This is a very touching short film on dementia produced by award winning Chinese filmmakers and worthy of your time.  Dementia can and does tear at the family fabric causing strife, guilt and anger.  Learning how to recognize and cope with its effects is critical.

Years ago my eighteen month old son went into my bedroom, picked up the phone and started punching keys. I noticed he was missing and when I called him he came toddling out of the bedroom. It never occured to me to go in and check the room. The next thing I knew there was a policeman at my door telling me someone had called 911. The phone was still off the hook and there was a 911 operator on the other end.

This may have been cute when they are a year and half old but what do we do when they’re 87 with Alzheimer’s and your still getting emergency personnel showing up at the door?

I took care of several seniors who had problems with this. The solution for one family was to put the phone on the top of the refrigerator so mom couldn’t get to it. Another, an elderly man, would have trouble dialing his daughters number, when the 911 operator would answer, he thought it was his daughter and would start telling her all his woes. You, of course, know what happened next, I’d be at the door explaining to the officer that there was no emergency.

The man who wrote the following article also had some problems with his dad and telephones and came up with some solutions also.

Telephones and Alzheimer’s

Understanding the language, usage, behaviors and needs of dementia. How learning the inner journey of those with dementia can help you be a better caregiver. And help bring that person peace and security.

Course Title: Dance/Movement Therapy with Seniors

30 Continuing Education Hours for LMFTs, LCSWs, and Dance/Movement Therapists.
Also partially fulfills alternate route education requirements for dance/movement therapy students.

Offered by
The Center for Movement Education and Research

January 9,10, 2010 – Scripps College — Claremont CA
February 13,14, 2010 – Pomona College –Claremont CA
9:00am – 5:30pm

This dance/movement therapy theory, practice and application course will cover the specific developmental needs of seniors and the dance/movement therapy skills pertinent to working with this population age group. The course content will focus on physical, psychodynamic, psychopathological, and enculturating factors impinging on the later years of human development. Students will be exposed to various clinical concepts of dance/movement therapy viewed within a developmental framework that are pertinent to selected late adulthood populations, including clinical disorders of late adulthood and, the types of somatic transference/countertransference issues that might be encountered.

This course has been approved by the American Dance Therapy Association as meeting the Alternate Route Requirements for the R-DMT credential” and satisfies 30 hours of DMT Theory and Practice Training.

This course meets the qualifications for 30 hours of continuing education credit for MFTs and/or LCSWs as required by the California Board of Behavioral Sciences (Provider #3888). Students taking the class for continuing education are excused from the required assignments other than attendance and participation.

Course Objectives:
1) Students will develop an understanding of the developmental needs, tasks and challenges presented when working with various senior populations.
2) Students will develop a basic understanding of dance/movement therapy assessment and application of dance/movement therapy interventions as they apply to various senior populations.
3) Students will learn interventions through which to facilitate an individual or group dance/movement session for various senior populations.
4) Students will be able to design and facilitate a dance/movement therapy session for seniors that is developmentally sound and takes into account the unique developmental, physical, emotional, psychological and cognitive needs of seniors.
5) Students will conclude the class with a beginning level awareness of dance/movement therapy processes and techniques utilized in working with seniors.

Locations:
Scripps College
Richardson Dance Studio
1030 Columbia Ave
Claremont, CA 91711
Pomona College
Pendleton Dance Center, Studio 16
210 East 2nd Street
Claremont, CA 91711

Course Fee: $750.00

Course Instructor: Gabrielle Kaufman MA, BC-DMT, NCC
is a CMER faculty member, dance/movement therapist and counselor with close to twenty years experience in the helping profession. She has taught creative movement to preschoolers and elementary school students, has used DMT with the elderly, Holocaust survivors, adults with mental illness, individuals with eating disorders and body image issues, with teens at high risk and other individuals suffering from anxiety and depression.
Currently, she is the coordinator of the New Moms Connect Program of Jewish Family Service of Los Angeles. She has run several programs for high risk children and teens in both English and Spanish languages, taught classes to parents of newborns and toddlers, and runs support groups for single parents, women with eating disorders and women with perinatal mood disorders and with seniors. She is a coordinator with Postpartum Support International and has a private practice in Los Angeles.

For Information and Application Contact:
Judy Gantz-CMER Director
POB 2001
Sebastopol, CA 95473

(310) 477-9535

“You have a month left to live if you’re lucky,” the doctor had said. “You should use the time you have left to make arrangements for your wife, if you have not done so, already.” Remembering his words, I looked out the window and watched as a tinge of burnt scarlet crept up from beneath the horizon. I had been waiting for the sun to return for such a long time.

“Earl?” I heard her soft voice say.

“I’m here,” I told her as I got up from the arm-chair and walked to the shaded side of our bed. I could barely see the silhouette of her head on the pillow, but I smiled down at her anyways. She had remembered my name.

“I hope Teddy doesn’t kill himself on that pony,” she said.

“He’s a good rider,” I said. “I’m sure he knows what he’s doing.”

I knelt down, felt for her hand, and squeezed it. She was always articulate in the earliest hours of the morning, even though her thoughts were still muddled. I had waited up all night for it.

“If it’s raining, I hope Mary had good sense to bring my rugs in off the line,” she said.

“She brought them in last night,” I assured her.

I always detested being dishonest with her, but I wanted the moment to last. I wanted to feel normal again, just one last time. In my mind, I could still see her beauty. Long golden hair resting on her shoulders that always seemed to hold its own rays of sunshine and blue eyes so alive, you would swear they never saw rain. But the prize of her angelic features was her smile. I fell in love with her smile the first time I saw her. I swore to God himself, I would do anything if He blessed me with her smile everyday for the rest of my life. He granted me fifty-two years.

“I truly detest winter,” she said. “It’s always so cold.”

I released her hand and pulled the blanket up across her shoulders. She sighed softly and I felt safe enough to press my lips to her forehead. My heart skipped when she didn’t turn away like she usually did. It was a good morning.

“Do you hear the birds outside,” I asked her.

“Are they singing for me?” she asked.

“I believe they are,” I said.

“Silly things,” she said. “They should know better. It’s too cold out to sing.”

As the room began to lighten from the sun’s rays peeking in the window, I stayed there beside her watching her face. I had been waiting for the sun to return for such a long time. For ten years we had lived in the darkness. It was as though an ominous cloud had been hovering over our house blocking out the sun’s light and discarding any promise of its return. As I listened to her talk of past days, I silently gave thanks to God for granting me one last request.

“You left that window open again, didn’t you?” she scoffed.

“I sure did,” I said.

“I swear, you are going to cause the death of both of us,” she said. “Close that thing before I freeze.”

“Anything for you,” I said.

I stood up and walked over to the window. I looked through it and saw that her lilies out by the old barn had finally come to full bloom. She would have loved to see them, but I knew it was best not to tell her. It would have only confused her even more. I banged down on the ledge of the already closed window so she would hear me and be content.

“I wish that boy would stop his rough-housing,” she said. “Teddy knows I’m trying to rest.”

I looked at the silver framed pictures sitting on top of her bureau. Our boy, Teddy, smiled back at me with his arm around his Jenny and both their twin sons sitting upon their laps. They had been living in Alabama for the past five years now, but promised a visit next month. The frame sitting next to theirs held a picture of our Mary at her college graduation. She was as much of a beauty as her mother and I thanked God she had inherited her smile.

“Earl,” she said.

I returned to her side, once more, and knelt beside her. She had said my name again and I fought back my tears of joy.

“Yes,” I said, hearing the roughness in my voice.

“If I marry you, do you promise not to be like my daddy?” she asked.

“I promise,” I said.

“I mean it. I can’t be with someone who won’t love me enough to stay home at night,” she said.

“I will never leave you alone,” I promised as I reached up and ran my fingers through her snow-white hair. I said a silent prayer to God for her to hear me.

“This room is always so dark,” she said.

“Yes, it is,” I replied as I watched the light cast a glow upon her face.

“Did Teddy and Mary catch the school bus on time?” she asked.

“They did,” I said.

“Oh, my,” she sighed.

“What is it?” I asked.

“I just know that boy is going to kill himself on that pony,” she said.

I nodded and tucked the blanket in tighter around her frail body. Inside I felt like screaming. I wanted to curse at God and praise His name at the same time. For fifty-two years I was given the greatest glory of love a man has ever known and now this was the end. I would not wish it on another man, and yet, I would not trade it for the world. Those last few moments of time with her felt like a blessing because it was my opportunity to say goodbye. Not many people are lucky enough to get that privilege.

“You saved me, you know,” she said.

“How?” I asked.

“You got me away from my daddy and never let anyone hurt me again,” she said.

“You were worth saving,” I said.

“We’ve had a good life, haven’t we?” she asked.

“The best life anyone could have asked for,” I said.

“I have always loved you, Earl,” she said.

“And I will always love you,” I said.

I let the tears fall, because God had heard my prayer. She was with me again. For one last moment of time, we shared the same train of thought. I took God’s gift as a sign. I smiled at her and she smiled back. I could feel my old heart pounding and wished things could stay like that forever. I had been waiting for the sun to return for such a long time. Waiting for one last spark of clarity to reach her soul so she could once more see mine.

“Earl,” she said again, which seemed to make the time in our room come to a full stop.

“Yes,” I said, shaking.

“You always leave that window open,” she said.

“Yes,” I said as I slowly slipped a hand beneath the bed.

“I swear, you are going to cause the death of both of us,” she said.

“I’m sorry,” I said as my eyes burned and hot tears scorched their way down my cheeks. My throat felt swollen and it was difficult to swallow the spit that had accumulated in my mouth. For fifty-two years I have loved this woman and she loved me in return. We had seen a lot of hard times and shared many memorable good times. I am grateful to be with her in the end.

I pulled my hand out from under the bed and placed the barrel of the gun against her left temple. I closed my eyes and allowed only one agonizing sob to escape my mouth before I pulled the trigger. I had been waiting for the sun to return for such a long time. Now, she and I shall embrace it together, forever.

“Kath, your mom’s gone.”

That’s the phone call I expect to receive from my dad when my demented mom dies.

I have no idea when that call will come. Could be next week or could be 10 years from now.

Really not sure how this disease will kill my mom.

Alas, it varies from parent to parent. Dementia likes to mix things up.

My guess, however, is that dementia will continue to invade and warp her brain, twist her reality, manipulate her thoughts, finally ripping apart her mind with its black, twisted tentacles until she can no longer remember how to swallow her own food.

Larry carefully placed Olivia in her arms. And suddenly it was like a switch had been turned on. She smiled and cooed. Her love for babies cut through the Alzheimer’s fog. She was the little girl who was born to be a mommy. “Baby,” she said. “Baby.” It was the last word I heard her say. Soon she forgot how to speak. Then she forgot how to eat. And, lastly how to swallow. ~ From Irene Zutell’s new book, Pieces of Happily Ever After

This idea, DEATH….. is something I think about often. I think about her death and I think about my own. I don’t know if Death is something to be feared or something to be welcomed with open arms. Is Death my salvation or the Devil? If death is another part of life, why are so afraid of his arrival? I suppose the unknown is always frightening….. but it is what it is and we are so attached to living — yet we’re never taught how to cope with our own mortality. We cling on to life, as we should, yet we can’t let go when it’s time. Is this healthy?

Or has dementia twisted my mind too?

Death in near, that’s a fact. So what course of action should we take when he taps on our door? Should we invite him in? Or let him fight for his prey?

What pact will YOU make with the Death?

When she doesn’t know your name. She can’t place your face. She becomes agitated at the littlest thing. When other parts of her body begin to shut down. When pneumonia has invaded her lungs, when death is imminent — the inevitable right around the corner, let me ask again, what do you do? What should you do? What should I do?

The patient, Leo Oltzik, an 88-year-old man with dementia, congestive heart failure and kidney problems, was brought from home by his wife and son, who were distressed to see him agitated, jumping out of bed and ripping off his clothes. Now he was sleeping soundly with his mouth wide open…

Mr. Oltzik’s life would end not with a bang, but with the drip, drip, drip of an IV drug that put him into a slumber from which he would never awaken.

The New York Times today had an interesting article about Terminal Sedation...

… A treatment that is already widely used, even as it vexes families and a profession whose paramount rule is to do no harm. Doctors who perform it say it is based on carefully thought-out ethical principles in which the goal is never to end someone’s life, but only to make the patient more comfortable.

But the possibility that the process might speed death has some experts contending that the practice is, in the words of one much-debated paper, a form of “slow euthanasia,” and that doctors who say otherwise are fooling themselves and their patients.

Speed up Death’s arrival? This is an interesting question in the case of dementia. Do you give the demented damned medication that is only designed to SLOW the inevitable or do you let the disease take it’s course… naturally… allowing dementia to invade the brain at its leisure, turning it into protein-infested mush……….ultimately killing its host or at the very least, turning them into a person you hardly recognize.

Yes, this piece pertains to VERY end-of-life situations. Death is actually sitting on your bed, holding your hand. Dementia, however, can take years… even when your loved one is gone in the mind, their body still functions………………

Death is playing a game.

Their heart still beats.

Talking about death and dying is something we’re taught to avoid discussing at the dinner table. No one wants touch this very morbid topic, but it IS a part of life.

Very easy to gloss over, yet a very real question to ask.

Slow euthanasia………

An interesting ethical debate.

It’s SIX pages, but you might want to read the entire article……………………..

~Images by Pareeerica from FLICKR

]]> http://falconplog.wordpress.com/2009/12/26/joy-to-the-world-and-dementia/ Sun, 27 Dec 2009 03:54:05 +0000 bwoof http://falconplog.wordpress.com/2009/12/26/joy-to-the-world-and-dementia/

It’s becoming a theme…learning to have joy even when living with someone with dementia.

Today we celebrated Christmas with another part of our extended family and we had a very spontaneous musical interlude, a hearty carol sing-a-along. Surprisingly, the long-ago-used piano playing skills came back perfectly and our special person played by ear, beautifully and in time with dad’s trombone which she had requested. When our carols were finally over she said that we weren’t done because Jim  had not yet played the trombone.

Wow…it had only been a couple of minutes since we had had that lengthy musical duet with she herself as the most active participant. Stunning…in a way. Yet also predictable in that we can’t predict anything. Dementia, I’m learning, is like that.

Joy to the world…and you find it in tiny little places, without a lot of notice, and you’d better catch it while you can. It’s a choice.

True confessions time: I’m a fan of mystery novels – most often British. And so naturally my eye is grabbed by a portrait of Dame Agatha Christie in The New York Times Sunday Magazine recently. I was even more drawn by the headline Literary Alzheimer’s. Apparently last March a pair of academic researchers analyzed the text of Christie’s fourteen novels and determined that “Christie’s lexicon dcreased with age, while both the number of vague words she employed and phrases she repeated increased”. Authors Lancashire and Hirst suggest “”the question is not early style versus late style. but the late style of someone who is elderly but healthy versus the late style of someone who is elderly but not cognitively healthy’”. Lancashire and Hirst intend to analyze the work of P.D. James (80+ and healthy) as well as authors such as Ross MacDonald (known to have suffered from dementia).

This is all the more interesting in light of the Nun’s Study and its insights into lanaguage sophistication in youth and the likelihood of developing observable signs of dementia in later life.

Originally appeared in CNN.com and written by Kate Mulgrew. Ms. Mulgrew a stage, film and television actress who is best known for her TV role in “Star Trek: Voyager.” She is currently appearing in the NBC series “Mercy.”

BELOW IS AN EXCERPT OF HER STORY, HER HOPES…. APPEARED ON CNN,COM:

After the Alzheimer’s came, my mother could not know how shadows fell across our once ebullient family: our solidarity fractured, our tempers flaring in furious incomprehension, hearts breaking in mute despair.

None of us knew how to watch this woman disappear, her features slowly masked with blankness, her supple body rigid and wooden, her absolute vividness obliterated by the heavy fog of her disease.

As those of us touched in some way by Alzheimer’s know too well, the emotional, social and economic burden of this disease is nearly unbearable:

• 5.3 million Americans are living with Alzheimer’s disease; a new case develops every 70 seconds.

• One in eight people aged 65 and older has the disease, and the risk is even higher for those over 85.

• Today, 9.9 million people are caring for a family member with Alzheimer’s.

• Alzheimer’s and other dementias cost Medicare, Medicaid and businesses $148 billion annually, a number that will grow quickly and substantially as baby boomers reach age 65.

Prevention. Cure. Hope. These are words seldom associated with Alzheimer’s disease. But groundbreaking scientific research and an opportunity for powerful collaborations could lead to discovery of the ultimate cure for Alzheimer’s disease: its prevention.

This achievable goal adds “hope” to the vocabulary of Alzheimer’s disease and holds the promise that my children and yours will never suffer its hardship.

My son, Alec, is an artist like his late grandmother. His paintings are large and uncompromising, stunning in texture, original in design. He’s got the real thing. He’s got “it,” just as she had. But what if he also has something else, like the APOE-e4 gene, known to increase the risk of Alzheimer’s? What if he is in line to inherit this devastating disease?

What I could barely endure happening to my mother, I know I could not possibly endure happening to my son.

My friend Dr. Karen Hsiao Ashe, an internationally renowned Alzheimer’s disease researcher at the University of Minnesota, has developed a research road map that calls for bringing together a group of the world’s foremost laboratory and clinical investigators in the field to make prevention a reality by 2020.

Karen is identifying the biological processes that occur in the earliest stages of the disease — long before symptoms appear — to develop cost-effective, widely available interventions.

Karen and her colleagues are homing in on a promising possibility: a pill containing the molecular compound that could block the chemical chain reaction in the brain that leads to Alzheimer’s.

So what’s the holdup? Well, money, of course, and attitude, perhaps.

According to Harry Johns, president and CEO of the Alzheimer’s Association, “No other disease causes so much suffering, is so certainly fatal, affects so many and drives so much cost with so little spent to overcome it.“ Why is that? Johns names ignorance, age discrimination, stigma and denial as likely explanations.

My plea is deeply personal, but by 2050, Alzheimer’s will affect as many as 16 million Americans, and none of us will be able to deny the reality. We must fight mightily now to prevent the shadow of this disease from darkening the lives of our children and grandchildren.

We must invest today in research that will most swiftly lead to the ultimate cure: PREVENTION.

Gift Giving Another Causality of Alzheimer’s Disease

By Lori La Bey, of Senior Lifestyle Trends

My hands were aching from shoveling the wet heavy snow and my body was chilled, but I wanted to stop at Mom’s.  If I didn’t do it now I knew I would curl up at home and not want to leave.   So off I went to visit Mom at the nursing home this X-Mas day.  I didn’t even get the card I had picked out for her.  I didn’t trust myself. 

I was afraid I wouldn’t leave the house once I went in.   I figured Mom wouldn’t mind if I brought the card tomorrow. This was my first year I wouldn’t even bring Mom a gift for Christmas. I almost bought flowers, than realized I was going to be buy them for me, not Mom.  The truth is I’m not sure how much she can really see any more. 

I knew for sure she wouldn’t remember the flowers were for her, or who they were from.

I knew beautiful flowers didn’t trigger anything special for her to hold onto, so what would the point be? 

Yes, the flowers would be for me.  I would ”look like” a caring daughter, but flowers have nothing to do with how much I care, how often I visit, or the quality of my visits.  So I decided to pass on performing for looks, purchasing flowers to play a part.  Performing for my ego.  It felt strange to put my gift buying in prospective like that.  Even as I write this knowing full well my thoughts are true, it was so strange to walk in empty handed.

Yet on the other hand, for many years now I’ve whined about the commercialism of Christmas and how disgruntled it makes me feel.  How we have lost the true meaning of the holidays and the simple appreciation for one another.  Since Mom’s been diagnosed with Alzheimer’s, I am usually able to look at things in my life in a deeper fashion.  What is relevant and what is not?  What has meaning and what doesn’t and why. 

That part of Alzheimer’s disease has been a gift to me.

But like most Caregivers dealing with this disease, I ping, and I pong.  I can see the good, the bad, and the ugly; depending on the mood I’m in.  I also realize the sadness I feel about not buying a gift for my Mother because there is no joy in giving her a gift at this stage. Who would have thought Alzheimer’s disease could take gift giving from me?  Of all the things I could list which I’ve lost due to this disease, I have to admit, gift giving would not have been something I would have ever thought to write down, but the reality is, gift giving another causality of Alzheimer’s.  Another loss. 

Now in the later stages of Alzheimer’s it is work to try to get a response out of Mom for any gift she receives.  Gift giving is not meant to be work.  It is not meant to be work of recognition of receipt, but many times, it is what we do with an Alzheimer’s patient.   We try to connect and the gift is a tool to do that.  So we try hard to get approval, recognition – for what we have given someone.  When a person with Alzheimer’s is not able to respond to simple comments or directions, it can become counter-productive and frustrating for all. 

I also have to mention, prior to Mom being in her end stages of the disease, she gave me much joy when I gave her something, anything.  She was like a small innocent children thrilled to receive any present or kind gesture from another person.  I guess I need to balance the loss I’m feeling today, with the extra joy she gave me with that glint in her eyes in earlier stages.

I need to focus on that which I already know.  I need to accept and appreciate the gift of our self is simple, easy, and needs no direction or comment. There is no decision on what to buy or how to wrap it.  Our delivery is the important thing with this gift.  Our attitude.  Our love.  Our compassion.

Hoping you all enjoyed the holiday!

Sometimes WE gotta translate idioms (‘em’s idiots) in order to SEE what peepole are actually telling US.

Hear ossifer krapkey tell ME: ” i’m not gonna argue with YOU.”

i’m not gonna argue with you = don’t confuse me with the facts

a picture of just...what?

I’m just gonna say it. I am not digging Christmas this year. At all. 2009 has been, all in all, a challenging year for me and I just don’t feeling like toasting the holidays. OK, maybe I’m focusing more on the negatives of the year — there have been plenty…… but lots of positives too. Good job. Good friends. Lots of love. Kind acts. Two balls of fluffy kitten love. Sunny skies in December. Parents who love me very much. A mother who still tries to mother me……………… in her own demented way. I suppose love is the thing. Love takes strength. Love is courage. Love is fearlessness. Stare love in face. See what you get back.

Interestingly, I’ve been called a pessimist or negative a lot this year……
thing is, I challenge anyone to walk in my shoes (or any caregiver’s shoes, especially the full-timers) and still see the silver lining every second of every day.

I struggle with that label: NEGATIVE. But the thing is, this disease never really lets me move on. Every week is a reminder of the loss. When the holidays come around, it’s like taking a BIG YELLOW HIGHLIGHTER and highlighting the fucking loss……… specifically, the loss of family or what I always wanted family to be. Happiness, lots of people, a big living room filled with tinsel and laughter.

My heart is filled with a mixed bag of emotions…………….sadness, happiness, grief, anger, passion, frustration, love, joy, wishes, fears, anxiety, wildly vivid dreams, HOPE.

I confuse myself.

There are days when I feel strong. There are days when I am my own worst enemy. I have no idea when this is going to end. It’s terrible to say, but when I think of HER death, I think of the ties that bind being cut loose. FINALLY. Freedom? I don’t know. Will guilt consume me instead? Will the holidays serve as a reminder of how I failed her or how I should have done more?

Negative.

Blue.

Life is good.

Optimist.

Glass half empty.

Full.

Family.

L’amour.

Death.

Dark.

Angel.

Dismal.

Blue.

Me.

Nefarious thoughts.

I have no bits of wisdom when it comes to any of this.

I could give you my usual HOLIDAY TO DO LIST: Keep the crowds to a minimum, it may confuse your demented parent. Try to stick to the schedules. Don’t ask, “Do you remember…….,” avoid celebrating around sun downing, etc. You know this. You can Google this…………. instead, I want to talk about the caregivers and how the holidays affect all of us, part-time, full-time, near and far.

Dementia is a TERMINAL disease.

We are the damned ones.

Oh dear.

This post has turned quite negative.

I’ll leave it as such.

A dash of hope.

There is a light, but there is also another tunnel behind it.

REALIST.

]]> http://caringcommunity.wordpress.com/2009/12/24/creating-a-healing-environment-a-planetree-pioneer-explains-that-theres-more-to-this-than-bricks-and-mortar-featurearticleplanetree-organization/ Thu, 24 Dec 2009 15:46:06 +0000 caregivingcorner http://caringcommunity.wordpress.com/2009/12/24/creating-a-healing-environment-a-planetree-pioneer-explains-that-theres-more-to-this-than-bricks-and-mortar-featurearticleplanetree-organization/

From: Creating a healing environment: a Planetree pioneer explains that there’s more to this than bricks and mortar.(featurearticle)(Planetree Organization) by Komarek, Allan G.
Source: Nursing Homes, 10/1/2004.
Via: HighBeam™ Research
COPYRIGHT 2004 Vendome Group LLC

Excerpt:

“Although skilled nursing facilities have long been ahead of their acute care counterparts in the physical design of their environments, beautifully designed settings can only go so far in creating a healing environment. They meet the extrinsic needs of the residents, families, and employees, but do they meet their intrinsic needs? Psychologist Abraham Maslow believed that human beings are motivated by their needs and, as “lower order” needs are met, the “higher order” needs become more important to them. (2) Using Maslow’s Hierarchy of Needs framework, the external environment can only satisfy some of the physical and security needs of resident and families. The caregivers’ attitudes and behaviors lend themselves to satisfying their higher order social, esteem, and self-actualization needs. Regarding the latter, “Self-actualization is defined as ‘a process of becoming, the process of development which does not end [emphasis added].’” (2) This process continues until death and we, as caregivers, have the rare and wonderful opportunity to assist our residents in that process.

Nine components make up the Planetree environment: a supportive environment, physical involvement of family and friends, physical environment, respect for the individual, access to information, participation, choice, human environment, and autonomous decision making. As is seen with Maslow’s needs hierarchy, realization of these components depends upon the staff’s attitudes and behaviors. Following the nine components of the Planetree environment are the nine principles that form the basis of patient- or, in this case, resident-centered care. These principles are human interaction, information, healing partnerships, nutrition, spirituality, human touch, complimentary practice, alternative practice, and healing environments. Again, staff have a key role.

These components and principles can only be achieved through a cultural shift in the organization. The answer lies in creating a resident-centered culture, a culture in which the staff are empowered to make decisions in the best interest of residents and families, and which, in the long run, better serve the organization.

To create a culture where these nine components and nine principles are met, leadership must take the first step in deciding that it is the right thing to do, and then realize that it all begins with staff empowerment. According to Flesner and Rantz, “An empowered staff is a successful agent for residents and can act to assist the residents in meeting their life preferences and goals.” They point out, “Management practices, including open communication patterns, participation in decision making by staff, and relationship-oriented behaviors, can positively influence four resident outcomes: prevalence of aggression, restraint use, complications from immobility, and fractures.” (3)

Empowering staff has many benefits, and the barriers to this are usually systemic, not personal. According to McManus, “While we might want to believe that it’s the people that cause our daily challenges or hold back our efforts to make things better, it is the systems we use that affect performance, attitudes, and effort.” (4) Leadership must first identify systems that create barriers for staff trying to do their jobs. These barriers can range from bureaucratic policies and procedures to not having enough equipment and linen available.

Planetree begins the culture change process through staff retreats, such as we conducted. The goal is to ensure staff’s ownership of the principles. Education about the components is provided and discussions are held concerning why the individuals chose a health career. The thought behind this is that taking stock of one’s own reasons for entering the healthcare field may help staff realize “what’s in it for them.” Recalling when they or a loved one received care, or when they provided care to a loved one, helps them to get in touch with what “caring” is all about. Educating staff about the effects their behaviors have on residents also helps.

According to Stone, the “most important prediction of job satisfaction and nursing assistant turnover is management style allowing worker autonomy.” (5) What does worker autonomy look like in a long-term care environment? Autonomy is having control over day-to-day activities through the use of guidelines; it is not allowing staff to run amok and do whatever they want to do. Let the staff make choices on how to deliver care: “If the organization wants employees to be creative and innovative, it must facilitate the appropriate working environment. The organization must treat its employees as their most important resource.” (6)

Communication plays a key role in this autonomy. The findings by Scott-Cawiezell et al show that “nursing homes with good communication are expected to have better performance than nursing homes experiencing poorer communication among staff members.” (6) Staff must know what their limits are in the decision-making process. What, specifically, are they empowered to do? If a resident asks a nursing assistant for ice cream and the diet allows it, can the nursing assistant call the kitchen or should she instead have to go through the charge nurse? Can nursing assistants sit and read to a resident during their shifts? What are the limits to their autonomy?

Human interaction is the first, and arguably the most important, of Planetree’s nine principles of resident-centered care. It encompasses what residents desire (value, respect, sense of control, and the opportunity to participate) and what employees want (appreciation and recognition, communication and participation, and kindness). Frank, open discussions with staff about what residents desire and what that means can trigger an invaluable dialogue. It’s important to remember that staff, to a large extent, share the same desires as residents.”

Older people’s vision for long term care Joseph Rowntree Foundation, November 2009

Click on the title above to access the full report and summary

Abstract:

Highlighting what older people in care homes want and need.

How can we ensure a ‘better life’ for older people in residential and nursing care homes when their voices are rarely heard?

This study examined the experiences and aspirations of these older people and highlights their ambition to increasingly influence decisions about care, support and wider issues such as:

• Whether or not to move to a care home
• What helps to enhance their quality of life
• What is needed to promote their inclusion in care home, family and wider community life.

Lancashire Care staff can either click on the link above, or email: susan.jennings@lancashirecare.nhs.uk

Our writing springs from our lives. As a nurse, I dealt, for the most part, with the elderly and dying. Many of my patients had Alzheimer’s or similar forms of dementia. When I participated in the PAD Poetry Challenge, one of the prompts was to write a love poem. This one didn’t make my final cut, but I thought I’d put it out there. Real love endures all the many losses associated with aging.

“Sweet Romance”

I can’t forget those eyes–
silver-blue like
meadow flowers
that looked into mine,
pierced my soul.

Your touch,
velvet smooth,
sparked shivers,
fire in the core of my body.

The heady scent,
lily of the valley,
flooded the room
when you walked in.

Sweet as honey,
the taste of you
lingers.

Flowing from your lips
each word you spoke hangs
like a note of music
fills my head
with haunting melody.

Where do you hide?
Your body a husk
of who you used to be.
You finger the fringe of
a shawl wrapped around
fragile shoulders.
You look at me
but don’t remember
who I am.

This easy christmas activity is good for a variety of populations and will save you a fortune on buying brand new jingle bells.  Head down to your local craft store and purchase pipe cleaner, beads and jingle bells.  Slip beads and bells in any particular order/design you like over the pipe cleaner, leaving a small space at both ends.  Tie ends together when finished by wrapping them around each other (you may need pliers or another tool to make sure there are no sharp tips sticking out).  Celebrate by singing and shaking the bells along to Jingle Bells, Silver Bells or any other related Christmas song.

“A TEENAGER has been knifed to death – allegedly by his best mate – after a bust-up over a message on Facebook.”

…Because of a “Disrespect” message.

Read more here.

This is madness!

There are many people addicted to these social networks needing a psychologist.

Facebook was supposed to be a networking place, not a dementia place…

This is NOT evolution!

From: Caregiving for the elderly: impact on caregivers and their children.(Invited Insights)(Report) by Hamill, Sharon Boland
Source: Psychopharmacology Educational Updates (PsychEd Up), 3/1/2008.
Via: HighBeam™ Research
COPYRIGHT 2008 NEI Press Neuroscience Education Institute. www.neiglobal.com email: info@neiglobal.com

Excerpt:

The aging of American society is having a dramatic effect on families caring for the elderly. Currently there are 37.3 million older persons (aged 65+) in the United States, representing 12.4% of the population. By 2030, this number is expected to double, with the elderly comprising 71.5 million people, or 20% of the population.1 This growing population will result in an increase in the number of elderly in need of care. Today, over 50% of the elderly report some kind of sensory, physical or mental disability which impacts an older person’s ability to complete activities of daily living (ADLs; e.g., bathing, toileting) and instrumental activities of daily living (IADLs; e.g., shopping, transportation). (1) When elderly are in need of assistance, it is the family that steps in to help. Many of the adult children who serve as caregivers are members of the “sandwich generation”–those individuals providing care to aging family members while raising children and adolescents of their own. (2) Whereas a great deal of research has focused on these “sandwich generation” caregivers, little attention has been paid to the impact caregiving has had on their children. This ‘forgotten generation’ (3) may be at risk for the same kinds of poor physical and mental health outcomes known to affect adult caregivers.

Whereas a great deal of research has focused on these “sandwich generation” caregivers, little attention has been paid to the impact caregiving has had on their children.

Who are the caregivers?

Despite the myth of the abandonment of the elderly in the U.S., research has shown that families are highly responsive to the needs of their family members. It is estimated that 34 million adults provide assistance to individuals 50 years of age or older. (4) Caregivers are most likely to be female (61%), approximately 47 years old, employed full- or part-time (51%), and average 21 hours of care per week. (4) Adult children are the family members most likely to provide care (44%), and approximately 40% of these caregivers are providing assistance to their elderly parents while providing support to dependent children of their own. (2,5) The estimated financial cost of this informal care is $257 billion per year; (6) however, the toll caregiving takes on caregiver health may result in even higher costs.

How does caregiving affect caregiver physical and mental health?

Most research focuses on the physical and mental health of the caregiver. Primary stressors stemming directly from the caregiving demands (e.g., the patient’s problematic behaviors and the provision of help with ADLs) and secondary stressors that result from the primary stressors (e.g., conflict with family members over not providing enough help) combine to create poor health outcomes. (7) For example, numerous studies have demonstrated that caregivers experience poorer physical health than their non-caregiver counterparts, including poorer immune system functioning, higher blood pressure, and increased risk of cardiovascular disease. (8,9) Compromised immune systems result in problems such as greater susceptibility to flu and slower wound healing time. (10,11) Caregivers have also been found to exhibit higher mortality rates than non-caregivers. (12) Collectively, these studies suggest that a major cost of caregiving is the decline of the physical health of the caregiver. It is often the poor physical health of the caregiver that leads to institutionalization of the elderly. (13)”

High cholesterol levels in midlife significantly increases the risk of Alzheimer’s disease 30 years later.

The national study shows that not only high cholesterol, but also borderline high cholesterol, is associated with dementia.  

Researchers noted that studies have shown that treatment with a cholesterol-lowering statin drug may lower the risk of dementia.   “What’s good for the heart may be good for the mind,” says Jesse Slome, executive director of the American Association for Long-Term Care Insurance.  Alzheimer’s disease is one of the nation’s leading causes of need for costly long-term care. 

The study, published in the journal Dementia and Geriatric Cognitive Disorders, involved 9,844 men and women whose cholesterol levels were determined between 1964 and 1973 when they were 40 to 45 years old.

Between 1994 and 2007, a review of their medical records showed that 469 had Alzheimer’s disease and 127 had vascular dementia, the second most common form of dementia after Alzheimer’s disease, which is caused by clogged blood vessels and other conditions affecting the blood supply to the brain. 

Compared to people with desirable cholesterol levels below 200 milligrams per deciliter of blood (mg/dL) in midlife, the risk of Alzheimer’s disease three decades later was 57 percent higher in people with high midlife cholesterol levels of 240 mg/dL and above.

Borderline high cholesterol (200 to 239 mg/dL) tended to increase the risk of Alzheimer’s disease as well, but the results were not statistically significant.  However, midlife borderline high cholesterol increased the risk of vascular dementia by 50 percent. High midlife cholesterol also tended to increase the risk of this type of dementia.

A very interesting article in today’s National Post on music and the connection with memory.  Enjoy!

http://www.nationalpost.com/story.html?id=2372046.