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Welcome to

Presenter

Beth ProppMaster Trainer

AGE‐u‐cate Training Institutebeth@ageucate.com

1© 2016 AGE‐u‐cate® Training Institute

A Foundational Tool for Person‐CenteredCare Practices

© 2016 AGE‐u‐cate® Training Institute 2

The Need

© 2016 AGE‐u‐cate® Training Institute

As the population of people living with dementia rapidly expands, care providers must learn new ways to UNDERSTAND and RESPOND to the needs of these individuals.

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Answering the Need

Pain, hunger, thirst, boredom, loneliness, underlying di l  di i

Examples:  behavioral expressions such as restlessness, anxiety, aggression, screaming

Root causes

© 2016 AGE‐u‐cate® Training Institute

medical condition

Unmet Needs

Dementia Action Alliance, 2015

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Understanding

© 2016 AGE‐u‐cate® Training Institute

Empathy

Compassion

Care

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© 2016 AGE‐u‐cate® Training Institute 6

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© 2016 AGE‐u‐cate® Training Institute 7

© 2016 AGE‐u‐cate® Training Institute 8

© 2016 AGE‐u‐cate® Training Institute 9

3/27/2017

1

Welcome

Presenter

Beth ProppMaster Trainer

AGE‐u‐cate Training Institutebeth@ageucate.com

© 2017 AGE‐u‐cate® Training Institute

“Items we see from when we were younger hit a soft spot in ALL of us and open lines of communication.” Anonymous  

Can be used with:

STAFF OR FAMILY CAREGIVERS‐To build insight intoSTAFF OR FAMILY CAREGIVERS‐To build insight into how everyday items are a powerful communication tool to strengthen care partner relationships.

ELDERS ‐To reconnect elders with experiences of daily life, re‐capture feelings, and strengthendaily life, re capture feelings, and strengthen bonds with care partners.

FAMILY ENGAGEMENT in community and/or home care ‐ To engage family caregivers in meaningfulcare  To engage family caregivers in meaningful interaction with loved ones. 

COMMUNITY OUTREACH ‐To strengthen marketability with an innovative approach tomarketability with an innovative approach to community engagement.

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“ I have learned that NO MATTER our age or appearance of ability, When we do something that we LOVE

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When we do something that we LOVE, It Transforms us.”

Ronnie Sellers‐Author50 things to do when you turn 50

Dementia Live Empowerment Tools for Better Communication and Understanding

Dementia gradually diminishes a person’s ability to communicate. They have more difficulty expressing thoughts and emotions, and have more trouble understanding others. Here are some ways to help you better communicate with a person with dementia. TIPS TO EFFECTIVE COMMUNICATION

1. Eye contact is always best! Position yourself on their level and establish direct eye contact. Speak calmly in a normal tone of voice. A gentle hand touch can be an effective tool for engaging with a person with dementia.

2. Listen with understanding and interest. We all want to be heard, cared for and

validated. When we show others our authentic selves, we connect with them on a personal level. Remember they have feelings, and while they may not be able to express them as they once did, who they are and how they feel are very real.

3. Limit your conversations to short, simple sentences. A person with dementia

will often shut down when they are given too much information. Their brain cannot process communications like they used to. Slow down, give them time to process and respond back.

4. Never ever argue! A person with dementia does not have the same reality that you do. Their world has changed. It’s your job, as their care partner, to creatively step into their world with empathy, understanding and love. Remember that they are not acting this way on purpose.

5. Reminisce. Persons with dementia usually recall memories from long ago. They often find security and peace by sharing old memories and life stories.

Challenging Expressions of Need As dementia progresses a person may have difficulty expressing what they need. When this happens, behavior may become a means of communicating. The unpredictability of these changes in behavior can be stressful for caregivers. Anticipating behavior changes and understanding the root cause can be extremely helpful in learning to navigate them.

Tips for understanding challenging expressions of need

1. Ask questions. There are many causes for behavior. Ask yourself why your care receiver is behaving this way. Is their agitation an expression of pain? Is their reduced appetite due to ill-fitting dentures? Back up to what was happening just before the behavior – this may hold the clue to what the behavior means.

2. Look for a pattern. Talk with other members of your care team (including family)

and see if you can observe a pattern related to the behavior. Look at circumstances surrounding the behavior. Does it happen at the same time of day or in the same situation?

3. Be positive. Behavior that is met with a positive response will generally be repeated. Don’t be condescending, but rather encouraging. We all like to feel that something we do is appreciated and done well.

4. Look at your nonverbal communication. People with dementia can be sensitive to changes in facial expression, posture, mood or tone of voice. They can feel your stress and your impatience. If you have a difficult time with a person, take a minute to assess what message your face, your mood and your body position may be communicating.

5. Smile! We’ve heard it a hundred times, but a smile can go a long way. The times

when your smile may make the biggest difference in behavioral change is when it’s the most challenging to do. So, take a deep breath, count to 3, smile and be positive.

6. Validate, join and distract. One effective method for managing a challenging

behavior is to connect with their emotion, then calmly and gently redirect the conversation or activity. If, for instance, they insist on wanting to leave, your response might be “I know you miss your daughter. I see these pictures of her. Can you show me your beautiful family?” And redirect them to the family photo album.

7. Step back when necessary. Aggressive behavior is often spontaneous and may

take some time to get to the root cause. Never argue or be assertive back. The safety of both you and your care receiver is always a priority. This may be when you need to pause, take a breath and ask for someone else to take over while you step out of the situation for a moment. Patience and calm must be the foundation of a care partner’s response.

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Dementia Live Empowerment Tool For Improving Care Processes

We recommend an assessment tool be used as a checklist prior to beginning care. This will be helpful in determining:

1. The person’s habits (eating, daily schedule, napping, toileting, etc.) 2. Family member’s input and choices concerning care 3. Observation to help determine the person’s current abilities to perform daily

tasks, and areas where assistance is needed. Key Areas of Care Bathing can be frightening, uncomfortable and embarrassing, especially for new care partners. A person with dementia may forget how to bathe or become more sensitive to hot or cold water. As a result, bathing may cause anxiety and resistance to care. Suggestions:

1. Be sure that you have a clear assessment of bathing habits so that fear and anxiety can be minimized.

2. Safety should be a priority at all times. 3. Help the person to feel secure by calmly coaching (through talking and

demonstration) each step of the process. 4. If privacy is a concern, loosely wrap the individual in a towel during bathing and

try sponge baths. Oral Care is vitally important to overall health, prevention of infection, eating difficulties and pain and digestive problems. A person with dementia may forget how to brush or why it is important. Suggestions:

1. Coach them through short simple steps and demonstration (hold toothbrush, put toothpaste on the brush, brush teeth).

2. If a person has dentures, recognize that they may prefer not to wear them all the time (eating may be one of these times because dentures can become loose.)

3. Look for signs of discomfort and infection so that a physician can provide proper care. Someone with advanced dementia, consider using a “toothette”, which is a simple cushion swab for the mouth.

Dressing should be an area that is discussed with family members and observed prior to starting to provide help. Suggestions:

1. Simplify clothing choices while allowing as much decision making as the person with dementia is comfortable and capable of providing.

2. Calm verbal and demonstrative coaching will help alleviate frustration and anxiety. Gently help them with their clothing, remembering they are generally not as flexible as the average person, and you do not want to stretch or pull muscles that may cause pain.

3. Comfortable clothing will generally be preferred, even if they like to “dress up”. Clothing that is easy to put and take off, well- fitting non-slip shoes and layering is a good plan.

Toileting is often a fragile topic. Many people with dementia have accidents because they may forget where the toilet is, no longer recognize the need “to go”, are unable to initiate the activity, or wait until it’s too late. Many persons in later stages of dementia lose control of their bladder and/or bowels. If this happens, have a doctor evaluate potential causes of incontinence. Suggestions:

1. Assess urinary and bowel patterns or incontinence including: smell of urine or feces in the home or on clothing, soiled clothing, use of adult undergarments, or increased privacy while laundering or bathing.

2. Create a toileting schedule that may reduce or eliminate accidents. 3. Suggest going to the kitchen or to do some other activity as a way to get the

individual up and moving and then as you start walking suggest a stop at the bathroom.

4. Maintain exercise, healthy diet and sufficient fluid intake to maintain health and regularity.

5. Be supportive and help to reduce feelings of embarrassment. Eating and Drinking abilities and preferences will change overtime as a result of dementia. The individual’s ability to sequence and prepare even simple meals will decline as will their ability to remember to eat or drink, remember when they last ate, know or say they are hungry or thirsty. Sensory changes will affect their food and drink preferences. At the same time, food and mealtime can be very enjoyable if prepared and presented appropriately for their needs. Suggestions:

1. Observe eating and drinking patterns, food/drink preferences and challenges. To the extent possible involve the individual with dementia in determining food preferences and as needed, ask their family for their food favorites and dislikes and note that preferences can change overtime. The goal should be to make mealtime as enjoyable as possible while also meeting nutritional needs.

2. Utilizing cups, dishes and utensils may become difficult. With proper assessment, it may be possible to adjust the way food is prepared so that they can eat with as much independence as possible.

3. Meal time should be a pleasant experience. Try not to rush, limit distractions and extraordinary confusion during mealtime and engage with them as much as you feel comfortable with doing.

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