All posts by Pam Brandon

Why State Dementia Training Requirements Are Expanding

More than 5.5 million people across the United States are living with Alzheimer’s disease and other forms of dementia.  As the baby boom generation ages, the numbers are projected to grow at alarming rates.  Although state dementia training requirements vary greatly, overall requirements are expanding for certified nursing assistants, administrators, licensed practical nurses, health aides, personal care assistants and law enforcement and emergency personnel.

People living with dementia are living in a variety of settings – nursing homes, independent and assisted living communities, adult day centers and at home.  Professionals and families provide daily care, but beyond that, the community at large is touched by dementia.  Our police, firefighters, and emergency personnel come in contact with persons living with dementia.  Hospitals are treating more persons with dementia every day.  Social workers, too are helping a growing number of persons with dementia and their families.  Volunteers in a variety of settings are assisting persons with dementia and their families.  the need for dementia training is growing and state requirements are expanding to meeting the demands across the healthcare spectrum.

Until just a few years ago, state dementia training requirements were minimal, with the exception of a few states that were leading the charge, thanks to visionary leaders that saw the when those caring for persons with dementia had little or no training, the quality of care is greatly compromised.

Although states are deciphering best practices in dementia care, as we understand more about the needs of persons with dementia and how to best serve them and their families,  more defined training requirements and being implemented quickly.  Person-centered care practices, when integrated properly, can lead to a transformational change in the quality of care.  Quality dementia training leads to reduced care partner stress and equips caregivers with effective tools to better respond and meet the needs of persons living with dementia.

Improving state training requirements is incredibly important work as we prepare for the fast-growing numbers of people who will be entering long term care.   As we move forward, it is our hope that states are expanding training requirements for those who serve people in all settings, not just those facilities that market themselves as serving individuals living with dementia.  Adult day centers,  assisted living and independent living communities are all seeing a dramatic rise in serving persons with dementia.

When communities train all of their staff who interact with their residents, person-centered culture change is possible.  This includes dietary, housekeeping, maintenance, administrators and others.

And finally, states are looking at programs that are effective, feasible and lead to sustainable change.  This is not easy, as program implementation across large entities requires training providers who are adaptable, understand the needs of that organization, and are equipped to partner with organizations to effect positive change.

Pam Brandon is President/Founder of AGE-u-cate Training Institute and a passionate advocate for older adults and those who serve them.  She is the creator of the internationally acclaimed Dementia Live® empathy training program and led the development of Compassionate Touch®, a clinically proven skilled touch program for those living with dementia and at end-of-life.  Pam may be contacted at pam@ageucate.com.

 

 

 

Is Stress Reaction a form of Behavioral Expression in Dementia?

Stress Reaction is a term being used more often to describe communication in persons living with dementia.  Behavioral expression, too, is communication.  In a growing number of circles, the term behavioral expression is being replaced by stress reaction simply because behaviors sometimes leans toward being a negative descriptive of how persons with dementia express unmet needs.

Stress reaction is communication that is caused by changes taking place in the brain caused by the progression of dementia.  These changes can cause behaviors such as:

  • Aggression
  • Irritability
  • Pacing or wandering
  • Withdrawing
  • Resistance to care
  • Crying
  • Yelling

It is important for care partners to understand that stress reaction is always caused by an unmet need.  The most common causes of unmet needs can be categorized in the following areas:

  1.  Physical discomfort – perhaps caused by pain, hunger, thirst, fatigue or other barriers.
  2. Nonsupportive environment – this might include noise, chaos, inadequate lighting, temperature changes or excessive clutter.
  3. Unmet social needs – boredom, lack of sense of purpose, lack of companionship, touch deprivation are some examples.
  4. Ineffective care partnering – examples include unrealistic expectations from caregivers, distrust from either care partner or inappropriate care (care that is not conducive to caring for persons with dementia)

Now that we’ve discussed stress reactions from persons living with dementia, we must then look at stress reactions from caregivers.  Understanding that it is how we as caregivers react to their stress reactions, is a core value of person-centered caring practices.

We cannot control their behavior, but we can control how we respond to their behavior.   Healthy care partnering means we understand that they cannot change what’s going on in their brain.  Their behaviors or stress reactions are a response to unmet needs, and it is the care partner’s responsibility to put the puzzle pieces together to help their care partners meet their unmet needs!

A few basic guidelines for care partners to keep in mind when there is a stress reaction:

Allow adequate space (in other words, step back if necessary)

The rule is always safety first for both care partners

Observe the environment, and what can quickly be changed, such as taking the person from a noisy room to a calm atmosphere

Observe body language and facial expressions, especially if the person is non-verbal.  What might they be trying to express?  And care partners, observe your own body language and expressions, as your stress reaction can either cause the situation to escalate or de-escalate

Watch your tone of voice!  It’s amazing how a calming voice will immediately bring calm to another person.  And just the opposite is true.  If stress reaction is met with similar behavior, it’s almost always a certainty that the outcome will not be positive.

And finally, learn techniques and tools that can prevent stress reactions.  Touch, music, redirection techniques, companion pets or dolls and more can have amazing outcomes and are simple to implement with the correct training.

Pam Brandon is the President/Founder of AGE-u-cate® Training Institute, creator of the Dementia Live® Sensitivity and Empathy Training program and directed the development of Compassionate Touch® for persons living with dementia and end-of-life.  She is a passionate advocate for older adults and those who care for them.

 

 

 

 

How Do You Score in Empowering Your Caregivers?

From the conversations I have every single day with our partners, I’m guessing most of you would give yourselves an adequate score at best.  And perhaps this is on a good day.  “Empowering Your Caregivers” – some of you might just be asking what exactly I mean by empowering caregivers.

Our old friend, Merriam-Webster says that Empower is to promote the self-actualization or influence of or to enable.  An example: the women’s movement has been inspiring and empowering women.  

What makes the challenge so difficult when we talk about empowering our caregivers, especially those who are serving persons living with dementia?  This is where it gets fuzzy, right?  We have massive numbers of persons living dementia and not enough caregivers to go around, so those that are doing so by and large are stretched – to the max.  And like all professions, when demand outweighs supply,  people look for other jobs if they are not satisfied.  Thus the reason for a very high level of turnover among caregivers, especially those who care for persons with dementia.

Certainly, there are other factors that are equally as important such as pay, benefits and the stress that comes with caring for another person with cognitive decline.

Why then, are some providers able to outperform others when it comes to staff turnover, more satisfied employees AND happier residents, clients or patients?  They are as vulnerable as anyone else is to staffing shortages, wage and benefit offerings and the job itself is just as challenging no matter where one works.  Right?

Maybe that’s not always true.  My discussions consistently come down to the winners in this game invest in their caregivers.  They invest their resources, time and attention in Empowering their Caregivers.  The winners stand out with simple but strongly held core beliefs:  that caregivers MUST be:

  • Educated
  • Have the Tools with which to do their job well
  • Listened to
  • Rewarded

It’s funny, that when someone is educated or trained to do their job well, they then have the tools available.  If they are listened to, they feel a part of the team, and low and behold, when they are rewarded, they feel like what they do everyday matters.

And what our caregivers do every day DOES matter – it matters to your resident, to their families, to the culture of your business and ultimately it matters in how others view who you are as a provider of services.

Let’s not underestimate the power of empowering your caregivers.

Pam Brandon is President/Founder of AGE-u-cate Training Institute and the creator of the Dementia Live® Sensitivity Awareness Training Program.  She is a passionate advocate for older adults and those who serve them.  

The Depression-Dementia Link and What Caregivers Need to Know

Far too often I talk to family caregivers who are concerned about their loved one’s cognitive decline.  It is not uncommon to hear such explanations go something like this:

Mom just has not been on top of things lately.  She seems scattered.  Her house is messier than normal, and she can’t seem to get things in order.  What concerns me most is that it doesn’t seem to bother her, and that is so unlike her.”

Dad was always such a strong decision maker, and now he can’t decide something simple, like where to go for dinner.  It seems like he’s stuck in limbo with just about everything when it comes to making choices – not just about the big stuff but everyday things”.

My wife has no interest in meeting with friends, going to church, or even going out for a stroll.  This is so unlike her.  I know she is blue, but it seems to be affecting her memory.  The other day she asked me the same questions many times.”

All of these scenarios certainly look like potential dementia-like symptoms.  Being disorganized, not able to make decisions and social isolation are certainly cause for concern, especially with older adults.  What often goes unnoticed is the possibility of depression.

What is Pseudodementia?

There is a link between depression and dementia.  It actually has a name – it’s called pseudodementia. Pseudodementia is a term—not an official diagnosis— that is sometimes used to describe symptoms that resemble dementia but are actually due to other conditions, most commonly depression. Unlike true dementia, depression that is caused by depression is often reversible.

Why is the Depression-Dementia Link often Overlooked?

My non-clinical opinion (but based on years of working with family caregivers and my own caregiving story) is that far too often families and even primary caregivers are not tuned into their loved one’s risks for depression.  Older adults who have at least one chronic health condition and 50% have two or more.  Depression is more common in people who have illnesses that limit their normal daily activities.

Loss and grief are common denominators in the elderly, especially those who are living alone, lost loved ones, especially spouses, and because of illness have lost their independence.  If, for instance, a parent has recently lost a spouse, moved from a life-long home, been diagnosed with a significant illness, can no longer drive or has to have help with everyday tasks – ALL of these are precursors to the possibility of that person’s loss and grief lead to depression.

The domino effects that occur when illness strikes, depression sets in and cognitive decline is recognized are often confusing and shocking for families.

It’s very important that loved ones look at life circumstances, and begin to make notes of lifestyle changes (such as not wanting to go out), lack of ability to make decisions, unkempt dress or cluttered living conditions.  The importance of noting these things will make all the difference when visiting the doctor.  Since we have limited time to spend with busy health care professionals, it is more important than ever that older adults have a health care advocate (preferably a family member) accompany their loved ones’ to doctor visits.

More often than not depression is not going to be diagnosed during a doctor visit unless their advocate is there to share what has been observed.  If it is too uncomfortable to do this with a loved one present, then ask for a consultation visit or at the least leave a note that clearly outlines your concerns so the doctor can read this before visiting with your loved one.

Dementia caused by depression is often reversible by treating the depression.  Before loved ones jump to conclusions that their loved one has Alzheimer’s disease or another form of dementia, they should step back and make comprehensive observations, share this with their healthcare professional and see if treating depression first will reverse what looks like symptoms of dementia.

As the holidays’ approach and families come together, this is an important reminder to observe your loved one’s emotional health just as much, if not more than what is going on physically.  Be willing to talk to others and what they have observed, and even with your loved one should be on your to-do list.

And lastly, keep in mind that the oldest generation did not grow up in the era of “happy pills” so, talking about depression and the possibility of taking a medication to treat depression can often be considered an “off the table” topic.  I’ve found that approaching with empathy and kindness and being prepared to explain that depression is treatable –  just like high blood pressure is helpful.  Above, as the saying goes, use your finest kid gloves.

Pam Brandon is President/Founder of AGE-u-cate Training Institute and a passionate advocate for older adults and those who serve them.  A longtime family caregiver herself, Pam has guided thousands of care partners and their loved ones with complex  challenges.