Be as cheerful as possible. Think about the beauty of the day, of nature, the fact that you have a job, and that this person does not mean to be cranky.
Establish a rapport with the patient – come in each day cheerfully. Engage them in conversation, talk them through the next task, so he/she knows what to expect. Bribe them, if necessary.
I volunteer for Hospice. Last week, I was visiting my patient and feeding her dinner. The gentleman next to her refused to eat. The dietician eventually came over and reminded him he had promised her he would drink a milkshake for her. He nodded and she brought the milkshake. When he had finished about 2/3 of the shake, she came in a poured a few more ounces in it, reminding him that he had promised he would drink it. And drink it, he did. There is always a way to cajole or persuade the patient to do what you need them to do.
Common sense also applies to toileting. If the patient no longer makes it to the bathroom on his/her own, try using either pull-ups or a diaper kind of pull-up (easier to get on/off). Take the person to the bathroom every two hours, and ½ hour after meals. Doing so will ensure that accidents do not happen too often. Take extra clothes in the car, just in case.
Caregiving Maxim #20:
Change is constant
Change is constant – every day can be different. Long periods of constancy are also possible. However, assessing each month, three months, or six month periods will show changes in the patient’s health and capabilities.
Be aware that the patient could change at any minute. Watch how he/she performs different duties and accommodate any activities that are no longer possible. Journal the changes in caregiving notes to keep a record of what has occurred. These notes will be important to medical professionals.
Know that change can be important to the patient’s health and well-being. Do not be afraid to call the primary care doctor or Hospice nurse and ask for help or advice. What the caregiver sees may be vitally important and indicate a change in medications or assistance level.
Be aware that the patient could change at any minute. Watch how he/she performs different duties and accommodate any activities that are no longer possible. Journal the changes in caregiving notes to keep a record of what has occurred. These notes will be important to medical professionals.
Know that change can be important to the patient’s health and well-being. Do not be afraid to call the primary care doctor or Hospice nurse and ask for help or advice. What the caregiver sees may be vitally important and indicate a change in medications or assistance level.
Caregiving Maxim #21:
Don’t take this path by yourself – support is absolutely crucial to your wellbeing now and afterwards
Caregiver stress is very easily acquired, especially in family members. It isn’t that the caregiving itself is so hard – it is the day-to-dayness of it and the constant worry. The caregiver is watching his/her loved one deteriorate. This deterioration becomes a worry and burden, almost like having fifty pounds of weight on one’s shoulders. One worries about what is going to happen and how it will happen.
For example, my mother had emphysema. I was worried about her being in pain or suffocating as she neared the end of her life. These types of worries are why Hospice is so important. Hospice can alleviate the stress of caregiving. Medication combinations are very available to control pain and to make breathlessness calm down. No patient should be in pain these days. Hospice supports the family (if the family will accept their help) during the caregiving process and afterward.
Ask for support – go to caregiving support groups or support groups that can help the caregiver deal with a specific disease, like Alzheimers, Diabetes, Lung Disease, Cancer, etc. Ask the family to take turns relieving the main caregiver to give them a chance to get out of the house or to be on their own for a few hours. Find a close friend that you can talk to. Many times, all the caregiver needs is someone to talk to, someone who can be the peacemaker in the family and who can reassure the caregiver that he/she is needed and is doing the right thing.
For example, my mother had emphysema. I was worried about her being in pain or suffocating as she neared the end of her life. These types of worries are why Hospice is so important. Hospice can alleviate the stress of caregiving. Medication combinations are very available to control pain and to make breathlessness calm down. No patient should be in pain these days. Hospice supports the family (if the family will accept their help) during the caregiving process and afterward.
Ask for support – go to caregiving support groups or support groups that can help the caregiver deal with a specific disease, like Alzheimers, Diabetes, Lung Disease, Cancer, etc. Ask the family to take turns relieving the main caregiver to give them a chance to get out of the house or to be on their own for a few hours. Find a close friend that you can talk to. Many times, all the caregiver needs is someone to talk to, someone who can be the peacemaker in the family and who can reassure the caregiver that he/she is needed and is doing the right thing.
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