HOW TO CHOOSE A NURSING HOME FOR A PERSON WITH DEMENTIA Part III

A term that has gone out of use in the nursing home community is “custodial care,” and with good reason. The current term for care is “person centered care.” These terms are the difference between living and existing.

With custodial care you are existing but do people only want to exist? Existing means to; be present, to be alive, to be in existence, and to be surviving. Custodial care meant that the nursing home was protecting the elderly. They were charged with safe keeping and at times total guardianship of the elderly in their care. As was frequently said at that time, patients were kept “clean, dry and visitor ready.”

With time, thinking changed in the nursing home community, and people started to think about how they would like to be taken care of. Being clean, dry and visitor ready didn’t seem all that appealing. Now the thought is, if you look at all of your favorite activities over a period of time, and realize that you will never again do those things, how would you feel?

Take Ann who is now in her early seventies. Ann loves to cook, especially she likes to make soup. She makes two different soups every week. She likes to bake, making her favorite pumpkin muffins often, freezing them and eating them infrequently for a treat. Ann was a school teacher for many years and now works as a teacher’s assistant three times a week. She really enjoys staying in touch with the school atmosphere, other teachers and of course the children. Ann loves music, she sings in her church’s praise choir and she enjoys playing the piano. Ann also loves to knit and does her own small art projects making bookmarks as gifts for friends. She enjoys getting together with family and friends as often as she can.

Going to a nursing home in the future where she would only exist wouldn’t work for Ann. Living compared to exiting means; continuing your life style, maintaining your habits and activities, remaining active and relevant through being busy. Having dementia or not Ann would want to continue to; enjoy being with children, having her favorite foods, doing art, listening to music, being social, and remain connected to her faith.

Finding that nursing home that understands “person centered care,” and the concept of living over existing, is the best choice for a nursing home, for a person with dementia.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

HOW TO CHOOSE A NURSING HOME FOR A PERSON WITH DEMENTIA Part II

The choice of a nursing home has everything to do with the needs of the person with dementia. Look closely at what the reason is for the placement. Has this person just begun behaviors that the current caregiver can no longer handle? Is this person in another nursing facility that is just not meeting their needs? Is this a very large person, and the caregiver can no longer physically handle the work involved in their care?Match the reason to the services that the nursing home offers.

If the patient is always trying to walk away, question nursing home personnel about their security measures. They should have electronic monitoring systems that assure families that patients cannot leave the nursing home unattended. There should be hourly safety checks in place on all three shifts, so that a staff member is actually seeing where this patient is and what they are doing. There should be a picture of this patient at the reception desk as well as an alarm at all doors, connected to the monitoring system. The staff should indicate to the visiting family, where the security cameras are as well as who is monitoring the cameras.

If the patient needs placement because they have become more agitated and physically aggressive. Ask detailed questions about what kinds of medications the nursing home uses for behaviors. Ask what kinds of other non-drug related ways they work with the difficult patient. What does the activity program look like, and how many activity staff does the nursing home employ. There should always be an emphasis on the use of activities and getting to know the patients likes and dislikes (person centered care). The nursing home personnel should verbalize that they only use medications for behaviors as a last resort. Those types of medications should be reviewed  on a regular basis with ongoing plans for medication reduction.

If the large size of the patient is a consideration, ask about the nursing home’s equipment. Look at the size of the beds, and types of mattresses. A very large person will tend not to re position themselves  in bed as often as a slim person. This lack of movement as well as the additional weight of the person can be a cause of skin breakdown. While asking about available mattresses is an important question for any patient, it is even more so for the very large patient.

There are as many reasons for placement in a nursing, as there are patients needing placement.  Most families tend to not relocate their loved one once a choice has been made. Finding that right place where not only the patient feels comfortable but the family as well, is all important for a sucessful placement.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

HOW TO CHOOSE A NURSING HOME FOR A PERSON WITH DEMENTIA Part I

Choosing a nursing home for the person with dementia, is about where the person is in their disease process, as well as what their finances are and will be. The competition is currently very high for nursing homes caring for persons with Alzheimer’s disease.  This climate has brought forward many, very innovative programs. Programs that include plants, animals, special menus and dining options, activity programs for special interests, art, music, and the list goes on.  When a person is in the early stage of Alzheimer’s disease, they are more able to make use of special programs. Later in the disease process the person will have less interest or ability to participate in such programs.

Because many of the high end programs are usually found in private pay facilities, when assessing the elder’s finances, it makes good sense to use those resources when the elder can most enjoy them. Knowing that there is a progression to this disease, and that there is a slow decline, helps in planning. In the early stage of the disease, more funds should be available not only for the nursing facility but also for community events.  Going on outings, shopping, to a movie, out to lunch, to the zoo, etc., these opportunities need to be available.

When visiting a nursing home ask to see the activity calendar. Look for not only internal opportunities but for those outside events. Ask how they are funded, does facility have their own van, do nursing assistants accompany the elders as well as activity staff.

I well remember a nursing home that sponsored an outing to the zoo for its patients. The patients who participated were in early stage of Alzheimer’s disease.  Everything was going fine until the first patient went to sit down on a park bench and missed the bench falling to the ground. About 30 minutes later a second patient did the same thing. (both without injury)  The nursing home administrator decided it was time for this group to return to the facility. Thereafter a group never went out without a member of the nursing department, trained in Alzheimer’s care, in attendance.

Ask if there is a special memory loss unit? Is there a director of that unit? Interview the director and inquire not only about their program but also how they assess their patients for activities. The director should use terms like “person centered care” as well as vocalize an interest in your loved one’s history and “favorites.” Favorite foods, beverages, sports, music, any art interests, and more questions that would help the facility to design a program for your loved one.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

BUILDING BRAIN HEALTH PROTECTS AGAINST DEMENTIA – DON’T PERFUME YOUR OXYGEN PART III

Whether it is bath soap, air freshener, laundry products, scented candles, or the cologne on the check out clerk at your local grocery, we are surrounded by scented air. While it is law to list ingredients on these products, there is a significant loop-hole. The word “fragrance” in so many products used every day, represents many substances the average person would not consider a pleasant odor. These chemicals masquerading as a fragrance, are for the most part derived from petroleum and coal tar products.  These chemical concoctions are found is products all around us, and are directly related to many health concerns.

These chemical mixtures are protected under a misconception that they are “trade secrets.”  There might have been a time in years gone past that the combination of certain essential oils and flowers were highly protected secrets. However these days, the secret that is being protected, is where these chemicals come from and what they do to human health.

Current research is telling us compared to other senses, the sense of smell is directly connected to brain health. That smells are able to pass the blood brain barrier, that protects the brain from many other forms of attack. These hundreds of fragrances created in laboratories, with many times banned chemicals, are responsible for many disorders. Surrounding ourselves with all of these scents is leading to negative emotions, irritability, brain fog, fatigue, headaches, dizziness, tremors, convulsions, and the list is growing.

There is recently even a new term for that person, who through the use of strong smelling products, intrudes on others. It is “second hand fragrance” similar to second hand smoke. It is when one person makes a decision to use several strong smelling products (shampoo, deodorant, hair spray, perfume, laundry products) and by doing so contaminates the air quality of others. There was a recent report on the news regarding sunscreen products, and they found many people bought a product not on how effective it was for sun protection, but because of the way it smelled.

The elderly as well as the very young are at increased risk for neurological problems connected to fragrances that pass the blood brain barrier. Yet many times the offender is an elderly person who has become so addicted to their fragrance, that they literally no longer smell it.

If you have been guilty of second hand fragrance, do what people did years ago, put a little vanilla extract behind your ears.

Suggested reading: “Get A Whiff of This” by Connie Pitts

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

8 QUESTIONS TO ASK WHEN CAREGIVING FOR THE PERSON WITH DEMENTIA AND DIFFICULT BEHAVIORS

The person with dementia no longer reacts the way they used to, many times resulting in problem behaviors. When you have identified a problem behavior, which can be anything from the elder spitting, to striking out at a caregiver, or even becoming sexually inappropriate, start with identifying exactly what is happening.

8 Steps to understanding difficult behaviors in the person with dementia:

  1. Identify the problem or behavior. Make sure you are clear as to what the problem is, and whose problem is it. In the case of the elder with dementia who spits; it is embarrassing, someone has to clean it up, and many times it is hard to find a caregiver for the elder.
  2. Identify when this behavior occurs. Does this behavior only happen during times of direct care? Such as the elder who strikes out during times of dressing, bathing, or brushing teeth.
  3. Identify how often this behavior happens. Does this behavior only happen occasionally, as during a large holiday get together? Does this behavior happen only later in the day when the elder is tired?
  4. Identify how long the behavior lasts. Is this behavior of short duration, and once the incident is over it is quickly forgotten by the elder?
  5. Identify what is going on in the environment when the behavior happens. Is the environment understandable to the elder? Remember the elder with dementia needs a time of transition between activities. He can no longer just switch from one conversation to another, or do several things at the same time such as eating and watching TV.
  6. Identify who is present when the behavior happens. Does someone present tend to startle or surprise the elder? Does someone seem to not know how to approach the elder? Is someone asking a lot of questions the elder is no longer able to understand? Does someone have expectations of the elder that they are no longer able to meet? Does someone present seem to be critical of the elder.
  7. Identify how intense the behavior is. Is this behavior of such intensity that is scares the elder as well as all who are present?
  8. Identify if there is more than one thing contributing to the problem. Especially if the elder has been having trouble sleeping and may be suffering from sleep deprivation. If the elder’s behavior becomes more difficult in the late afternoon, see if the elder has an problem with oxygen deprivation. Many elders who are more agitated later in the day may benefit from a sleep study.

Finding out what happened right before, or what is happening during the behavior, is of the most importance, when care giving for the person with dementia.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

BUILDING BRAIN HEALTH PROTECTS AGAINST DEMENTIA – BY INCREASING OXYGEN – PART II

Blood is the transport system of oxygen to the brain. The brain uses three times the amount of oxygen as the muscles. An oxygen rich, blood supply, is very important to brain function. Known ways to improve in-door air quality and oxygen levels, are surprisingly simple.

Start with opening a window. Even sleeping with a window slightly cracked will increase the quality of the air in a bedroom. Bedroom are loaded with carpeting and fabrics know to have toxic chemicals. These chemicals can cause headaches, eye and nose irritation, as well as skin problems. Any allergic reaction will cause inflammation, possibly reducing quality air exchange, between heart, lungs and brain.

But more proven ways to improve air quality, come from straight from NASA. The NASA study tells us what plants produce the most oxygen and remove what chemicals. Opposite of us, plants take in carbon dioxide and give off oxygen. NASA recommends easily found houseplants, that are shown to be effective at removing toxic substances in the air, like formaldehyde, benzene and trichloethylene, while giving us increased levels of oxygen.

Especially sleeping in a room with increased levels of oxygen and reduction in toxic air quality, can help the person with dementia, avoid periods of agitation related to low oxygen levels. More than the general population, the person with dementia needs special brain support and increased oxygen provides that.

While searching for great oxygen producing, air cleaning plants be aware that many houseplants are toxic to children, pets and the elderly with dementia. The person with dementia will benefit greatly from increased oxygen to the brain, but needs to be protected from ingesting anything toxic. Even if the confused person has never attempted to ingest a non-food item, a person with dementia has that potential.

NASA recommended plants that are non-toxic include: dwarf date palm, areca palm, boston fern, kimberly queen fern, lily turf, spider plant, bamboo palm, broadleaf lady palm, barberton daisy, rubber plant and banana plant. While these plants are actually taking in carbon dioxide and producing oxygen, they are also adjusting the humidity in your home.

Due to the fact that houseplants are subtropical they do well inside with low light levels. The NASA study suggests one plant for every 100 square foot of living space. Some of these plants, (even with minimal attention) will grow to a very large, even ceiling height, providing even more improved air return.

When visiting a large greenhouse you will frequently hear comments about how much easier it is to breath in the greenhouse. There are also known psychological benefits for the person with dementia, when living in an environment with a large amount of plants.  The color green is known to be calming and also to help with memory. More oxygen to help the brain function, a pretty, calming color green and helping with memory. Plants, thank you NASA, what a good deal.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing 

BUILDING BRAIN HEALTH PROTECTS AGAINST DEMENTIA – PART I

There is an often repeated saying in healthcare, “what is good for the heart is good for the brain.” And I might add vise-versa, what is good for the brain is also good for the heart. So what is the heart brain connection, blood supply and oxygen.

The brain has 100 billion cells, which is also the number of stars in the galaxy. All of those cells need to be constantly fed, requiring a constant blood supply to keep up the metabolic demands. At all times over 20% of the blood in the body is located in the brain. That blood supply always needs to be highly oxygenated. Loss of oxygen for even 8-10 minutes can result in brain damage.

What is good for the heart and brain:

  • a oxygen rich environment
  • highly nutritious diet and hydration
  • low stress life style

We know that when a person has been diagnosed with dementia, they have already lost brain cells. Brain cells will die due to disease and poor life style choices. Smoking will not only suffocate the lungs but reduce that brain sustaining oxygen supply. Bad dietary choices create inflammation and are now proven to be as harmful as smoking.

This complex organ, the brain, is only 3-4 pounds depending on the size of the individual, about the size of a cantaloupe. When a baby is born they already have their 100 billion cells, what they don’t have is the connections between the cells. And those trillions of cell connections we call learning. To support that development, and even to survive, the brain needs the nutrients and oxygen from the heart.

The blood supply to the brain is so important that when the body experiences a reduction in oxygen it will automatically redirect blood to the brain. Increasing the blood supply even two times the normal volume.

Improving the supply of oxygen and nutrition to the heart and brain, can be accomplished day by day, meal by meal, through life style changes. Start by opening a window.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing 

 

EXERCISE LIKE YOU ARE IN GRADE SCHOOL AND YOU WILL HAVE BETTER BRAIN FUNCTION

Remember when you were in grade school and you went out for recess three times a day? Well research now tells us that having those short bursts of exercise will support brain health. Over 25% of the oxygen in your body is in the brain. Increasing the percent of oxygen to the brain increases alertness, supports increased focus, is calming, and will even regulate behaviors.

When children are going out for recess, people will frequently say, “Its good for them, gives them a chance to run off their energy.” What those children are really doing, instead of running something off, they are taking in more oxygen through exercise. All the while improving their oxygen supply to the brain. Short bursts of exercise have been shown to be beneficial for brain function in all age groups. Everyone is able to benefit from increased oxygen through exercise.

There are very positive effects to periodic physical activity.  Short bursts of exercise have been shown to especially bring more oxygen to the frontal areas of the brain. Increasing oxygen to the frontal lobe of the brain helps with increased self control and emotional control. The ability to self regulate behavior is important whether in a social, academic, or religious setting, as well as just sitting on the couch at home.

Finding those opportunities for oxygen promoting exercise throughout the day are so necessary. Whether just stepping outside for a quick walk around the parking lot at work, opening a window while you vacuum for 15 minutes,  or popping in a short exercise video, whatever, call it your “recess.”

For the student studying, the restless child on a long car trip, or the elderly person with dementia who is getting agitated. Everyone it seems can benefit from a regular recess.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

DEMENTIA CARE – DECORATING FOR DEMENTIA – CREATING A SMART ENVIRONMENT

Lets face it we cannot get away from environment.  We are always in some kind of environment, but is it a healthy environment or troublesome environment? And for the person with dementia many things we take for granted in the environment are unhealthy as well as troublesome. These are environmental stressers that the person with dementia either hears, sees, or think they see.

Hearing stressors, are anything that is too loud. This can be the rattle and clink of utensils in a restaurant or even the voices when several people are talking at the same time, at the next table.  Anything that causes constant noise, like the TV or radio.  It will also be things that cause sporadic loud noises like a vacuum or landscapers.

A hearing stressor can also be when the person, who is trying to communicate with the confused person, just talks too fast. If the person is trying to understand, and can’t even catch the words, trying so hard will be stressful. And creates an environmental stress, where the person just seems to want to get away.

Things you commonly see in an environment can be very stressful for the confused person. When a person with advanced dementia looks at a shiny floor, it can appear as if there is water on the floor. Or even worse, that there is ice on the floor. A dark area of a carpet or tile can look like there is a big hole in the floor. Another frequent problem with flooring is small patterns. A carpet with obvious patterns will look like there is something on the floor. Many an elderly person has fallen trying to pick up something that wasn’t there.

The demented person does need contrast in color to be able to see the difference in surfaces. In a bathroom, if the tile floor is solid white and the toilet white, the person will have difficulty locating the toilet. He just doesn’t see white on white. In the same way when eating, a white plate on a white table, needs a colored place mat under the plate for the person to see it.

Keep this in mind, when walking around the house, think of contrast in doorways and furniture compared to wall color as well as floor color. Using the environment for great dementia care.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

WHAT DO THE ELDERLY AND TEENAGERS HAVE IN COMMON – MAKING BAD DECISIONS

They were clearly elderly, possibly in late 70’s. He walked with a four leg quad cane, very slowly as though he was chronically stiff in the joints. He probably had been about 5’9″ at one time, but now he was so stooped over, that he was the same height as his wife, who appeared to be about 5’2″. Yet, as they left the grocery store they were walking to a brand new, bright red, SUV in the parking lot.

In passing I remarked,  “boy, that car is very pretty, but looks hard to get into.” The wife sadly smiled at me and said “yes, but it is a little better since we got the running boards.”, Wow, a car with running boards at their age. Sure enough as she opened the door, she stepped up on the shiny chrome running board, as she tried to steady herself to slide onto the car seat.

I just knew this car was not her choice, yet there she was perched way up in the air as they crept out of the parking lot. I thought, what is going to happen to her when there is snow on the ground, or that running board is slick from rain or slush.

The frontal lobe of the brain, is where reason, judgement and decision making is located. As the frontal lobe of their brain begins to shrink and die, the elderly begin to make poor decisions. A newborn baby’s brain begins to develop fully from the back, neck area, going forward. A teenager’s brain hasn’t fully developed in their frontal lobe, which results in risky choices or bad decisions. The end result is in both cases a frontal lobe that isn’t very functional. Driving and safety turn out to be frequent concerns and conversations in families, for both generations.

Is buying a SUV, a red flag when it is clearly dangerous for you to enter and exit the vehicle? Yes, that is a red flag, even more so is this elderly man’s disregard for his wife and her safety. The first troubling sign families notice when the elderly have frontal lobe shrinkage, is the apparent disregard for others.

Would this be dementia? Yes, shrinkage in the frontal lobes of the brain are a form of dementia. Frontal-temporal dementia is probably the least diagnosed form of dementia. Families know that there is something wrong with the elder, that he is difficult to get along with, easy to anger, unable to change behaviors, decrease in personal hygiene, etc., but few use the word dementia.

Cars, driving, and bad decision making, whether very young or very old, a bad combination.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing