Author: Brett

Taking Bloods – “Can We Do It Differently With Dementia?”

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Bob had to have some blood taken recently and a pathology agency person arrived at the nursing home to make this happen. Myself and another carer were asked to hold Bob’s wrists as he sat in a chair. The lady told Bob what she was going to do and then placed the needle in his arm and Bob did not like it at all. He became tense and resisted, then as we all clamped down on him he became combative. No-one was hit or hurt but the potential was definitely there.

So why did this task turn pear shaped? I keep coming back to looking at events from the person with dementia’s point of view. So how did Bob see this event?…

Firstly, he had a stranger ask him to leave the lounge room (where he was laughing and enjoying his coffee and cake) and go to his room. He was then placed in a chair, was told the lady’s name and she explained she was going to “take some blood”. 10 seconds later both his wrists were grabbed and he had 3 people appearing to restrain him and hold him down.Bob would have been thinking “Is this a code black?..Am I going to be held down against my will again?….I need to fight back!”. Bob tensed up,his muscles tightened, the needle went in, a small amount of blood was taken, then the struggle began, the lady stepped back and things flared up for a split second. The lady was not happy and said “he is very strong, I don’t like what I just saw and he should be sedated more in future”.

I then decided to walk Bob out of the room to change the environment, I calmly spoke with him to de-escalate him, and he now had blood all over his shirt. Bob said to me “look what you have done to me!”. I felt I had to change his shirt asap to avoid the reminders of the incident. He allowed me to do this and was happy again within 5 minutes. (a very quick de-escalation indeed).

So how could we have done this differently?

– Firstly the lady taking the blood had no rapport with Bob and probably could have chatted some more, and got to know him. An extra 5 minutes of chit chat and a look through his photo album may have helped this situation. (it was too clinical)
– By holding his wrists down BEFORE the needle went in, made Bob react negatively making the whole process more difficult.
– Our focus was on protecting the person taking the blood (which is understandable) , but she was actually more at risk by having us “set the wrong scene” prior and restraining him. Of course Bob’s history would have warranted the action taken, but I know a better result would have occurred if we had a more ‘relaxed vibe’.
– Distraction has worked well in the past when taking bloods. I normally rub his knee quite vigorously and talk about old football injuries with him as the blood is being taken from his arm. This diversion takes the focus off the needle.
– Two people maximum should be involved to avoid “over crowding” and preferably have someone who knows Bob take the bloods.

*There are many ways to look at an incident like this, and there are no 100% black and white answers here. It does highlight once again that when dealing with a person with dementia, having their point of view ‘front of mind’ usually produces a better outcome.

*My Golden Rule – create relationship first, assess the risks, then do task (or defer it).

What is Life Like For Our ‘LGBTI’ Community in Aged Care?

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I have to admit I have not yet come across any people within aged care from the LGBTI (Lesbian, Gay, Bisexual, Transgender & Intersex) community. I have always wondered whether they have extra stigma to deal with on top of the stigmas associated with dementia?

I would imagine there could be some homophobic attitudes and ignorance from carers, people with dementia and other family members, in our aged care homes. On the flipside, I have also heard a story of a man that only felt safe to ‘come out’ once he entered an aged care facility.

Are transgender people considered by their birth gender? Are there specific policies for LGBTI people in aged care homes? Is there any training on this topic within Cert 3 (Aged Care)? As the background and personal history of a person with dementia is critical to handling behaviours (and providing person centred care)…does this still apply to the LGBTI community?… and to what extent?

As you can tell I have very little knowledge in this area (plus plenty of questions), but thought it was important to have the conversation. I believe that a ‘dementia friendly community’ should be one that is ‘all inclusive’ and no-one gets left behind. I am just interested to know if our LGBTI community are being considered and treated equally in our aged care system in 2016?

Dementia & Driving Through Shop Windows

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Too many times on the news there are reports of elderly people (or people with dementia) crashing their cars into shop windows after ‘putting their foot on the wrong pedal’.

In my opinion I believe that once a formal diagnosis of dementia has been given, the car keys should automatically be required to be taken away.

Whilst there is an argument that the dementia may only be mild or in early stages, it still brings an unacceptable level of risk to the person with dementia and also the community.

In hindsight when Bob was driving, we were probably not quick enough to remove the keys and he drove through two red lights. Imagine if he had crashed and been badly injured , or worse hurt or killed someone else?

If their is cognitive decline or memory issues with a person – being behind the wheel of a car is not the place for them to be. It may be hard to approach the subject at the time, but it is a conversation that needs to be had.

For some tips on how to remove the keys – Click the following link:

http://alzheimers.about.com/od/communication/fl/How-to-Talk-to-Someone-with-Dementia-about-Quitting-Driving.htm

 

Sticking To An Activity – How Do We Branch Out?

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I took Bob for a walk this morning and noticed that he really enjoyed picking up twigs every few steps , breaking the twig into smaller pieces then placing it back on the ground. We only walked for about 100m as he kept stopping and bending over to pick up the sticks.

I want to capitalize on this activity as it totally engages him and makes him feel happy. As most of you know Bob is really difficult to engage as he rarely watches tv, does not read books (besides his photo album) and has an attention span of about 6 seconds with activities.

He does however love his music and is often dancing with carers and residents.

Anyway, back to the twigs. I thought about bringing a bag with us for when we go walking so we can collect the sticks and use them as ‘kindling in my combustion heater’ . I want him to know that he is doing a worthwhile activity that I can benefit from, and he feels good about helping me.

My question today is ” Knowing that Dad likes doing this activity with sticks, what would you recommend as ideal activities that are along the same theme or may be tactile in a similar way?”……..

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Transition Techniques to a New Facility

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Bob is now back in his new room in his nursing home and is loving it. After 8 weeks in hospital we were nervous to see if he could settle back and be calm. I am very pleased to say we have had 2 amazing days with him, smiling, some tears( happy ones) and he laughs every time he looks at me. ( not hard to do…:-))

The transition has been successful due to the nurses and care staff being aware of changes documented in his personal profile, plus the kind ladies at DBMAS have placed some new signage up to help Bob find his room and make him feel special.

All the staff say ” Hello Bob” as they pass him and are very caring to his needs.

Well done all on a great team effort.
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Another Valuable Dementia Lesson Learnt

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A few months back many of you would remember a post that I wrote regarding our family reaching a pivotal turning point in Bob’s dementia journey. I made the comment that we needed to shift our care from one of fighting for Dad’s well-being and quality of life to one of simply providing comfort and care with a palliative mindset. I felt we had ‘lost him’ completely. Well I am pleased to say that I was wrong on that occasion…..

Just to recap – several months back Bob had erratic behaviour issues and was becoming increasingly violent and unpredictable. He had a very sore toe with the toenail lifting and was suffering with severe pain with it. I called the doctor and he prescribed a Norspan patch for his shoulder which can be an effective pain drug absorbed through the skin. Unfortunately Bob is extremely sensitive to medication changes and his behaviours became ‘outta control’ and he was doing unacceptable things and I felt that his brain was so damaged that he would not recover and become palliative.

He was transferred to the RAH and spent 5 weeks in a medical ward as there was no beds in the geriatric ward. He manically walked the ward all day and night with a nurse and/or family member in tow. We had another 12-15 code blacks during those 5 weeks and he was eventually transferred to the Repat Hospital – Ward 18. The environment was quiet, with only 8 patients and each person has an experienced nurse monitoring them across every 15 minutes. Decisions are then made to either return the person to their nursing home, ( or residence) or be transferred to a mental health facility.

Yesterday we found out that whilst Bob has declined significantly he has been given the green light to be transferred back to his nursing home on MONDAY to a brand new room and ward . He will be warmly welcomed back by the residents and staff. We are far from being out of the woods and have to hope his behaviours continue to subside. His warm smile is back.. he laughs often…and I am hoping we can keep him out of the hospitals from now on. fingers crossed……

The Lessons?….. any future changes to medications need to be done gradually and with extreme attention placed on looking for any side effects over several weeks. The big lesson I learnt however was that there is always hope for a better quality of life if you NEVER EVER GIVE UP and keep searching for answers and give it EVERYTHING YOU HAVE.

“C’mon Dad……Let’s do this!!!!”

What’s In A Name?….Plenty Mate!

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As I spend so much time with Dad in hospital (and at his nursing home) I often hear carers & nurses call the resident/patient “Mate”or “Buddy'”.

I personally don’t like this as it does not give the person dignity or respect. If using someone’s name makes them ‘feel’ good, then shouldn’t we make the small effort to learn their name and use it?

By calling someone ‘Mate’ we are saying to them- you are not important and you are not unique.

‘Off the Wall’ idea….What would happen if we wrote the resident’s first name on a sticker and placed it on their chest?

If they have dementia they are likely to forget things all the time. If everyone has a name tag maybe they can now call each other by their first name and create a happier place?….just a thought.

Acute Mental Health Assessment Wards

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Acute mental health assessment and treatment services are an invaluable part of our mental health system in SA. Ward 18 at the Repat Hospital (soon to be moved to Flinders Medical Centre) services the eastern/southern area of Adelaide, Ward SE based at the Queen Elizabeth Hospital covers western suburbs with Ward 1H at Lyell McEwin Hospital covering the north. When patients display violent or extreme/difficult behaviours this ward is the next option after hospital. The public hospitals do their best to control the behaviours but cannot sustain it long term, as the busy hospital environment is not really conducive to people with late stage dementia.

Essentially the public hospitals become temporary ‘holding bays’ and may administer medications to control the behaviours, whilst ensuring the person is medically sound. An ambulance transfer is required to the acute wards and then an interview with staff is had on arrival. This next hour is very important as it is your chance to chat with the senior doctor and nursing staff to discuss the best ways to handle the upcoming care for the patient. Behaviours, triggers and ways to de-escalate situations are all discussed in great detail. You are also given a document called an ‘Inpatient Treatment Order’ (under the Mental Heath Act 2009) refer links below for more information:

https://www.legislation.sa.gov.au/lz/c/a/mental%20health%20act%202009/current/2009.28.un.pdf

http://goo.gl/t7xyl7

k/docs/resources/Mental_Health_Act_Plain_Language_Guide.pdf

The difference with this ward is that there are less beds (approx 8-12), the patients are locked out of their rooms (for safety reasons) and any items that can be considered dangerous are ether confiscated or asked to be removed. This may include electrical items, dressing gown cords, shoe laces and sharp instruments. Bathrooms are locked and patients reside in a main common area with staff based behind a central glassed office area . There is very little stimuli in the ward and is extremely quiet, a welcome change from the very noisy public hospitals (which is better for people with dementia).The wards are very different to hospitals and may appear ‘prison like’ at first due to heavy lockable doors, heavy furniture and a barren environment. The heavy chairs have wheels on them to allow you to move them, televisions are installed behind strong perspex plastic and most doors and cupboards are locked. There are very few items for the patients to be in contact with. They include a handful of magazines, newspapers and their plastic cups, saucers and plates.Quiet activities are locked away in a cupboard to be brought out as required. These measures are to ensure the safety of both the patient and the staff.

There is a nurse allocated to every 1-2 patients and their role is to observe and document the movements and behaviours. The nurses are at risk of being hit at times and it can happen without warning. Patients may sit in silence or cry & shout uncontrollably,push furniture around or may display manic behaviour including pacing and speech issues, which is all part of a day in an acute ward . The patient is rarely out of the gaze of a staff member and they are observed across every 15 minutes (this includes overnight). These wards are a vital part of our health system and need to be in place to ensure people with dementia and others with mental health issues are cared for properly.

 

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‘This is Me’ – The No.1 Document That Impacts Dementia Care

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As carers and nurses are forever changing shifts they may not get the time to know the patient or resident, or understand their behaviours or triggers. By having a document like the one attached ready to go it gives your family member, relative or friend with dementia every chance of receiving the care they would prefer.

This is an actual document I completed last week and I have written my answers as if I was Dad. This ensures that the information is personalized and will connect with the carers or nurses. The best way to influence the care when you are not there is to have a document like this at the front of the file. I felt it was appropriate in this instance to post my actual document to illustrate the language and tone used to achieve a better result.

This document will reduce the chance of the carer accidently triggering bad behaviour, and will also assist them to de-escalate a situation also. Everyone wins when the background of the person is well known. It also ensures they will be treated with dignity and respect. I realised that it is not just the questions that are important in the attached document it is the way that you answer them. I imagined I was Bob and answered each question how he would possibly like to. I wanted to train the carers and nurses at the same time and allow them to bond with Dad as quickly as possible.

*Double click the following link to download my recent ‘My Life Story’ Form (you may need to click on it several times in a new window) :

This is My Story -DD Version

A Shiny New Hospital…But Have We ‘Forgotten’ Our Dementia Patients?

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Our new Royal Adelaide Hospital is the 3rd most expensive building in the world…that’s right…IN THE WORLD! Who would have thought little old Adelaide could produce something so big and bold? It has cost us taxpayers 2.1 billion dollars to construct and will include world class facilities and cutting edge technology. Everyone gets their own ‘hotel-style’ room complete with robots zipping about, and we will never be more comfortable when sick. However when the new RAH opens and the ‘razzle dazzle’ of our shiny brand new hospital subsides, the underlying problems of our healthcare system in South Australia will emerge, and it is bad news for our senior citizens. The impact of the new hospital has a dark crisis looming for our ageing population and needs to be talked about.

There will only be 120 extra hospital beds more  than we currently already have but here is the real problem. The geriatric wards of the RAH will be reduced and the overflow of people will most likely be sent to The Queen Elizabeth Hospital (TQEH). This is the engine room of our health services for our aged community, and has purpose built world class facilities (GEM unit) for our dementia patients including research departments trying to find cures. But here is the ‘game changer’. The Hampstead Rehabilitation Centre facilities at Northfield will soon be moved into the TQEH. In theory it is a good move to place all these services in the one location, but the cost is that to make room for this, the existing geriatric areas will be further reduced including their beds, gardens and facilities for dementia patients.

With our ageing population being one of our most significant issues looming in the next 10 years, where are our elderly going to be treated? The Repat hospital will be closed and their geriatric services moved to Flinders Medical Centre. Once again less beds for the elderly as the facilities are located in the one place.The only way the overflow of elderly and dementia patients can be treated is to place them back in the general acute beds within our remaining hospitals. This means that our hospitals (including the new RAH) will now have dementia patients mixed in with general patients having surgery or who may have diseases.

What’s the problem with this? DEMENTIA IS DIFFERENT….The patients wander and roam, they may have mental health issues and require an extraordinary amount of resources to look after them to ensure their safety. After spending 12 weeks in the RAH and 4 weeks in the Repat hospital I know exactly what kind of mayhem one single dementia patient can cause. My Dad required a ‘nurse special’ 24 hours per day, 7 days per week and had over 20 ‘code blacks’ which involved up to 6 security people each time. This is a lot of resources in anyone’s language.  If someone is diagnosed with dementia every 6 minutes then we have a crisis on our hands. Our bursting hospitals will now resemble an aged care home and our wards will no longer be safe or effective.

But what if it is your loved one that has dementia and is sent to hospital? They will be placed in an environment that will scare them, it will be noisy, and may increase their behaviours. This means that security teams will need to be boosted and more nurses required to keep the dementia patients in their beds. The patients will naturally want to wander and may disturb other patients who are critically ill. Dementia patients often manically pace the hallways, they are no longer in touch with the real world so often resemble an overgrown toddler. They get lost, they touch things they shouldn’t, they cry & scream, they hit and throw things, they run around naked and sometimes they are just plain frightened.

What about their dignity? How do they feel?…I would suggest probably ‘forgotten’ (which is ironic when you have dementia) .

Our aged community need to be considered and looked after properly, they have surely earnt that right.