Author: Brett

I’ve Bitten The Bullet…

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Today I made the life changing decision to go to Uni (while still working). This is one thing I never thought I would be saying, as ‘Partingtons’ & ‘Universities’ are normally natural enemies.

I will be studying ‘Dementia Care’ (online via University of Tasmania) and hoping in the future to be one of Australia’s leading dementia care trainers and advocates.

Considering I can’t stay awake long enough to read a newspaper, I have a lotta work to do. 🙂

I hope the course is a lot easier than the enrolment process.

Got off to a flyer yesterday by spending an inspiring hour at the home of Australia’s leading international dementia advocate and 2016 Australian of the Year state finalist, Kate Swaffer (who also has dementia).

Random Important Facts That I Have Learned About Dementia

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Over the last few months I have been studying everything I can about dementia, and seeing things unfold each day as Dad’s disease progresses. Below are some random but important things that I have learnt recently.

• Teaching people about dementia is difficult – why?…because just when you learn how to do something, the disease progresses and you need to learn something else. Dementia is a moving target.
• Every person’s journey is completely different, which means that you can’t just use a few core care methods, you need to use the ones that suit that person.
• We are about to have a serious problem with our hospitals in Australia with many beds being taken up by the aged, and not enough beds.
• Dignity is really important for the person with dementia.
• There is not enough follow up of ‘side effects’ from medications prescribed by doctors. People are falling through the cracks.
• Carers should be involved in the follow up process as they are the ones who notice the subtle day to day changes after medications are prescribed.
• One care person doing the showering is better than 4 (this happened last week)
• Lewy Body dementia is often mis-diagnosed up to 80% of the time.
• There are many different types of care models eg person centred care, feelings matter most etc
• You can positively impact on a person with dementia within 30 seconds, you just need to know how.
• Hospital wards are very noisy places and not suitable for people with dementia.
• Caring or nursing someone with dementia without knowing the person’s history is setting yourself up for failure. Doing your homework will reduce a lot of anxiety for the person, the carer/nurse, and others nearby. It may even avoid you getting hit.
• Environment plays a huge impact on patient behaviour. We just moved Dad from the noisy Royal Adelaide Hospital (RAH) to the Repat Assessment Ward (8 bed facility) and the improvement in his demeanour is incredible. He is calmer, happier and has stopped the manic pacing that he has been doing for over a month.

The Shower…Tips For Reducing The Stress – Part 3/3 (Final)

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3. AFTER THE SHOWER

Place a floor mat down and ensure the person stands on the mat for safety. I usually place the mat on the floor under the heat lamps if possible, as it is nice and warm.

Pass the open towel to the person and allow them to start drying themselves if capable.You may want to place it over the person’s shoulders as well. It all depends on the individual and their own personal routines. It is great if they can dry themselves as much as possible.

Go over the person’s entire body with a towel even if they have already dried themselves. This will ensure the person is as dry as they can be. It is important to dry them quickly in this case as they may argue that they have already dried themselves. It is all about being subtle and discreet.

I mop up any wet areas of the floor asap to reduce the chance of a fall. I may use towels or a mop if handy. I tend to do this task when the person may be drying themselves so it does not appear that I am ‘over caring’ for them. I believe they need to feel like they have washed and dressed themselves with only some minor assistance from the carer.

Be aware that spray deodorants may annoy people and they may prefer a roll on deodorant (if anything at all). If you are going to spray the person you to need to prepare them by telling them what you are about to do first.

Keep praising and remain positive at all times. If something goes wrong it is best to apologize and take the blame for it EVERYTIME. This will diffuse any frustrations for the person with dementia.

I like to dress the person outside the bathroom as the clothes are more likely to stay dry and it is a safer environment to do so. I will close the blinds/curtains and any doors for their modesty.

Dressing the person can be a stressful time also. Observing body language can really help by watching what frustrates the person when dressing them and establishing routines to make things easier.

Always ensure clothes are not inside out before putting on the person. If you have to take the garment off and on several times it can really irritate a person with dementia.

When placing pull-ups or pants on I tap the wall, get the person to hold the wall or rail (to steady themselves) then assist as required. Buttons on shirts are a flashpoint for frustration. Do not get concerned if the buttons are done up wrongly, you can adjust later if required.

When placing a shirt on the person I run their arm up one sleeve of the shirt and then quickly hold open the other sleeve from behind to ensure a fast and smooth action. I aim to make this ‘hotspot’ procedure as seamless as possible. I usually let the person try and do their own buttons up to empower them. Who cares if the buttons are not quite right? I may adjust them later depending on the person’s mood.

The key to dressing someone is to be ahead of the game and anticipate any frustration areas and practice your techniques. Everyone is different so there is not a ‘one size fits all’ solution to the best way to dress a person with dementia. As the disease progresses you also need to adapt to the person’s nuances and habits as they are ever changing.

I always ask the person first if they want to perform an action eg ‘put their shirt on’ before doing it for them. I believe it is really important to empower them and retain their dignity as much as possible. If the person does not react or respond, I will then perform the action but do so in a way that they are actively involved in the process. This way they feel they have dressed themselves and not treated like a baby.

The Shower – Tips For Reducing The Stress – Part 2/3

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2. HAVING THE SHOWER

Find out the person’s previous shower routine and washing habits where possible. eg what order they like to wash their body parts and try and do in a similar order.

Make sure you have a rubber mat down to ensure they do not slip over.

Get the person to hold onto hand rails in shower if you have them.

Showers with a flexible head that can also be attached to the wall are preferable. This gives you the freedom to be ‘hands free’ if required, or be able to reach difficult places of the body with the flexible head.

Turn on the water and test the temperature before the person goes under the water.

Be wary of the water pressure. It can be a scary event for a person with dementia as to them they may see the shower as a jet of water blasting from the wall that may harm them. Try not to hit them in the face with the water straight up.

Allow the person to feel the water before entering the shower. If the person is refusing to get undressed, turn the shower on as a ‘trigger’ that it is shower time.

If they feel the water first with their hand it can sometimes be instinctive for them to then remove clothes.

Let the person feel part of the process and empowered by allowing them to wash themselves if they are able. Place soap in their hands and guide them to wash selected parts of their body.eg “now do under your arms”. (*note – this may not be possible as the disease progresses)

Remove clutter from within the shower. The person can sometimes grab the shampoo bottle after you have already done their hair and re apply. If you remove the bottle after you use it, it will reduce the temptation for them to grab it. This may be the same with soap.

Make sure you go over all the areas of the body with soap even if the person has already
done them. This will ensure they are as clean as they can be.

Avoid confusing the person by talking too much or giving too many instructions in
the shower.

Clean very quickly across private parts or get them to do it themselves if possible.
Prepare the person by positively talking to them as you shower them.

Praising the person (not in a child-like manner)as they do things is really important. It
keeps the person upbeat and more likely to be less difficult.

If the person is becoming negatively focused on the shower process you may need to distract them by chatting about something else, asking them to hold something etc.

If the person is refusing to take their pants off for example (due to their cognition) you can try tricks like discreetly wetting their pants with the shower head. The pants will become heavy and the person may naturally remove them because of this.

I prefer to let the person remove their own pants if possible. It is a sensitive area and the person may be reluctant.

Many carers are hit when they do not warn the person as to what they are about to do. eg removing pants/underwear. Be respectful of their modesty.

 

The Shower – Tips For Reducing The Stress – Part 1/3

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Probably the ‘no.1 hotspot’ for frustration for people with dementia (and their carers) is the bathroom. Showering is difficult and exhausting, and everyone seems to end up wet. I have decided to share my favourite showering tips across 3 sections :

1. Preparing for a shower
2. Having the shower
3. After the shower

There are no set rules as to showering but you need to remain flexible. As the disease progresses you may need to change your showering methods as the person may have less mobility, less cognition or be experiencing health factors. Please feel free to comment with any tips you may have.

1.PREPARING FOR A SHOWER:

  • People with dementia DON’T seem to like taking showers. A big mistake to make as a carer is to waste energy on trying to convince the person to have the shower and arguing with them.
  • They will more than likely refuse to take a bath or shower every time you ask. As a carer you need to ACCEPT THIS. If they take the shower willingly…consider it your lucky day!
  • It is better to attempt to shower the person everyday, as opposed to twice a week. With people with dementia establishing the ROUTINE cannot be underestimated. It doesn’t matter if you succeed everyday, but is great if you can establish a pattern (eg shower the same time each day).
  • How often should they have a shower? No set rule…but I would aim for at least 3 times per week. Some cultures do not have showers for weeks. having a regular shower will reduce the risk of urinary infections etc.
  • BE ORGANISED – prepare some fresh clothes in advance inc pull-ups, pads etc…I usually lay out the complete outfit (inc shoes) and make sure everything is unbuttoned, untied and facing the right way prior to showering – this will keep things efficient.
  • Pre-prepare your towels and flannels. I take in 3 towels (one for foot towel, one for face/hair, one for body) and 2 flannels. It is worth the extra towel washing afterwards to have a smooth shower experience within the bathroom.
  • Have all toiletries on hand and mentally run through your routine to ensure you have items lined up in order ready to go. I start our routine by brushing the teeth first at basin, then moving straight into undressing, then showering.
  • Warm the environment – turn on the lights and heat lamps and make the bathroom a cosy place to be in. Maybe even have some soft music playing.
  • Some people are very modest when it comes to taking a shower. As carers we need to RESPECT THEIR DIGNITY and do small things to protect their modesty. eg turn your head away where possible, cover them up quickly etc
  • Expect the “No’s!” when it comes to showering – try and keep things light hearted and relaxed and say something like ” Let’s get all nice and clean, and then we can make you a nice breakfast”. Keep everything POSITIVE and remind them how good it feels to be clean.
  • Avoid lengthy explanations, keep it short and simple where possible.
    When ready to take them to the shower, gently approach them and try and get their attention, aim for some positive rapport and keep things light and happy. Then reach your hand out to them (palm facing upwards) and wait for them to take it.
  • I like to emphasize that “WE are going to have a shower now”. I believe that if you do it as a ‘team’ it is a shared experience and will make them less likely to resist (as we are doing it together).
  • If in a care facility, I prefer to have less people in the bathroom ( is less confronting for the person with dementia). If two carers are doing the showering I would rather have one carer making the bed while the other washes the person. The carer not in the bathroom needs to be super alert as to what is happening inside the bathroom and be ready to fetch an extra towel or lend a hand if the carer doing the showering calls for them. Effectively the 2nd carer will act as their support person/assistant and is a critical role to how smooth the shower process goes.
  • Don’t be bossy when showering! You are better to calmly GUIDE THEM.

A Chair was Thrown!….This is What Happened Next

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I recently went back to Bob’s nursing home to collect some items when I found myself in the middle of a hostile situation with a resident. There were two carers, a nurse and several others ‘milling around’ a resident called Barney in one of the lounge areas.Unknowingly, I walked up to Barney and shook his hand as always, and said “good morning”.

Within seconds the registered nurse (RN) pulled me away and told me to be careful as Barney was outta control and had just thrown some chairs and had tossed a glass of water over a carer to ‘cleanse him of his evil’.
The nurse also informed me that Barney had recently smashed his own television in a rage by throwing something at it. I have always had a good rapport with Barney so I asked the nurse if she was ok if I tried to calm him? She said “no problem”.

Straight away I jumped on to Barney’s side and asked him if he could show me his new room. I felt he needed to be away from others, and the change of environment may de-escalate the situation. I took him by the hand and once in his room I asked if he would mind if we sat down together for a while? He was ok with this and then I asked him how he was feeling. Barney answered “I am frustrated”. This answer was pivotal as it told me where to start digging for clues as to why he was violent. I asked him “tell me what things are frustrating you?”. Barney replied “I do not trust those people, they have messed with the chemistry and composition of the food and the drinks, and they are evil”. He said ” The Japanese cannot be trusted and the women have the codes and they can still be easily broken”. Straight away I knew he was talking about wartime and breaking secret codes.

I then tried to soothe him by playing his favourite classical music in his room. He told me it was Bach and he enjoyed it very much. I started to dig for clues as to why he was upset, and asked him some more questions. He then said to me “I only trust one person in here , but I can’t tell you who it is, we only communicate by morse code”. I was starting to think he was having some real delerium issues at this point. Barney then asked me if he could have my hand?. He held my hand and with his thumb and started to pulse and tap my palm . What I then realized was that he was typing the international morse code signal for help….SOS! (I took this as him telling me that he trusts me).

I excused myself to go and talk to the nurse to see what the medication situation was with Barney. She advised that he was refusing all meds and no-one could get near him. I knew it was unconventional, but I asked if she wanted me to try and give him his medication? The nurse said “it’s worth a try”. I then grabbed two fresh cups and his tablet and headed for Barney’s room. He was dozing in his chair listening to the music. I poured myself some water from his jug and made sure he saw me swallow it. I then poured him a drink and re-assured him that “the water is fine and is ok to drink”. (he had told me previously that the food and drink was tampered with). Because I had Barney’s trust he drank his water,and when I asked him to place the tablet in his mouth and swallow… he happily did so. I was so pleased and was silently cheering to myself.

We then sat for a few more minutes listening to his music and just talked. I advised Barney I had to leave, but thanked him for the water and the chat and shook his hand. He held my hands tightly and just kept saying to me ‘thank you, thank you for visiting me and listening to me.”

What I learnt:

  • gain the trust of the resident first and then distract them
  • remove them from crowded areas (eg. away from who he is arguing with)
  • change the environment to a much calmer one (eg music)
  • spend 5 mins or so just listening to their story, the clues may emerge.
  • get into their head space, and understand how they are thinking at that very moment of time
  • be creative – think outside the square when trying to find solutions
  • dementia is about being flexible and changing things to suit the individual. (you cannot have a ‘one size fits all approach)
  • By spending a small amount of time listening to the resident can save hours of stress and bad behaviour which can impact on the entire nursing home.

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What I Have Learnt About Dementia Lately…

Brett0 comment

Over the last few months I have been studying everything I can about dementia, and seeing things unfold each day as Dad’s disease progresses. Below are some random but important things that I have learnt recently.

• Teaching people about dementia is difficult – why?…because just when you learn how to do something, the disease progresses and you need to learn something else. Dementia is a moving target.
• Every person’s journey is completely different, which means that you can’t just use a few core care methods, you need to use the ones that suit that person.
• We are about to have a serious problem with our hospitals in Australia with many beds being taken up by the aged, and not enough beds.
• Dignity is really important for the person with dementia.
• There is not enough follow up of ‘side effects’ from medications prescribed by doctors. People are falling through the cracks.
• Carers should be involved in the follow up process as they are the ones who notice the subtle day to day changes after medications are prescribed.
• One care person doing the showering is better than 4 (this happened last week)
• Lewy Body dementia is often mis-diagnosed up to 80% of the time.
• There are many different types of care models eg person centred care, feelings matter most etc
• You can positively impact on a person with dementia within 30 seconds, you just need to know how.
• Hospital wards are very noisy places and not suitable for people with dementia.
• Caring or nursing someone with dementia without knowing the person’s history is setting yourself up for failure. Doing your homework will reduce a lot of anxiety for the person, the carer/nurse, and others nearby. It may even avoid you getting hit.
• Environment plays a huge impact on patient behaviour. We just moved Dad from the noisy Royal Adelaide Hospital (RAH) to the Repat Assessment Ward (8 bed facility) and the improvement in his demeanour is incredible. He is calmer, happier and has stopped the manic pacing that he has been doing for over a month.

Phew!…. Another Code Black Avoided

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I was walking into Ward R8 at the RAH when my mobile rang. It was the ward manager and she had bad news for me. I told her I was 5 metres  from where she was calling me from , so she hung up and came and spoke to me face to face. The very caring manager explained to me that Bob had been very agitated , refused all meds and grabbed the wrist of a nurse and hurt her. An intra muscular injection was called for and I gather a security team would be on stand-by. She was concerned about me seeing the trauma of the injection being administered, but I said I have seen it done enough to be fine. I asked the manager if I could have a try at giving the meds before they inject him, and she agreed.

I walked up to Dad carefully and gave him my normal happy greeting. He had the ‘evil stare’ he gets when agitated, and I reached for his hand to feel the tension. His hand was clammy and rigid and is a tell-tale sign of his mood and aggression level. We were surrounded by 4-5 nurses who were all trying to help the situation, but actually weren’t. Straight away I put myself in dad’s shoes…how is he feeling about the situation? To him it would look like another ‘code black’ was about to happen and he would be terrified.

I held his hand with a special grip that I learnt from an expert called Teepa Snow. It is used to comfort him, make him feel in control and give me protection against a possible hit. The grip worked well, I then directed Dad away from the crowd. Straight away I went onto his side of the situation and agreed with whatever he felt or said. Once I had distracted him and calmly spoke with him, I had his trust and he was compliant. As we did a lap of the hallway – I asked the nurses to prepare meds and water for me so I can give it to him smoothly. They handed me the cup and tablets on my next walk past, and I turned dad away from the nurses. I did my usual routine, placed the tablets in the palm of his hand, gestured with my hand to place them in his mouth and then gave him the water.

He complied instantly. The nurses were in shock as they had been trying for hours. The problem was they kept trying to give the meds to him by adding people, adding pressure and too much talk. He was confused, frustrated and also angry. I then decided to walk Dad up and down the hallways to get the medication to kick in quicker and also change the mood. More tablets were handed to me as I went past, and once again our medication routine worked a treat. After 20 minutes or so Dad’s hands loosened up, he started to smile and laugh and the incident was over. The manager ‘thanked me’ which was really nice of her.

Normally no-one would go near Dad after an agitated incident and a shower would be completely out of the question, as it is a potential hotspot. Something told me, that Dad may enjoy the water on his face if I can get him in the bathroom, and may keep him occupied. I usually start his routine by getting him to clean his teeth. If he doesn’t do it himself, I do it for him. He let me clean his teeth, so I knew we were a good chance of getting the showering done. The bathrooms in the RAH are horrendous. The shower is hand held (which means I can’t have both hands free), there are no shelves to put anything on and many people use the bathroom so they are not always clean. I asked a nurse to bring me 3 x towels and 2 x flannels asap.

You have to be extremely organised when showering, have everything on hand and be ahead of the game. I like to have a helper on the outside of the bathroom to pass me things as required.The nurse had walked off for some reason, and I was cross because I had forgotten the pull-up pants that were required.  I yelled out for someone to fetch them, which they eventually did. I was starting to sweat with the steam and the tension of the moment. It is critical that I am ready with his clothes the second he is dry. I throw them on him very fast as this is another guaranteed flash point for him. Even if he can’t get his arm in his shirt sleeve within 2 seconds, he may hit out. If you don’t get his pants and shirt on fast enough he may storm out of the bathroom naked and then you have a real problem.

Amazingly I showered Dad faster than normal and had him clean and dressed within 15 minutes. The nurses were staggered with the change in his behaviour and also the fact he was showered so quickly. The reason why I was able to turn things around is I understand dementia, I know Dad’s body language back to front and also he is familiar with me. It is hard for the nurse special as most are not dementia trained and are ‘going in cold’ with no idea of what Dad is capable of and what may set him off. By simply trying to assist to take his pants off he may firmly grab your wrist or hit you. I like to let him take his own pants off always (would you like your pants pulled down for you?). If he won’t take them off I may wet his pants with the shower head and they become heavy and he then naturally removes them. You need to think outside the square with dementia.

Dad’s dressing gown cord was missing and he started to tug at the front as he felt exposed and I could tell it was annoying him. I believe he would fiddle with it all day as it kept opening, which is an unnecessary stress. I then decided if we can’t find his cord , I will make one. I asked for some scissors and made  a belt from two pieces of material. I wrapped him up like a big present and he was then happy. His mood was now jovial and relaxed and everything was sorted. It was a great lesson for the nurses, to show them that dementia can be turned around without drastic measures if you know what to do. Thank goodness they rang me before calling the ‘code black’.

How Cute Is This?

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Bob has always been a very kind person, and during one of his stays in hospital (2014) was no exception. He loved all the attention he received from all the staff and he wanted to give a donation to the hospital to thank them. He asked the nurse for an envelope, he spent a lot of time trying to write the details on the front. He then paid the hospital in the only currency he had available to him…plastic counters!

It is the thought that counts:-)

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