Tag Archives: Senior Care

Alzheimer’s Disease: What Would Maslow Say?

Human needs remain intact regardless of age, situation, or condition.

Abraham Maslow was an American psychologist who taught that survival needs must come before social or spiritual needs. Alzheimer’s disease impacts all these needs, for instance, as in a woman named Faye.

The need for physical survival. Faye relied on caregivers to assist with physical needs. 

The need to have personal security and to feel safe.  Faye didn’t recall recent events, so she didn’t realize where she was. Memories of past experience faded.

The need for a sense of belonging and connection to others. Faye had been active in her church.  The move to a nursing home separated her from familiar people and consequently became withdrawn and anxious.

The need to express feelings and have them acknowledged.  Alzheimer’s decreases a person’s ability to express thoughts. Faye was frustrated because care-partners didn’t understand her.

The need to give to others and to be treated with respect.  We all need to feel useful. We thrive with mutual understanding and respect.  However, people with Alzheimer’s may believe they have nothing to contribute.

The need for a sense of self and a connection to spirit. Many assume that Alzheimer’s robs people of their identity.  Although memory and cognition become impaired, it appears that the person living with dementia seems to retain a sense of self—the essence of who he or she is.

In conclusion, understanding human needs may help us to be a little more empathetic with people living with Alzheimer’s disease.

Ann Catlin, OTR, LMT: For twenty years, Ann led in the field of skilled touch in eldercare and hospice. She has nearly forty years’ clinical experience as an occupational and massage therapist. She created Age-u-cate’s Compassionate Touch program and serves as a Master Trainer and training consultant.

Can Computer Access in Long Term Care Improve Quality of Life?

The importance of computer access for people living in long term care facilities is on the rise.  As the number of seniors using technology increases, so will use of personal computers, smart phones, tablets and social media no matter where they live. One study found that among people 65 and older:

  • Four-in-ten  own smartphones.
  • 67% have internet access in their homes.
  • 32% own tablet computers.
  • 34% use social media regularly.

Those numbers will likely increase as baby boomers age.  Anyone working in senior services see instances where technology access enhances quality of life.

I once volunteered at the Rowe Sanctuary in Nebraska,  along the Platte River. Thousands of Sand Hill Cranes gather there on their way north.  People from around the world visit to witness this spectacle.  I was given the task of operating what is called the Crane Cam.  It is a remote camera on the river. Its images are sent to the web through the National Geographic website.  While operating the camera, a couple approached.  I explained how it all worked. The woman said her mother was in a nursing home in another state. She  has been an avid bird and visited the sanctuary several times. However, now that she is in a facility she could no longer bird watch. Her daughter had recently set up a computer in her mother’s room .  Her mother could now look in on the Cranes via the internet!

A man I provided Compassionate Touch sessions to for several years used a PC to write poetry and letters to his family. He was a successful business man in his career. His desk and computer helped retain part of his identity that was important to him.

A young man with cerebral palsy who lives in a facility regularly plays games and records music on his PC . Sounds like a typical 20 year old, doesn’t it?.  His keyboard is modified compensating for his poor coordination, therefore he manages  independently.

I think we will see more individuals in facility care with personal computers.  It might serve to lessen the feelings of isolation and boredom that plague so many who must reside in long term care.

What are your thoughts about the link between technology and quality of life for those in facility care?

Ann Catlin, OTR, LMT: For twenty years, Ann led in the field of skilled touch in eldercare and hospice. She has nearly forty years’ clinical experience as an occupational and massage therapist. She created Age-u-cate’s Compassionate Touch program and serves as a Master Trainer and training consultant.

Grief, Guilt, and Anxiety – How We can Help Caregivers

As a long time family caregiver and professional in this field, I can tell you that the myriad of emotions that caregivers face on a daily basis is complex and ever-changing.  That said, grief, guilt, and anxiety are certainly at the top of the list.   How can we, as professionals in this field, better understand family needs and partner alongside them on this difficult journey?

Let’s talk first about the emotions that family members experience in deciding to move their loved one into assisted living or another level of care.  First, families are often focusing a tremendous amount of attention on helping their loved one cope.  This can be overwhelming in itself, and certainly where the grief, guilt, and anxiety begin to kick in.  Grief may be the sadness of realizing that their loved ones are aging.  If there is chronic or serious illness, anticipatory grief might be the realization that death is in the foreseeable future.  If a loved one is living with dementia, grief is felt over the loss of who that person once was.

Families, especially primary caregivers live with guilt.  I often tell caregivers this is an added benefit of the job.  Often second-guessing decisions,  caregivers tend to be overly sensitive to their loved one’s own emotions.  At the same time, juggling family, job responsibilities, and caregiving duties can leave a person feeling like they are not doing a good job in any of those areas.  When guilt piles up, it often spills to feelings of unfounded fear and doubt.

Anxiety, like grief and guilt, can be caused by and can cause a snowball of other emotions.  When a family member is the one “in charge” of taking care of the many tasks associated with moving their loved one to a care facility, anxiety kicks in quite easily.  What often happens is that when one is under stress, rational decision making sometimes goes out the window.

It’s important that as professionals we assure families that, as hard as this process is, it is normal to feel these emotions.  Helping them with resources (movers, real estate professionals, support groups, etc. can ease some of the burdens and also provide a network of people who are experienced and trusted).

While family members, especially primary caregivers are learning, most have not walked this path before.

If there is one piece of advice that professionals need to remember it is that families know far less about the complex world of caregiving, levels of care, chronic illness, Alzheimer’s and other dementia, legal and financial planning and dealing with stress and burnout – than we expect them to!  This is not to diminish the admirable responsibilities that caregivers take on.  There is just so much to learn.  I was years into caregiving myself before I even realized what I needed to know – and then under stress, I’d forget the things I did learn!

Professionals can be a much-needed gentle guide through this process.  Here are a few tips that may benefit the family:

  1.  Give them a checklist of things to do before their loved one moves.  This list may include what to bring in the way of furniture, clothing and personal items.
  2. Invite them for lunch and go over the list and any concerns.  This is a good time to get to know a bit more about their future resident, but also the relationships of the family.
  3. Assure the family that as difficult as this time is, it will get easier and that staff is there to ease the transition for everyone.
  4. Make sure the family feels comfortable with the staff that will be most involved in the initial move and transitioning their loved one.  Knowing and discussing any questions upfront will save day-of moving confusion.
  5. Encourage the family to give their loved one a few days to settle in.  They will benefit by the break, and many times it helps the new resident get acclimated to their new home.

A smile goes a long way, a hug calms fears, and humor eases tension.  

Pam Brandon is President/Founder of AGE-u-cate Training Institute and a passionate advocate for older adults and those who serve them.  

Communicating with Terms of Endearment – A Big NO NO

Dear, Honey, Hun, Sweetie, Buddy, Chief, That’s a good boy, Let’s go potty now.  No, I am not talking to my 18-month-old, I am repeating terms of endearment and phrases I hear in memory care and assisted living every day. There is so much research behind the use of this type of language researchers refer to it as elderspeak. I know I am guilty of using terms like these and I know you are too but explore the impact it may be having on our residents.

Although our intentions are generally well-meaning, communicating in such a way with a resident conveys a message of vulnerability, frailty, and inferiority. In fact, communicating with terms of endearment can be viewed as a caregiver trying to control or take charge of the situation rather than providing help and support to their resident.   You may be thinking “this doesn’t matter to me, my resident has dementia, they won’t remember anyway”. And while it is true that your resident may have little to no short-term memory, they are capable of associating feelings with interactions. They will pick up on the tone of your voice and the inflections that you are using.

I feel it’s important to mention that not all residents will respond negatively to the use of elderspeak, but to keep things consistent for all our residents we should stop using terms of endearment, they can be viewed as belittling, condescending and can trigger negative behaviors.  Did you know that using terms of endearment with a resident could lead to a state citation?

Let’s talk about some negative and positive examples:

When helping Ann, a pleasantly confused woman, after lunch the caregiver says “Sweetie” let’s go change your shirt, you spilled juice all over it, and then we will go potty, OK Annie?” The caregiver reaches out her hand to guide Ann to her room and says, “that’s a good girl, come this way” While the caregiver only means to help Ann and show that she cares for her the impact of her words could have a negative effect on how Ann will respond to the care she is about to receive. She may pull away from the caregiver and the caregiver will think that Annie is just being resistive when really Ann is feeling disrespected or confused.

The caregiver’s tone and language may remind Ann of a time when she was young, and her mother would call her Annie when she was caring for her, it could help to create feelings of a safe environment for “Annie”. OR depending on where Ann is at in her current reality it may trigger negative feelings. She could be reminded of a time after she was physically abused by her spouse when he would use terms of endearment to control or belittle her, maybe he only called her Annie after a nasty fight. OR consider this Ann was a high school principal and the use of a term like this offends her! She demanded that her students and staff respect her and the education she worked hard to achieve, and they called her Mrs. Brown, never Ann and most certainly never Annie!

The immediate impact of Elderspeak may not always be apparent and we must never assume that using a term of endearment is appropriate. Always call a resident by their proper name and if they have a title like Dr. or Professor until you have gained permission to call them by another name. If they have a nickname that they prefer to be called it must be documented in their ISP. For example, John has been called Bub his entire adult life, this is ok! If fact Bub might respond negatively to be calling John.

Research has shown there are 3 main factors on a caregiver use of Elderspeak.

  1. Familiarity with the resident- The more comfortable we are with the resident the more likely we are to use elderspeak.
  2. Whether the resident has dementia- the level of dementia plays a huge role in our use of elderspeak, the further progressed the dementia is the more likely we are to use a term of endearment. Maybe we view the resident as helpless or frail and in our effort to show or convey caring we may use elderspeak.
  3. If the resident is alone with the caregiver or if there are others present during the interaction. In the presence of family, other residents, or other caregivers we are less likely to use elderspeak, maybe because deep down we know it is disrespectful and we are more aware of what others would think if we used endearing terms.

So, have you ever caught yourself addressing a resident with Elderspeak? I know I have. And the only way we can change this behavior is to be aware of it then stop it.

My challenge to you is to be more aware of not only your communication methods but of those around you.  Maybe you need to remind a co-worker, in private that they shouldn’t use endearing terms. Or you may need to be reminded yourself on occasion.  After you catch yourself using elderspeak you may need to apologize to your resident when you call her Sweetie and correct your actions by using her preferred name. I challenge each of you to focus on the strengths of your residents and not their inabilities or weaknesses. Remember that everyone has value and should be treated in a respectful way.

Emmy Kaczmarksi, RN is a Master Trainer for AGE-u-cate® Training Institute, Dementia Educator, Behavioral Specialist, and works at White Pine Senior Living in Hudson, WI.  

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