Articles on Caregiving

Articles On Caregiving

By Sue Ellis 06 May, 2016

When the care giving role has finished, the individual usually experiences a loss of identity. Here are ten ways of transitioning successfully from being a caregiver to creating a new life.

“Now you can get on with your life” are the words of comfort we hear when our role as caregiver is over. The depression that we sink into, and others cannot fathom, is grief for ourselves. Others will attempt to help us get over the grief for the person lost from our life but will fail to realize that it is the loss of self for which we grieve later. Indeed we don’t realize this for ourselves at the time. Since we have spent a long time putting the needs of another first, we fail to understand how much of self-identification was tied up in those needs.

I was a caregiver for almost 10 years. Grief followed my partner’s death. But my “depression” did not hit till 18 months later. It was a period of transition – from one self to the next. From one identity, one image of self – to a new me. The transition has a big question mark at the beginning. “What am I going to do with the rest of my life?” “Who am I, anyway?” The journey is that of our own transformation.

How do we successfully transition?

1.   Recognize that this is the task at hand.
2.   Re-evaluate the role that we have played and now lost. This means look at it as if we were writing a job description. We do not need to dwell on criticizing how successfully we performed, but focus on what skills we acquired, what tasks we accomplished, what creativity we showed. Society does not place value on the role we have played. We must not fall into the trap of belittling our own accomplishments. We must familiarize ourselves with whom we have become because of this experience. We have been forever changed.
3.   Recognize that over time we searched for recognition in the role we played. To do it well, the caregiver role became us. It was how we identified ourselves. Others related to us through that role. Any socializing we had was a respite from that role. Any emotional support we received was to help us cope with that role. Most of our conversation was about the talk of care giving. Then it is over and all the professionals who shared the challenge have disappeared. We are not supposed to need them any more. But they were the people who validated who we were. All those routines that had become our life – the doctor visits, the care giver support groups, the volunteers – have all gone. Suddenly we are naked. We have no identity and we are alone. The task at hand is to build a new identity.
4.   Don’t deny the pain, look at the fears, and accept the feelings for what they are. We are learning how to face change. We are learning how to let go of the past – of whom we were, of what was. We are in a transition where there is no going back. A time when this moment truly is the most important of our life. For it is the only moment that is real. The only moment that counts. How we live it will determine what is ahead of us.
5.   Find a mentor who has been there. If no one is available chose someone who is prepared to listen without thinking they must solve problems. Only you can forge the future path. It must come from within you, not the suggestions of others. The gift others can give you now is the ear that witnesses your progress. Their only task is to stop you from dwelling on negative repetition. We used to call this being a “broken record.” Sometimes we used to imitate playing on an imaginary violin to indicate the repetitive telling of a sad story. We do not make changes when we are repeating the same old story over and over again.
6.   Slowly open new doors and test how you feel. My breakthrough came when I started reading books on spirituality and healing. I will list a few that have impacted my life and caused me to shift my views, beliefs and attitudes. They moved me from being a victim of my circumstance to being the captain of my ship. This is not a complete list but examples of books that helped me look at the world, life and me in a different way. They helped the change process.

Anatomy of the Spirit / Why People Don’t Heal and How They Can – Caroline Myss
When Things Fall Apart – Pema Chödron
The Four Agreements – Don Miguel Ruiz
My Grandfather’s Blessings – Rachel Naomi Remen MD
Home with God – Neale Donald Walsch
Man’s Search for Meaning – Viktor E. Frankel

7.   Let go of self restricting beliefs and attitudes about yourself and your future. “Poor me,” “my life is over,” “I shall never be able to…” – they will not serve you well. They are a devise to stifle facing change. If we see our cup as half empty – it will remain so. If we see that same cup as half full then there is room for more. When we believe in “can’t,” then that is what we will experience.
8.   Let go of the need to make yesterday a living presence today. Instead use the knowledge gained yesterday to make today more successful. The brain cannot distinguish between what is happening now and what you are remembering from the past. To remember the pain of the past is to bring it back to make it real – a conscious decision. The brain can’t tell the difference. The brain can only bring into awareness one thing at a time. Again, you choose what you focus on.
9.   If you experience real difficulty focusing on the now, finding it so much easier to retreat into the past, we must develop rituals to stay present. Going for a walk and consciously focusing on everything we see is a helpful exercise. Quickly we realize how much we are missing when our thoughts are not here. Actively listen to the conversations of others. Don’t concentrate on how you can segue conversation to go back in time with you. In conversations with others, discipline yourself to only talk about new information, not stuff they have heard before. This is a powerful exercise because it forces you to bring newness into your life – what you saw on your walk, the book you have just read, the TV program, the baking you have tried, today’s weather, sports teams etc. Now you are creating new life, not regurgitating the past.
10.   Gradually the new you will emerge with new dreams and aspirations. They may have to be adapted to fit the budget or the limits of increased age, but we are no longer letting the budget or our age be the excuse for not doing something.
11.   To be a caregiver is a gift. Often a painful one that we were unprepared for, but the new butterfly that emerges from our transitional cocoon could never have seen life if we had not met the challenge.

The person I am today, ten years after my care giving ended, is not the person I would have become without the experience. I am filled with gratitude and know I have become the person I was supposed to be in this life.

By Sue Ellis 06 May, 2016

By Barbara McDowall of www.AuthenticLives.com

Just back from almost 2 weeks in my favourite part of the country, kind of my spiritual home away from home – Canada’s east coast and PEI in particular. When I spend any time along our Atlantic seaboard (Nova Scotia in particular), I invariably find myself asking “How can I live and work here”? And I feel I am getting closer to having an answer to that question.

Along the way to PEI, I happened to notice one of the ubiquitous roadside signs. This one said PEACE BEGINS AT HOME. It got me thinking about what that meant to me. Personally, I had to ask myself how peaceful was I within myself (my home), so to speak?   Based on my level of personal peace, what was the impact of me being peaceful on the world around me? To paraphrase Forrest Gump, “peaceful is as peaceful does.”

With that awareness how can I then make a positive contribution to world peace through intentionally and consciously becoming more peaceful within myself? What would I need to change about me to make that happen?

To change or improve any habit or skill most often requires some kind of unlearning/relearning or training regimen. With that in mind, what regular program or practice will help me shift my focus to peace within. What works best for me is a regular practice of daily meditation of no less than 30 minutes first thing in the morning and 30 minutes at the end of my day. Frequent affirmations such as “I am a peaceful person and I bring peace to the world” are helpful in reminding me who I am and wish to become more of.

Gandhi said it so well many years ago – be the change you wish to see in the world. If I wish to see peace in the world, I must be grounded in peace, to the point that should I meet someone who doesn’t speak my language, it is clear I am grounded in peace because I am that person in the world – they can see it in action.

Peace is not something that can be imposed externally. World peace will become a more probable reality every time one or more of us intentionally and consciously choose to be peace in the world. Thankfully, this energy is an ever-increasing part of our world today. Witness the prominence of Eastern philosophies which support personal awareness, personal responsibility as essential components to creating an aware and responsible world with a commitment to ending judgment and shame.

Buddhism continues to offer me the opportunity to love myself, to love others, and to love my enemies. It offers the compassionate lens to our common “suffering” and our ability to look at ourselves as microcosms of the world. If we can be honest with ourselves, fully loving and approving of ourselves, our innately compassionate hearts become engaged in this life, as we open up to our commonality and our shared wish for a better life for ourselves, for our children and for our beloved planet.

I am grateful for that roadside billboard and for its reminder of one of many truths – as within, so without.

Barbara McDowall is a spiritual teacher, mentor, doula for the dying and celebrant (weddings, baptisms, celebrations of life). Located in Toronto, Canada, she is available for consultation by phone or in person. For more information, and visit http://www.AuthenticLives.com

By Sue Ellis 06 May, 2016

Written by: Jenn Weesies

Each February everyone puts a lot of effort into demonstrating their feelings towards their loved ones. They make or buy gifts, plan special excursions and recommit their lives to each other. They act in such a way that makes their special someone feel loved, cared for and cherished. Some people though, will argue that this demonstration of affection toward loved ones shouldn’t just occur during February but should happen all year long as well. Caregivers and family members of people experiencing incontinence are constantly striving to provide the best care for their loved ones to demonstrate their affection. However, as many know, caring for their loved one’s unique incontinence situation can be difficult.Incontinence is not uncommon. Urinary incontinence affects more than 200 million people worldwide and nearly 25 million American adults are currently experiencing temporary or chronic urinary incontinence. According to the National Association for Incontinence (NAFC), incontinence characteristically affects more women than men. In fact, one out of four women and one out of eight men experience incontinence.

Enhancing the quality of care you are providing your loved ones experiencing incontinence means improving the quality of control with the right products and right fit at the best price. Here are three ways that can help you demonstrate your affection towards your loved ones experiencing incontinence by ramping up the quality of your care.

1. Buy hospital grade incontinence care products to keep your loved one comfortable. Hospital grade incontinence care products are far superior to the products that you can buy at a local superstore. These products are better quality and can increase your assurance in managing your loved one’s incontinence. They provide the highest level of protection, superior odor protection, the best fit, and the latest technology to quickly draw wetness caused by urinary incontinence away from your loved one’s body. With hospital grade products you can be sure that your loved one will remain dry and comfortable all day long.

2. Buy from a knowledgeable home health care center or medical equipment supply company. Highly regarded home health care centers and medical equipment supply companies focus on ongoing personalized management for your loved one’s unique urinary incontinence situation. They can provide personal support over the phone, online and in the store to find the best incontinence care products for your loved one. Briefs, protective underwear, pads and liners are available in gender specific fits and an array of sizes and protection levels. Home health care centers and medical equipment supply companies can offer insight to customize incontinence care products for your loved one. They can also recommend products that are easy to get on and to change, improving the ease of care. Their knowledge can enhance quality of life for individuals dealing with incontinence and can help caregivers and families provide more supportive care.

3. Enroll in a home delivery program to save money and time. Experienced home health care centers and medical equipment supply companies can connect you with money and time saving options that other stores cannot. The best offer discreet home delivery programs that can supply caregivers and family members with the convenience of on-time supplies at their doorstep with a range of cost effective savings plans. These programs allow you to order the highest quality products in bulk. After all, buying and ordering incontinence care products should not have to take precious time away from spending moments with your loved ones.

Demonstrate your feelings towards your loved one experiencing incontinence all year long through providing them the best care and incontinence care products possible. Seek the help from a knowledgeable home health care center or medical equipment supply company. They have resources and support staff dedicated to making your job easier and your loved ones happy and comfortable.

About the Author Binson’s Home Health Care Centers began in Center Line, Mich. and has grown to the home health care center it is today. Currently, there are centers in Michigan and Florida. For more information about incontinence products and programs call Binson’s at 888-246-7667 or visit:  http://www.binsons.com/

article from Content Crooner

By Sue Ellis 06 May, 2016
A habit is a constant, often unconscious inclination to perform some act, acquired through its frequent repetition. If the habit is objectionable, we call it a “bad habit”.
It’s possible to control your habits and make a positive change in as little as 30 days. Focus on one habit at a time.
Caregiving bad habits often lead to increased stress and sometimes, even to elder abuse.
Elder abuse often starts as psychological abuse. If a caregiver doesn’t properly deal with her/his stress, they may start to wreak havoc by means of threats, fear, humiliation, fear, manipulation, or other bad conduct. This may include frequent harassment, criticizing, insults, or denigration.
It is important to be aware of any signs that you may be heading in the wrong direction.
Some of the signs include:

1. Trying to do too much, resulting in not getting anything done
2. Doing the wrong thing, regularly
3. Procrastination, everyday
4. Having no clear cut goals
5. Improper or no planning
6. Not completing tasks
7. Negative self talk
8. Guilt trips
9. Lax hand washing
10. Holding in, or offering no support
11. Smoking
12. Drinking too much
13. Junk food, poor diet
14. Emotional eating
15. Too much caffeine
16. Compulsive spending
17. No time off
18. Sleep deprived
19. Constant bad temper
20. Can’t or won’t delegate
21. Disorganized
22. Holding breath
23. Can’t prioritize
24. Time management problems
25. Can’t make a decision

Take an honest inventory of yourself. Make it a point to correct those bad habits. Habits are a matter of self-control. When you break bad habits you will be much more successful.

Here are 15 ways to reduce or diffuse stress which will, in turn, help alleviate bad habits.

1. Be honest about your bad habits and stress level.
2. Give your care-receiver a hug every day.
3. Do something nice for yourself each week.
4. Remember to breathe deeply.
5. Take a few minutes each morning to repeat an affirmation or focus on calmness.
6. Take at least a 20 minute brisk walk every day.
7. Choose 1-2 people to whom you can vent your frustrations. You need a good listener.
8. Choose to be happy.
9. Before you go to bed each night, review your day, and let go of the bad stuff.
10. Relax with a cup of tea.
11. Listen to your favorite music to relax.
12. Count your blessings
13. Be assertive with a smile on your face.
14. Keep a journal.
15. Try aromatherapy. Spritz some lavender on your pillow.

Being a caregiver is one of the most difficult jobs you can ever have. It is important to take good care of yourself so you can take good care of the care-receiver. It becomes even more critical the longer you are a caregiver. Put the odds in your favor and keep those habits in check.

Author Resource:- Rebecca Colmer is an Eldercare Advocate, Author, Speaker, Publisher, and Caregiver Expert. You can find   books published by the author.
By Sue Ellis 06 May, 2016

By: Rebecca Sharp Colmer

The caregiver role is complex and differs for everyone depending on the needs of the care-receiver.Many times, in the beginning, there may only be a few needs, such as providing transportation or helping with shopping or cooking.

Over time, needs increase, requiring additional services, until the care-receiver is fully dependent on the caregiver.Here are some tips to help you get started:

1. Every caregiver should know as much as possible about the care-receiver.You should know their characteristics and personality style. For example, you should know their likes, dislikes, family members, ailments, etc.

You should know if the care-receiver is outgoing or reserved, task-oriented or people-oriented. Once you get to know them better you will be able to understand their needs and behavior patterns.

2. Every caregiver should know and understand his/her responsibilities, duties, and tasks.As a caregiver, you have a responsibility to be sensitive to the needs of the care-receiver, and to find a way to satisfy their needs.

This may require you to enlist the help of others. The duties of the caregiver usually change and increase over a period of time. Set up and follow a care plan.

Recording essential daily information will assist everyone on the Care Team. It also allows another caregiver to take your place fairly easily.

3. Stay updated on the health condition of the care-receiver.

As the health of the elder deteriorates and more needs start to surface, it is important for the caregiver to find out how to cope with them.

Keep a log of his/her daily activities (medicine taken, food intake, sleep habits, temperament, etc.) so that you will always have a snapshot view of their current health.This information will help the doctor get a more complete picture of the condition of the care-receiver.

4. Assist as little as possible in tasks the senior can usually handle himself/herself. Just as it is not easy being a caregiver, it is not always easy being a care-receiver.

The gradual loss of independence and control over just about everything is difficult to accept. Remember, seniors have the right to their dignity and pride.

5. Caregivers should express warmth and concern towards the welfare of the care-receiver.

If the care-receiver has a poor self image or feelings of inferiority, the caregiver may have to provide reassurance while ignoring negative behavior.

A caregiver must have patience (and stamina) for change in moods.

6. Be a good listener. Many times seniors may simply want you to listen.They want to share their stories. Caregivers must be careful to avoid put downs and choosing sides.

Pay attention and be able to connect the dots between past, present, and future. Listen intuitively or use your sixth sense to hear underlying messages.

7. Smile a lot. Be a good friend and companion. Be as positive as possible.

8. When friends and family neglect to call or visit, do not hesitate to remind them.

9. Ask for help. Advocate for what you need. Sharing the care of a loved-one benefits everyone.

10. Maintain your self-composure and avoid stress. Elder abuse can occur as a result of caregiver stress.

It is imperative that you are aware of and deal with stress.

Author Resource:- Rebecca Colmer is an elder Care Advocate, Author, Speaker, Publisher, and Caregiver. You can find more caregiving tools and resources at her website:
Caregiving Tools

By Sue Ellis 06 May, 2016

The way people think, the way they behave, the goals that they have and how they go about achieving them are the products of attitudes, values and beliefs learned as children. Many are a reaction to situations experienced in the past. Unless an individual consciously sees a need to change them they become part of their persona.

In aging, the ability to maintain that persona with its power, independence, control etc., becomes more difficult. It is then that new behaviors may develop that are not understood by the younger people around. For example it is common to see in long term care facilities a behavior called hoarding. This is seen in the collecting of food, toilet rolls or pencils etc. and hiding them. Tracing the individual’s history may show that when young they lived through the depression era of the 1920’s and 1930s; they had lived in war torn areas where homes and possessions were lost. They may have spent years starving and searching for food,   clothes and shelter to feel secure. Today any feeling of insecurity may bring back that fear and the old behavior becomes part of today’s drama.

During the Second World War those in concentration camps were stripped and shaved and gassed to death in shower rooms. They were victims of medical experiments, forced labour and lived amid disease and starvation. Holocaust survivors relive those memories and behave accordingly when today’s situation triggers the past.

Traditionally healthcare providers – doctors, nurses, social workers, rehabilitation professionals, personal support workers and attendant care providers – all those who work with the elderly, are younger than those for whom they care. They may have no knowledge of their past. It may come as a complete shock to the professional when the elderly person has a catastrophic reaction to being examined naked, being wheeled into a shower room, being talked to in a loud voice or being woken up suddenly. All triggers to bring past traumas to the surface.

Perhaps the situations mentioned are more obvious as we are increasing more aware of post traumatic stress syndrome in modern soldiers returning from wars zones. TV and movie dramas have included many stories of vets having flashbacks. However there is another group whose trauma is less documented and the implications of the impact of their childhood experiences less researched.

Numbered amongst today’s elderly are those who were disabled pre/post natal or in childhood. In the past most died young. But today there are many seniors who experienced hospital and institutional care from the 1930s -1950s with conditions such as Cerebral Palsy, Spina Bifida, Polio and Bovine Tuberculosis. Now as they succumb to other diseases of aging or deterioration of preexisting conditions they are having severe reactions to hospital treatment or placement in long term care facilities. Many deny that they are losing independence, many refuse to accept help from technical aids. Many resist intervention with anger. Many show what seems to be irrational fear when needing assistance. Is something from the past being triggered?

A look at the values, attitudes and beliefs common in Europe and North America in the era when these individuals were growing up gives us the key to today’s problem.

1 A work ethic prevailed that said salvation comes from working hard and that rewards from life came from working.

2. Conformity. You had to fit in and not be conspicuous by being different.

3. You should not show your vulnerability. This meant you had to hide your weakness, win at all costs.

In this environment then, the disabled and those unable to work were to bring shame, pity and humiliation to the family. When possible those with physical, mental and intellectual disabilities were hidden away in institutions or rehabilitated to “pass” as normal. Some of those who couldn’t “pass” and couldn’t work did find employment in freak shows at fairs. In Ontario Canada the best freak show of the 1930s was viewing the Dionne Quintuplets where 6,000 people would travel great distances each day to see them. President Roosevelt was always seen standing or seated hiding the fact that he wore leg braces to stand and used a wheelchair. It was felt that the American people would not feel safe in the hands of a cripple.

Little value was placed on the lives and worth of a person with a disability. Their professional caregivers were also underpaid and under appreciated. There is evidence of systemic abuse. In hind sight we call it abuse. In those days physical, emotional, verbal and sexual abuse was common in environments of low self esteem and when the belief system saw the vulnerable person as not whole. This has also been seen in residential Aboriginal schools and so on.

Many adults, because of childhood disabilities or being considered different, were brought up to believe that they were without value, god’s punishment, the work of the devil, a mistake, a burden, the cause of all the family problems and had brought shame to the family. They weren’t even considered human, but freaks. Many live with that burden today and live out the victim role, continuing to accept abuse.

Many, however, accepted the challenge facing them and despite their limitations excelled and are accomplished citizens. Many despite severe limitations chose to experience the joy of being alive and have given much joy to those who care for them. Some, like many minorities who are oppressed, have struggled to a position of power from where they have become the oppressor.

Others have from an early age denied or repressed the memories of abuse but slowly as they age and become less independent the suppressed fears and emotions resurface. When being told they need help with bathing, they can’t walk safely and must use a wheelchair or they can no longer live independently and must go into a long term care facility – all the past suppressed feelings emerge.

The professional must understand where their client is coming from. They must validate the origin of the fear. They must bend over backwards to offer choices and options so that the client can feel they are making their own decisions. Wholeness can be attained when there is empowerment. The professional should avoid harsh words or language that is perceived as threatening – after all this will only reinforce that the past is alive and well today. Respect was something rarely shown a person with a disability in the past. It would be worth showing now if trust is expected and you need risk taking from them.

Rather than reacting defensively when confronted by unexpected responses to your statements, ask yourself what does the behavior you are witnessing mean? Do you know if it was triggered by some past memory? Are the assumptions you are making – making matters worse? Spend time learning the truth now. Both your futures depend on it.

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By Sue Ellis 06 May, 2016
By :  Andy West      
 
We are a nation that is aging rapidly, with the largest generation, Baby Boomers, growing near to retirement age. Because of this, there will be many Americans in need of medical care in the next three or four decades, more so than in previous years. This means that more and more children and other relatives will be called upon to take care of their aging relatives. The economy in its current state has financially ruined hundreds of thousands of people, and this will undoubtedly affect the retirement of our Baby Boomers. In home health care and family caregiving, some predict that many of us will become do-it-yourselfers. That doesn’t have to be a daunting prospect if you have the right outlook and family caregiver training.

Nurturing those who nurtured you during your early years will give you pride in your familial relationships, not to mention the fact that you will be spending the last days caring for your relatives. The bonds shared during this time will give you memories for a lifetime after they’re gone. You’ll be helping your family in one of the best ways imaginable. It’s a noble calling, but you’ve got to be prepared in order to do it right. One of the best ways to prepare is by purchasing and watching training DVDs on the subject of elderly home care. Some of the material on training DVDs may already be common knowledge to most, but much of the material may be new to family members who’ve never had to care for a parent, disabled friend or elderly relative. A variety of videos are available on the market that will assist you in everything from the very basic to the very detailed and concise.

For instance, it’s vitally important to know what to do in cases of emergency, such as a home fire, or if the person you’re caring for has a heart attack, a stroke, a seizure, or a fall. Falls can have devastating consequences for the elderly, so you need to know what to do so that you can act quickly and calmly. Some efforts taken within the first five minutes of a serious event can safe a life. Knowing what to do in family emergencies will enable you to take appropriate action quickly. You will be prepared and know not to panic, or just make plain bad choices. Getting the proper training in family care giver techniques will help you to preserve the life and health of your important loved ones for years to come.

It’s not only important to know how to cope with emergencies; you must also know how to assess a person’s quality of life and know how you can assist. You may be required to carry out the common day-to-day tasks that caring for an elderly and infirm person demands. Some of them are simple things like knowing how to do laundry efficiently, iron, clean, help with showers and general hygiene. It’s also important to understand the value of good nutrition. Your needs may be completely different from your 90 year old aunt. She may need calcium, low sodium, low fat, nutrient enriched supplements, just to name a few. Being able to prepare a variety of different, tasty, nutritious meals is essential to caring for another person, especially when appetites are low. It is essential that the person you are caring for eat regularly, so they can maintain a good quality of life.

Being a good housekeeper, a good cook, and good training all make a great caregiver. With the current prices of medical care and the state of our economy, it’s no question that caring for your family will soon be more of a responsibility for the younger generations. Be prepared with family caregiver training, and get your siblings and cousins to join your efforts. You won’t soon be disappointed.

Author Resource:- Andy west is a writer for Medifecta, is dedicated to enhancing the well-being and knowledge of professionals through family caregiver training. For more information please visit Medifecta.com.
By Sue Ellis 06 May, 2016
Towards effective communication with those cognitively impaired by Alzheimer’s disease or other dementias.

1.    Gain Attention


No information will be retained if the individual is not attentive or concentrating on the person giving instructions. Gain eye contact, call out the individual’s name, touch her and do not begin to talk until you are sure you have her attention. If hearing is a problem, never call out instructions when the back is turned, when a distance away or calling from another room. The sound will be a jumble of noise, which has no clarity.

2.    Break down task into stages

Those with memory problems have difficulty retaining a multistage command such as “After you have finished shaving put on your blue shirt and gray trousers, and don’t forget to comb your hair.” With all this information the person with a dementia does not know where to begin. Recall will be confused and the individual will become frustrated, afraid of failing and may refuse to attempt the task. You must decide on the sequence needed to complete the task.

3.    Give instructions one step at a time

Give only the information that is relevant at that time. Let all the clues in the conversation be geared to the fulfillment of that one step. Only when it has been completed should you move on to the next instruction.

4.    Avoid ambiguity

Language is lost in dementia. It is not just the forgotten word, but the language becomes more concrete and is interpreted more literally. Ambiguity therefore leads to misinterpretation. Humour, which depends so much on a play on words, the double entendre, is not understood. The individual may be able to use long-term memory to tell a joke, but may not get it when told one. Euphemisms must be avoided. We must explain precisely what we mean. To “Make a bed” literally means to get out the hammer and nails; “do you need a washroom” does not literally mean, “do you have to pee?” The question “how many children do you have” may be met with the answer “I don’t have any children.” Whereas the correct answer may be produced by asking “how many sons/daughters do you have?”. In the mind of the concrete thinker, children are youngsters and have not grown up. Our words must be more literal, have less flowery descriptions and be to the point.

5.    Limit distractions

Those with a dementia have difficulty interpreting the stimuli that bombard them. We may hear the siren from a fire truck in the distance, recognize what it is, assess that it is not coming to our house and then tune it out. For the person who is cognitively impaired that sound is of unknown origin and will distract her from the task at hand. It will occupy her thoughts and your words will be lost. The radio or TV playing in the background may not distract you, but it will certainly absorb the person who is having difficulty understanding and focusing on her environment.

6.    Speak slowly and clearly

We must slow down our speech to the speed of the impaired person’s thinking. We must speak clearly to aid the hearing impaired and to ensure our words are not misinterpreted. When the mother tongue is not the one you are communicating in ensure your language is straightforward. Words from a second language are often lost and individuals may return to their mother tongue.

7.    Use visual clues, gestures, demonstrations, pictures

Many who have dementia suffer from perceptual problems. That is, they have difficulty correctly interpreting the stimuli they receive from their environment. This may show itself through failing to understand verbal instructions, read warning signs, or recognize familiar objects and their use. If a blue shirt is placed on a blue bedspread, an impaired individual may not be able to differentiate the colours or textures and fail to locate the shirt. If the blue shirt is in a crowded closet, the individual may only see a jumbled mass of colour and not identify the shirt for its whole shape is not visible. He may face the closet, not recognize a shirt and say that there isn’t one there. Or in frustration will just keep putting back on the one taken off the previous evening. Sometimes understanding where the body is in space maybe impaired, dressing and undressing may become difficult. The individual may choose not to undress at all. Some will have difficulty initiating an action or plan a series of actions. Dressing and feeding will become more difficult. To compensate for these losses we must provide the individual with clues. Pictures and gestures may provide recognition when your words do not. Some may be able to mimic the action of another person while being unable to initiate the action. If you gesture with a toothbrush, he may be able to mimic the action. If you guide the spoon to his mouth, he may be able to carry on when the instruction “drink your soup” brought no response. What may be lost is the recognition of an objects use. Therefore the toothbrush may be used like a comb, the razor like a toothbrush. If this is the case we must ensure the safety of the individual and give clues, such as handing the person the correct object for the task.

8.    Repeat

There are so many reasons why a person with a disease such as Alzheimer’s may have difficulty following instructions and performing tasks. Therefore it is important to repeat the information over and over again. We may become angry and wish to shout “but I’ve told you a thousand times…..” but it is important to understand that they are hearing it as if for the first time.

9.    Limit Options

“What do you want for lunch?” May be met with “I don’t want lunch” since the individual cannot conjure an answer out of nowhere.
So you counter with “Would you like a ham and cheese sandwich or an egg salad sandwich?” and the reply is “I don’t know.” Most people with a dementia cannot make a decision and so often will reply “no.” If given a menu in a restaurant she will order what the person before her ordered – even if she has never liked it. So you say “But you never order liver.” Now the person with dementia is embarrassed, anxious, uncomfortable and has really lost her appetite.
Finally you say “How about an egg sandwich for your lunch, okay?” The sandwich gets eaten.
It is only by trial and error that we find out at what level the decision-making ability is. But by giving choice we can offer a sense of control and confidence. Sometimes that choice is purely agreeing with the decision we have made. We would not want to say “do you want your pills now?” because we don’t want her to say no. But we can offer the pills with apple juice or water. By providing limited options we give information that can be acted on. If we just ask, “What do you want?” we will be no further ahead.

10.    Avoid confrontation

“I told you to meet me outside the post office.” “No you didn’t.” “Yes I did.” This is a conversation that is going nowhere. There will be no resolution to the argument. There will be two angry people. Projecting fault onto others is a defense mechanism all of us use. An object which has been misplaced, must have been stolen. We can protect ourselves when we can blame someone else. It is important that we do not enter the argument. Change the subject till the anxiety has lessened. It is possible to think more clearly when less anxious. Avoid having the last word.

11.    Use residual skills

An individual with a dementia such as Alzheimer’s disease is loosing the ability to perform past learned skills. We must recognize the skills that remain and provide opportunity to perform them. This way he will remain stimulated, involved and retain self respect. Activities of a repetitive nature are best because sequencing is often difficult.

12.    Reduce chance of failure

Learn the limits of her performance and attempt to secure an environment where he can function within those limits. Maybe she used to like to watch TV but now gets agitated when the commercials come on. Pre-recording programs with the commercials removed can lead to hours of enjoyment. We can use the memory loss to advantage by re-playing the same program at intervals. Indeed the familiarity often relaxes the individual whose memory loss makes her feel as if everything is new.

13.    Avoid sensory overload

A person with a cognitive impairment will often have difficulty interpreting the sights and sounds of the world around her. Too much sensory input will cause confusion, anxiety and fear. It is as if a fuse blows and there can be what is known as a catastrophic reaction. That is behaviour which, to us, is out of proportion to the events occurring. There may be displays of aggression, running away, shouting etc. It is often possible to recognize the signs of this building, but often we fail to see the warning signs. Often we do not realize the distracting stimuli present when we demand action. We may feel we do not have time to wait for him to calm down before proceeding. But time invested in preventing a catastrophic reaction will be well spent in the long term.

14.    Provide a calm familiar environment.

Maintain routines in daily schedules. Don’t make major changes like rearranging the furniture. If the individual has to be moved to a new setting, then take some familiar objects to be there when she arrives. When complex task are performed such as dressing and eating, ensure that distractions are minimal. If she must follow verbal instructions, ensure your voice is the one that will be noticed. Turn off the TV; close the door to others etc.

Caregivers, especially relatives, who have known an individual before the cognitive deficits changed him/her, have difficulty altering the way they relate. It is hard to break well-established habits. But the impaired person is in fact no longer the person from yesterday. The person before you now has new needs; severe limitations and can no longer live up to past expectations. It is the caregiver who must let the past go and learn to communicate on a new level. This cannot be achieved alone. All caregivers need emotional support. They must build around them a support system, a network of friends and professionals as they fulfill this difficult role.
By Sue Ellis 23 Sep, 2014
Article submitted by Rebecca Sharp Colmer: Eldercare Advocate, Author, Publisher, Speaker. Find Rebecca’s books online.
The Gift of Caregiving – Click Here
More Books by Rebecca Colmer – Click Here 
By Sue Ellis 20 Mar, 2013

When assuming the role of caregiver for a loved one with a chronic progressive disease we know we are in for a long journey. It would be helpful if we had all the answers and information we needed, right from the start – but it doesn’t work that way. So what, in hindsight, did I learn about staying whole? I learned that I needed to constantly nourish my body-mind-spirit, my total self.

The body only works properly when it receives healthy nutrients, purposeful exercise, rest and relaxation. This has to be part of the contract. Time outor good food, sports or walks, sleep, spa days, massage and yoga are not luxuries. They are a defense against breakdown or “on the job injuries.” They are no different that wearing a hardhat or steel toed shoes on a construction site. Those around us will not understand the comparison. That is why our assertiveness on this issue is imperative. But we have been indoctrinated with the belief that our needs are worth less than the person for whom we care – after all, we are healthy. The bottom line is that to succeed at this task we must take care of our body.

The mind must be clear on its goal and the value of its task. We must understand that the impossible cannot be expected of us. Positive attitudes towards disability and care giving must be adopted. We have choices. We must distance ourselves from beliefs – our own and those of others – that belittle our worth, see disability as a punishment and our efforts as a waste of time and life. We must surround ourselves with the energy of those who validate the journey. We must reaffirm at the end of each day we truly have done the best we could have done.

The Spirit lives and grows when we accept change as a normal part of life. We learn from the past, we do not dwell there. We honour the present and we do not waste one moment of it. We must not live in isolation; we must share the journey, this honourable, worthwhile journey with others. We prepare for the future without fear or resignation, but secure in the knowledge that we are not alone. The spirit is nourished when we respond with our instinct or gut reactions not the chatter of a critical mind. The spirit is awakened when we find joy even in the small things we do as care givers. The spirit is liberated when we cease to play the victim role and become the grandest version of whom we are supposed to be.

My care giving sojourn has ended. I am blessed with the knowledge that I am a better human being because of it and I can now share those gifts with the universe. Being a care giver is not a waste of time. It can be a time well spent for growing into our wholeness. But you are right – no one said it would be easy!

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