Category: Diary Blog

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.

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.