Caregiver Tips: Communicating change in condition for confused elderly in Nursing Home to the staff

Communicating change

Family members see changes in confused elderly.

Family members aren’t always the recognized authorities on their loved one’s condition. Yet they are an invaluable resource for the nursing home staff. Family and friends have that one-on-one, usually for hours that the facility staff isn’t able to provide.

The right kind of communication.

I recently spoke at a family support group where a family member voiced her frustration with the staff. She said her mom “just isn’t right”, “something is wrong” and “this has been going on for over two weeks.” She repeated these phrases over and over, communicating nothing. What isn’t right, what is wrong, what have you seen for over two weeks?

What is a significant change in a confused elder’s condition?

The rule of thumb is that a dramatic change in any body system must be reported to the physician immediately. This includes an abrupt change in:
• behavior
• difficulty arousing the elder
• high fever
• dizziness or unsteadiness
• sight or hearing
• ability to communicate or speech patterns
• personality
• eating
• difficulty swallowing
• weakness or decreased use of an extremity

The elderly need to be watched constantly for anything that appears suddenly and is dramatically different from the norm for that person.

Communicating the change you see to Nursing Home staff.

• Don’t hesitate; voice your concern to the nursing home staff.
• Identify and talk to the staff that may be more pro-active in problem solving.
• Establish yourself as part of the team caring for the elder.
• Be willing to participate as part of the solution.
• Realize that seeing an unaddressed change in condition can be stressful. Try to communicate your concern without becoming overly emotional.

Book excerpt from: Please Get To Know Me- Aging with Dignity and Relevance

Caregiver Tips: When the confused elderly suffer abuse in the Nursing Home

Nursing Home Abuse

Couple shows signs of Nursing Home abuse.

Every time someone walked by her, she flinched. Ella reacted as though at anytime she thought someone might strike out at her, and so she ducked.
Ella and Carl had come to us from a nursing home out of state. They arrived off the plane, both in hospital gowns, bathrobes and slippers. They looked like they had literally just gotten out of bed and got on the plane. No one had ever arrived like that before or since.

Ella and Carl had decided on retirement to relocate to a southern state, with warmer weather. Their niece visited as often as she could, but as the years went by it became less and less frequent. Now, when she had gone to visit, they both were in a nursing home, and she decided to move them closer to her.

We soon realized during the admission process that both Ella and Carl had numerous bruises. Their niece confirmed that “It wasn’t a very nice place” she had taken the couple out of. Now it was our goal to give this couple, married for 62 years, the opportunity to enjoy their remaining years together.

Abused couple find comfort in Nursing Home.

Both Ella and Carl had a moderate degree of dementia. They knew who they were and recognized their niece, but had very limited verbal skills left. A plan was put in place to reassure and reassure them again, that they were “safe.”
All staff were instructed on how to approach Ella and Carl.

• Always approach from the front where they can see you, don’t approach from their side or from behind them.
• Make direct eye contact when you approach.
• Smile – present yourself as a friendly, safe person.
• Say their name as you approach so they realize they know you.
• Never attempt to touch them and begin to provide care before you have followed previous steps.

Carl passed away soon after they came to stay with us. Ella lived for several years after losing Carl. It took four months for Ella to be totally comfortable and we no longer would see that flinch when people approached. Ella spent the rest of her days with frequent visits from her very caring niece as well as the staff that grew to not only care for her but about her.

Caregiver Tips: Choosing a Nursing Home for your elderly parent (Part III)

Choosing a nursing home

The responsibility of choosing the Nursing Home.

Bob was an only son and over the years had wished for a sibling, but never so much as now when he needed to find a Nursing Home for his mom. He had thought he had this done, and she was settled. The entrance to Friendly Acres was elegant, the receptionist so friendly. She offered him coffee and freshly baked cookies, while he waited for the director of Admissions.

The tour couldn’t have been better, so very clean, “hospital” clean. It had all smelled something like a hospital now that he looks back. They had the best of everything, the best equipment, the newest and prettiest bedspreads and curtains. When he visited Friendly Acres it had never occurred to him to look at the elders living there, or to talk to them.

But now after a few months, everything was looking different. While mom never was a big eater, she now said nothing had “any taste.” Whenever he stopped by to see mom, she was sleeping in her chair. He never noticed anyone talking to her. Come to think of it he never saw staff talking to any of the elderly people there. Mom had always liked to take a tub bath, he remembered Saturday nights when he was a kid and they all took turns taking a tub bath. Now I guess at Friendly Acres they only have showers and the schedule for mom didn’t fit for Saturday night. It just isn’t working out.

So here he is starting all over again – wishing for that sibling to talk it over with.

5 Things to look for when choosing the Nursing Home.

• Take someone with you for a second or third set of eyes and compare impressions after the visit.
• Visit more than once – the nursing community should not mind showing you and a friend or family member around again. After all this is a major decision.
• Ask the staff if they like working there – they should say something about how they like working with the elderly. If they say it is “close to home” and “better paying than fast food”, take a closer look.
• Ask permission to talk to a resident. Ask the resident how they like it there, and how is the food? Remember food is subjective and not a deal breaker.
• Do the residents look busy, occupied, in small groups doing something? Or are they all asleep in their wheelchairs?

When looking at a nursing community, keep in mind everyone won’t do everything exactly the way you would. What you are looking for is how does it “feel?”

Caregiver Tips: How to choose a Nursing Home for your elder, when you need a break. (Part II)

Choosing a Nursing Home

Finding the right Nursing Home for a respite stay takes as much time as looking for long term care. In the case of a respite stay however, there are fewer emotions involved, because this decision is not a permanent placement. However when a good fit is found for the elder, it becomes much easier for the family if in the future they do need to consider a permanent situation.

5 Things to look fro during your Nursing Home tour:

• Are people friendly – everyone you pass during the walk through should smile and at least nod if not say “Hi.” The person touring you from Admissions/Marketing will be very friendly and personable; those are the kind of people who work in Marketing. But how about the rest of the staff? Does the management team – Administrator, Director of Nursing, Owner, smile and greet the residents of the Home? Or, do they just rush past as though they are too busy? From the nursing department to the housekeeping, maintenance department everyone should be greeting you, residents and each other when they pass.

• Are people interacting with residents? Do you hear conversation? When you walk past a resident’s room is the staff chatting with the residents? Or, is the staff off in a little group talking to each other? Nursing staff should be scattered throughout the facility, doing things with the residents?

• Do they use words like “person centered care” and talk about the choices people have. Or do they talk where the elder would fit in on their schedules? Do they seem interested in who your elder is, or do they seem more interested in the tasks needed to be done to care for your elder?

• Are activities in one large group – with most of the residents sleeping?
Or, do they have small group activities going on at the same time. Do the residents seem engaged and enjoying the activity?

• Staffing – how many residents per Nurses or Certified Nursing Assistants.

The time is long past to talk about – how does the facility smell! The nursing home may not smell and may look great, but the question should be how does it feel?

Caregiver Tips: When the family caregiver, of a senior with Alzheimer’s disease, is tired…

Respite care

Respite care, just means giving the family a break.

“I’m just so tired I can’t think” said Myrtle, as she sat across the desk from me. Her white hair was disheveled; she held her head down and kept rubbing her forehead. Myrtle appeared to be in her mid eighties, and so, so tired. She said “We always promised to take care of each other.” This wasn’t the first “Myrtle” I had met.

These Myrtles had gotten into a habit of doing everything themselves. And now after years of being the caregiver, they are providing 90% of the care for a totally dependent elder, while they are now elderly themselves.

They usually:
• Have someone in to help a few hours a week, so they can do errands, banking, grocery shopping, get a hair cut.
• Do not use the time they have help to meet a friend, have lunch, see a movie.
• Have become very isolated, and have lost contact with friends.
• Have not let people know they need help.
• Have not taken a vacation for years.

Two kinds of respite for the caregiver.

Two are two kinds of respite. For the first the caregiver goes away and you have home health help come in. This works well for the caregiver going on vacation or for a family occasion away.

For the second, the caregiver is staying home and needs a break, so the elder goes to a nursing facility. Respite is usually short term, from a few days to several weeks.

Watch for Part II, picking the right facility.

Aging: Check your expectations at the door, when you visit the elderly in the Nursing Home

Visiting Nursing Home

Visiting the Nursing Home

Mom seldom had her familiar ear to ear smile of greeting anymore. I’m not sure when we started to realize the change. But in going to see her every Sunday, I had somewhat gotten used to it. But not so much my sister Ruth. When Ruth came she had over a 3 hour drive one way and could only come once a month. And in the winter months coming from Northern Wisconsin, she usually couldn’t come at all for months at a time.

So when Ruth came, she kind of expected to see that look of surprise and delight that she was used to. Many times when she came she would find Mom dozing in her wheelchair and wake her up. Upon seeing Ruth, Mom would immediately share her most recent concern “My feet hurt, could you get the nurse to put on my foot crème.” Or maybe “My back hurts I need to lie down for a nap.” “But, Mom I just got here don’t you want to stay up for awhile?” Ruth would ask.

Caregiver Tips: When the caregiver in the Nursing Home is too involved.

Caregiver Too Involved

The Caregiver’s story:

Her name was Beverly, she was a middle age woman of short stature with dark brown curly hair cut short. This was her first night on the 11-7 and she told me how she had worked for over 20 years at her previous nursing facility where she had just been let go. She appeared more than willing to tell of the unfairness that had fallen on her after her years of service.

The story spilled out of her. Seems she had for the last several years cared for a lady in the late stages of Alzheimer’s disease. This was the nicest, sweetest lady she had ever cared for. As time went on she became aware that this lady had no visitors. She helped herself to the woman’s medical record and saw that she had a son and family living in the next town.

This information bothered Beverly and eventually she built up her courage and went to the son’s home, rang the doorbell and confronted him about what she saw as his neglect of his mother. And for this she was fired.

The Family’s story:

I asked her if during this time when Beverly had taken care of the mother: had the son provided for his mother? Oh, yes! Did she have clothes? Oh, yes he always brought her things and left them at the front desk, but didn’t go to see his Mom. Did, he support her? Oh, yes she had noticed ( again while looking the chart) that the son was the guardian and bills were sent to him.

So then I asked her why she felt that she was in the position to judge him.

So often over the years, I have heard healthcare workers be judgmental of family members. Who would want someone taking a magnifying glass to our family dynamics and judging us? For all of us there will someday be a judging, but till that time, Let Go – Let God.

AGING: Promise you won’t put me in a nursing home – fear of becoming old, and frail make seniors ask for “The promise”.

People 85 and older, fastest growing segment of population.

Senior citizens fastest growing segment of the population. As people age they often ask of their family “Promise you won’t put me in a nursing home.” Fear of nursing homes is connected to the fear of aging. In this culture people often fear aging, frailty and disability more than death. The picture of aging is often a picture of someone helpless and hopeless.

Many family members give the promise.

As a nurse, many times when talking to a family member, they have shared the information with me that “I always promised I would never put her in a nursing home. But I tried to take care of her as long as I could, I just couldn’t give her the care anymore that you can.”

People now living much longer.

It used to be rare in a nursing home to see someone over 100 years. When we had a resident over 100 years, staff would all go to see that “old person.” Now it is very common for a nursing home to have much older people. My mother’s home had a monthly birthday party recently and of the 4 people honored – 3 were over 100. My Mom is 85 soon to be 86 and her best friend there is 104 years. Old enough to be her mother.

However for her friend, being 104 means she has out lived almost all of her family. She now has only a Granddaughter left with one child. Anyone she would have asked to make that promise to her is gone. As the population ages, many families who have made such a promise with the best of intentions, because of their own age and health concerns are no longer able to care for a elderly spouse or parent.

3 Promises you should make instead of “The Promise.”
• Promise to do the best you can. The person asked you because they trust you. Tell them that you will always do whatever you can to take care of them. You don’t know what circumstances may happen in the future.
• If someday you may have to find a caregiver or a Nursing facility, promise to find the best one you can.
• Promise to visit regularly – the fear of being abandoned is great. Because people are afraid of being abandoned they use the word put “promise you won’t put me in a nursing home” instead of admit, place, register, words with a more positive sound. As my Mother once told me, some people are just put here like something on a shelve to be forgotten.

If you have an elderly parent see:

Caregivers Tips- for Celebrating the Holidays with Elderly with Alzheimer’s Disease in a Nursing Home.

Holidays Alzheimer's Disease

Change expectations of the “Perfect Holiday”

I’m Dreaming of a White Christmas, sometimes that perfect picture of the “oh, so perfect holiday” needs to be re-visited when a family member has dementia. Many times try as they may to have that Merry Spirit, the underlying sadness of loss still is there. Things to keep in mind during the Holidays:

Elderly with Alzheimer’s remember music.

Music is stored in the brain in different areas than language, so a person no longer able to speak many times will still be able to sing those – long remembered carols.

Plan to visit elderly with activity.

When visiting a person with Alzheimer’s disease – plan to do something. When a person can no longer sit and chat, they may be able to make a connection through an activity. Decorating the tree, wrapping presents, watching children at the mall with Santa, addressing or making their own cards, baking (or eating) cookies. This will take planning but remember – failing to plan, results in planning to fail.

(Remember safety first – gifts to persons with Alzheimer’s disease should have no sharp edges or small parts)

Wanting to go “Home” may be sign of anxiety.

If the elder lives in a Nursing facility, do not take offense if the elder talks about going back to the facility saying, “I want to go home.” Many people with Alzheimer’s disease find comfort in routines. Holidays, and especially leaving the Nursing Home, breaks the routine and therefore may cause anxiety.
Everyone needs to be supported and included at this time – elders, family and caregivers.

If you are looking for an activity to do with an elderly person,
See my web site:
for a free Life Story Book to download.