At the Adult Day Services (ADS) program we have participants that tend to wander. Dementia and wandering are common. Wandering usually occurs because the participant has an urge to “Go.” Usually, that means to “go to” the bathroom, they want “to go” home or “to go/ get away” from something that they don’t understand or find stressful (i.e. how to play a game or do a project). This is why it is very beneficial to have scheduled activities for our group. We have learned that routine keeps our group on task/busy so they do not have to wait or wonder what is going on. During small group activities and games, one might get up and go/get away from the group. If it is not a bathroom matter, we give the participant the option to switch activities or go to another group that is more to their liking. Participants also have the option to relax in the library.
Acknowledge and Redirect – Solutions for Managing Dementia and Wandering
When wandering occurs, first, the staff will see if the person needs to use the bathroom. Many times this is the reason for the “urge to go.” Another reason for wandering is the person is concerned about the whereabouts of a family member – the “urge to go home.” In order to guide the participant back to joining the group, our staff uses acknowledgement and redirection. First, the staff member acknowledges the participants concern and reassures them that their family knows they are here and will be seeing them at their discharge time. Then the staff member redirects the participant by asking him or her to help with a task, tell them what the group will be doing next and/or asking an open ended question. We have learned that wandering is a coping mechanism and allowing the participant to do just that can be a form of relief. Trying to stop the wandering may increase agitation and cause anger or frustration, so if the above suggestions don’t work, we just allow the person to take a stroll.
I have just highlighted three of the most common reasons that a participant might want to wander. Please keep in mind that there are many other possible causes for wandering.
Lately, professional documentation of care notes has been a concern for both care providers and clients. Better care notes serve as a guide for parents and their case managers to know what our care provider and their child have done during their time together. Care notes are used as data to mark the progress of the child and/or concerns that the care provider may have for this child. As a parent, please do not hesitate to ask the care provider to go into greater detail in the care notes, or request that the care notes be rewritten.
Care providers, here are some words of advice to address some of the common concerns about care notes:
How to Write Better Care Notes
1.Make sure all your documentation is professional
2.Use proper grammar in your documentation. There should be no slang.
Write “out of,” not “outta”
Write “had snot and drool,” not “was snotty” (could be misunderstood)
3.Write your name and care notes legibly and neatly. Especially on the medication sheet.
4.Remember to write the facts about what happened, not subjective opinions.
For example, stating a client was being “testy.” This is opinionated/labeling. Please note clear facts.
5,On shift duties and medication records, be sure to sign your initials or write “n/a” on each line if the duty did not apply to you on your shift. At the end of your shift, make sure there are no blank lines.
6.Try to “paint a picture” of what happened in your documentation so that anyone who reads it has a clear idea of what happened on your shift.
For example, “his pants are wet…as of right now they are in the washer,” should be clear and state that the care provider assisted the client by changing his pants when they were wet.
7.Document when clients get their showers: if the client assisted and with what (i.e. washing their own hair and body).
8.Document the specific activities you did with each client on your shift, where you went, what they did by themselves and what you assisted with. For example, you can state, “I drove Amy to the park and pushed her on the swings. She appeared happy because she was smiling and clapping her hands.
Remember to always include what goals are being addressed!
Jeff Nunham, Adult In-Home Supervisor, recently attended a seminar at Tri-County Office on Aging focusing on free legal help and how to spot legal issues in situations of elder abuse and neglect. Whether you are the caregiver, the one receiving care, or an advocate for someone receiving care, it is good to know about local resources.
Resources for Free Legal Help
The seminar was presented by several attorneys from Elder Law of Michigan, Inc. This nonprofit is home of the “Legal Hotline for Michigan Seniors” and “Sixty Plus, Inc.” They had a number of handouts which seniors could find helpful if you are ever in need of legal counsel.
There was brochure for the Legal Hotline for Michigan Seniors and the Sixty Plus, Inc. a program which offers free legal services to persons over 60. This sounds too good to be true, but it is. Here is the number to call if you or someone you know needs help: (517) 372-3484
From a Handout Legal Remedies That May Mitigate Instances of Elder Abuse
1. Breaking a Lease – Michigan Landlord-Tenant Act, MCL 554.601b, now allows tenants to receive releases from leases if the tenant can document that he/she is under apprehension of danger for domestic violence, sexual assault, or stalking.
2. Eviction – If the person causing the abuse or neglect lives with the individual, an eviction proceeding can remove the threat from the individual’s home.
3. Personal Protection Order (PPO) – A PPO is a court order to stop threats or violence against a person. The individual seeking a PPO needs to have a reasonable fear for their own safety.
4. Guardianship – A court proceeding where a competent individual is appointed to oversee an incapacitated person’s comfort, care, and maintenance. A guardian could use their authority to remove a person from a situation of neglect or abuse by securing safe housing, medical services, and care treatment for an individual.
5. Conservatorship – A court proceeding where a competent individual is appointed to oversee an incapacitated person’s property, estate, and financial affairs, when the court considers a person unable to handle their own property. A conservator could protect a person from potential or continued financial abuse or exploitation.
6. Durable Power of Attorney – A private agreement between two individuals, when cognitive capacity is not an issue, allowing a person to act on behalf of the other as allowed by the document. This generally applies to a person’s business affairs or financial matters. This does not apply to medical decision-making.
7. Patient Advocate or Durable Power of Attorney for Health Care – An agreement created while a person has cognitive capacity that nominates another person to make medical decisions for a person only when two doctors certify that the individual can no longer make medical decisions for themselves.
8. Divorce – If the abuse or neglect stems from a spouse, the individual could seek a divorce.
All abuse and neglect is illegal. The courts have put in place laws which protect us from these crimes. However, elder abuse and neglect is occurring all around us. There are very specific and legal actions which can rescue a person who is a victim. This information and phone number may be the first step to helping someone get the legal help they need. Pick up the phone and call. Or go to www.elderlawof Michigan.org
Breaking Barriers Today celebrated its first full month of service on July 8, 2015. The new program running smoothly, is located within the Gier Community Center. It provides an opportunity to serve more participants and their families, with more hours, more programming and community enrichment.
This program is an alternative to the limited hours of the former After School Program, and answers the need to provide activities and stimulation for those individuals who may have aged out of special school programming. State law limits attendance in the special school settings after the age of 26. “This Breaking Barriers Today program can serve individuals, with varying skills, from age 13 to 50. It really answers a critical need for those from 26 to 35,” shared Program Supervisor Elizabeth Krumm.
The first weeks of the program have been about becoming acclimated to a new environment which is rich with things to do and places to be…a gymnasium, a dance studio, an art room, a game room that doubles as a dining area, and a quiet area for reading and resting. The Gier Community Center also has several acres of outdoor play space. “There has been a learning curve in becoming comfortable with the flow of people from place to place and to see those organic opportunities to interact with other visitors to the community center.”
The participants are also looking forward to getting out into the community. On the calendar for July is a tour of the State Capital building, and a trip to a Lugnuts Baseball game. These are activities that would simply not been possible in the former location and program.
“I want to thank all of our families for their patience as we work out the details. We are dedicated to making Breaking Barriers Today a quality resource for more members of the community who may have a need,” said Krumm. “We know that we have to walk before we run, but it is so exciting to have the space to run!”
Families interested in learning more about the Breaking Barriers Today activity program should contact Elizabeth Krumm at firstname.lastname@example.org
On occasion children, with special needs, in our care may present some difficult behaviors. First and foremost, it is important to use our skills of empathy and compassion. It is good to remember and understand that you are not dealing with a disability who has a person, but a person with a disability. We compassionately remember that in many cases this difficult behavior is not a result of a conscious or willful choice and it is almost always rooted in some precipitating event which can be avoided in the future. If it appears that an angry outburst is imminent there are some signs that the child is becoming frustrated and angry. Here are some things to watch for:
Signs of Anger
Increased breathing rate
Teeth grinding, or jaw clenched
Physical attacks (hitting, scratching, biting)
What to Do in Managing Angry Outbursts at the Peak of the Crisis
1. Send others away from the area.
2. Increase distance from you and the child. Stand at least two leg lengths away from them. Instead of standing face-to-face, stand to the side (L-shape) of the child. Keep your hands out of your pockets, to your side and available to protect yourself. Stand with one foot slightly in front of the other with your weight evenly distributed. This stance is non-confrontational and non-threatening.
3. Remove dangerous objects or attempt to get the child into a safer room.
4. Remain in control; stay calm and quiet. Anxiety can make the client feel anxious and unsafe which can escalate aggression. Allow yourself to disengage emotionally, and don’t take the behavior personally.
5. Use a pillow or cushion to protect yourself if the child strikes or tries to bite. You may put your arms and hands up to block an attack.
6. Take deep breaths to help you stay calm. Do not try to restrain the child! Physical intervention increases aggressive behavior and can inadvertently cause injury to you or to the child.
7. Remove yourself and/or the child to another room to give them time to regain sense of control. It makes it less likely for other individuals to get involved or become an audience for the agitated child. This also creates a quieter environment and may help in de-escalating the child.
This helpful guide was assembled by Helping Hands Respite Care’s Child In-Home Care Supervisor, Tarra Boris. Contact her at 517-372-6671 ext 103 or email email@example.com
A personal story about helping reluctant seniors to receive help. Shared by Helping Hands Respite Care’s Adult-In Home Care supervisor, Jeff Nunham.
My son, who is 30 years my junior and a successful business man, will sometimes say to me; “ You had better be good to me because I’m the one who is going to decide which Old Folks Home you’re going to live in.” We laugh about this and I try to say something about inheritance which always comes off very lame. However, this issue is actually a very difficult time of life for the aging parent and the supportive adult child. It is especially difficult when the aging parent is in denial about their failing abilities and their vulnerability for falling.
Helping Reluctant Seniors Acknowledge Their Need for Help
Gratefully, my mother (86) is in pretty good health and emphatically tells me that she will never be cared for by her children. Instead she will take herself to the retirement center of her own choosing. Whew! That was easy. However, getting someone to acknowledge that they need help can be a daunting task.
I like that saying ” denial is not a river in Egypt” it makes me think of my friend and neighbor Frank. He is showing very obvious signs of dementia which are making his life difficult. The simple tasks of everyday life are now impossible. From his perspective, every appliance he owns is broken. When he complains and I take a look at the broken appliance, I discover that he simply doesn’t know how to turn it on or set the timer or push the “send” on his phone. I recently stopped by the house and found him extremely frustrated with his cell phone. He complained that it was broken so that he could not make a call. When I asked him to let me see if I could get it to work, he handed me the remote control for his TV.
From my perspective, Frank’s most menacing problem is not dementia; it is denial. Frank is convinced that there is nothing wrong with him except some signs of aging in his hips. My greatest challenge with my friend is convincing him that he needs help and that he should be thinking about medical care and the possibility of assisted living. He will hear nothing of it. So, what does one do with a person who refuses to admit that there is a problem?
Two Strategies for Helping Reluctant Seniors
The tack my wife and I have taken is very simple and two fold. First, we are readily offering and giving assistance to Frank, but we also make sure that he understands the failures he is having. We look for times to gently, but firmly, present the realities of his confusion and other struggles. Our suggestions that he should see his doctor are rebuffed. However, over time and after “layer upon layer” of helping him see his condition for what it truly is, he is beginning to acknowledge that he has a need.
The second aspect of our attempts to help Frank is a little scarier. We have come to see that for the person who is adamantly refusing to acknowledge his need, the best form of meaningful communication are the consequences of his condition. This may mean letting him feel the frustration of not being able to do those simple tasks which once were done without thought. We do not “rush in to rescue” Frank from his struggles. When he is forced to face the reality of his struggle, he will begin to acknowledge that there is a problem.
I am happy to say that Frank has just recently consented to having an MRI and will be having an evaluation by a Psychiatrist in a couple of weeks. We believe that Frank will benefit from the treatment of his doctor. For my wife and me, we will continue to lovingly help Frank navigate the murky waters of dementia; hopefully without getting caught in the Egyptian Eddies of Denial.
For more help in navigating the murky waters of Dementia, visit this helpful website
To learn more about Helping Hands Respite Care’s Adult In-Home Care, contact Supervisor Jeff Nunham at 517.372.6671×105 or Jeff@HelpingHands Respite.care, his office hours are Monday – Friday 8am to 3pm.
Learn more about the link between dementia and nutrition. Eating a healthy, balanced diet is important for people with dementia. Poor nutrition can result in dehydration, reduced muscle strength, and, in some cases, an increase in behavioral symptoms.
Some people with dementia experience problems with eating and drinking. Common reasons include difficulty communicating their likes and dislikes; pain due to constipation or poorly fitting dentures; a change in medication that reduces appetite; or not recognizing the food placed in front of them. It can be a challenge to determine what the problem is, especially if the person is unable to verbalize it.
Making a few changes can help make mealtime less stressful.
Limit the number of food items on a plate. Too many foods at once may be overwhelming.
If someone is not eating well, sticking with what is familiar and avoiding the introduction of new foods into the diet is recommended.
Check the food temperature. A person with dementia may not know if something is too hot to eat or drink. On the other hand, if food goes cold, it could seem less appetizing.
Prepare food that is easy to pick up. Loss of motor skills can make using utensils difficult. If the person appears to be struggling, chop food into smaller bites that can be eaten with a spoon.
Provide plenty of time to eat. People with dementia can tire easily, and it may appear that they have stopped eating.
Don’t force a clean plate. Instead, gently encourage them to eat and remind them what the food is.
For those who traditionally start a meal with prayer, not doing so might make it difficult for them to begin the meal.
Increase fluid intake by offering soups, gelatin, or popsicles. Sometimes changing the presentation of beverages can make a difference (e.g., using a cup with a straw, or a sippy cup). Maintaining good hydration is very important as dehydration can lead to further challenges with cognition.
People with advanced dementia may need a prompt (such as putting the fork or spoon in their hand) along with verbal cues to begin eating.
Watch to make sure food is chewed completely to avoid choking.
When possible, make meals a social event by eating together.
Eliminate distractions as much as possible and keep the atmosphere relaxed. Recent studies have linked deficiencies in vitamins B12 and D as well as Omega-3 fatty acids with people who have dementia or Alzheimer’s disease. However, use only vitamin supplements recommended by a physician.
With just a few changes, a caregiver can ensure the person they are caring for enjoys their food and eats a healthy, balanced diet.
To answer your questions about your loved one with dementia contact the Helping Hands Adult Day Services (ADS) program Supervisor Alison Sarkozy at 517.372.6671×107 or email Alison@HelpingHands Respite.care; For our Program Nurse, Jane Rogers call 517.372.6671×108 or email NurseJane@HelipingHands Respite.care
This helpful article on Dementia and Nutrition was written by Ava Stinnett and shared by ActivityConnection.com
Karl Ochs is a member of Pi Kappa Phi at Michigan State University and has been a volunteer for the last year at Helping Hands Respite Care’s Adult Day Center. This summer, he is riding across the country with other fraternity members from the west coast to Washington D.C. to raise money for people with disabilities through the fraternity’s nonprofit, The Ability Experience.
Helping Hands Hosts The Ability Experience with a Summer Picnic
They will be making a friendship visit at Helping Hands Respite Care’s Adult Day facility at 201 Hillside Court East Lansing on Sunday July 26th at approximately 12:30 pm. They will stop for food and to rest, with plans to be back on the road by 3:00 pm. In honor of their fundraising ride, Helping Hands Respite Care will be having a picnic for all of our families. The Center will be open (at no charge to the participants and all other clients we serve) from 11:00AM to 3:00PM on Sunday, July 26th. Please come down and enjoy food, fun, and games. Meet the cyclists and wish them well as they continue on their journey to Washington D.C. For more information or to RSVP for this fun event please call the office at 517-372-6671.
Clients, family, staff, sponsors, and donors are all welcome. City dignitaries (Mayor Nathan Triplett and staff) will be invited. The East Lansing Farmers market will be in full swing right next door to our party; explore all the goodies – fresh fruits, vegetables and meats available.
Remember these men are riding to raise funds to support families with disabilities; so, come out enjoy a picnic meal courtesy of Helping Hands Respite Care and show your support for the whole crew, and our local volunteer Karl Ochs.