Monday, 28 October 2013

The small miracle of making a difference for eldercare


                       The welcoming dining room in The Annex

I probably won't have a gravestone.
But if I did, I know what I'd want it to say.
She made a difference.
And I'd want it to be true.

At Christie Gardens, where I work, I have the opportunity every day to make a difference for an amazing group of seniors. They are from every profession and background, and they have the most interesting stories. I see their kindness and their grace. They add to my life every day.

Change and innovation has always been a part of Christie Gardens, but this has never been more true than now. We are seeking to change the way eldercare is provided, going from a medical model to a social, homelike model.

How does this look? We are developing four "neighbourhoods" which have approximately 20 residents. Let me walk you through the first one, called "The Annex."

When you enter the area, the first thing you notice is the colours. The warm golds and rusty oranges are welcoming. The family room is inviting, and has a door leading to the garden. It's the perfect place for a cup of tea and a chat. Private rooms line the hall, which leads to an open area. A room on your left is the studio, where several residents with their care partners are preparing for a game of bowling. Cloe the cat wanders over, yawns, and heads for a resident's room to sleep on the bed. The open lounge is inviting, and leads right into the dining room, where residents and care partners eat together. The nutrition partner is there with her apron on, looking like "mom in the kitchen." She often sits and chats with a resident while they are eating. The shower and laundry rooms are on your rights. Two residents enjoy folding laundry (especially the clean, warm smell) and do that task every day.

It's the atmosphere that I love. It isn't rushed, as care partners provide care and interact with their six residents. There is laughter and music. Everyone works together. The nurse comes in to deliver medications and treatments, but isn't a central figure. A resident arrives mid-afternoon and is served a cup of tea. It's home.

If you go down the hall, you will see the next neighbourhood, which is due to open late November, under construction. Excitement is high as it takes shape. The kitchen is in, sans appliances, and the wallpaper is up. Residents and staff peek as they go by, anticipating the opening.

I work down the hall from there. Our neighbourhood will be the next one to be constructed, and we are forever speculating where the dining room will be.

But it's not just about the construction, although the cosy, open atmosphere is integral to the model of care. It's a way to provide care that is respectful. It says, "You are a person. You have a choice. You can still grow and learn and be interested in life." So the residents choose when they get up and what they like to eat and what activities they enjoy. They interact and make new friends. They visit with family and old friends. They live.

All of this is expensive, and Christie Gardens is fully self-funded and non-profit. Our capital campaign has so far raised over $50,000 toward the project. Each neighbourhood costs approximately $250,000.

Here is where you can make a difference.

Aviva Insurance runs a contest each year through Aviva Community Fund. They invite participants to submit projects that will make a difference in their community. What was that? Make a difference?

You got it.

Christie Gardens has entered their project, not only to build the neighbourhoods, but to challenge the status quo of eldercare. We are pioneering a new model, and showing others that it is possible. You may not live in our area, or even in our country. But this revolution will affect you in some way.

What can you do? You can vote. Register once, and every day until November 4th, vote at www.voteforchristiegardens.com

Our support has escalated, and I believe it because people are catching the vision.

 It is possible.

Make a difference.

Today.

Wednesday, 23 October 2013

Caregiver Wednesdays- Finding the Trigger on the Smoking Gun



I don't know much about guns. I shot one once, at a target. I missed.

I know a gun has a trigger, and in order to shoot it, you have to pull the trigger. (Duh!) I learned that first from Road Runner cartoons. Wile E. Coyote would shoot his gun and then stand casually blowing the smoke away. That was usually when a stone or heavy weight fell on him. But I digress…

In dementia, anger and aggression can be caused by many sources, or "triggers." If you can discover the source of the agitation, it might be possible to intervene and remove it.  This isn't only true for anger, but works with many behaviours.

What could be possible triggers?

Is the person ill? A low-grade fever or a urinary tract infection or even a slight cold may not have shown itself in symptoms, but you know how it can make you feel. If you are feeling ill, you have less patience. How much more the person with dementia?

How are they sleeping? Sleep disturbances are common, and someone whose sleep has been interrupted is going to be more prone to anger the next day. Related to this are their medications, some of which might cause drowsiness.

Are they hydrated? This seems simple, but many seniors don't drink enough, and dehydration can cause all kinds of problems in frail elderly.

Beyond this, you need to become a detective. What happened immediately before? Is there something going on in the family that is making them sad or anxious?

Is the person frustrated or embarrassed because they know they aren't able to cope, can't remember or live in a state of confusion?

Is there too much stimulation? Too much noise, too many people talking, too much information to try to process?

Are they frightened or threatened by something real or perceived in their environment?

Here are some examples:

Laura's daughter just left on vacation. She is far enough away that there will be no communication for ten days. Laura doesn't understand why she feels anxious and angry. There are times when she forgets her daughter is away. But she lashes out much more frequently than is normal for her.

George hates to be touched unless he initiates it. If someone "helps" him to walk, or guides his walker away from danger, he becomes furious.

Mavis can't handle money any more, so she doesn't have any. However, throughout her life, she paid for everything, and it is a constant source of agitation for her that she doesn't have any money. Assuring her that everything is paid for doesn't help. She knows life isn't like that.

Florence knows that she can't remember how to cook. She used to love to create meals for her family, and not being able to brings her anxiety and huge embarrassment. She feels that she is failing in her calling. It makes her angry.

Roger loves family gatherings, but after a few minutes, he becomes impatient, and sometimes yells. The noise of everyone talking and the faces he knows he should recognise cause him embarrassment which leads to anger.

Every trigger is a fantastic discovery. If you can find the "why" behind the explosion, you can sometimes prevent it.

Next week: Tackling the triggers.


Wednesday, 16 October 2013

Caregiiver Wednesdays- Dealing with Anger pt. 1



Some of the best content on Facebook is when my daughter posts pictures of my granddaughter's visits to the Hallowe'en aisle of WalMart. Picture a  cherubic six-year-old who favours pink and anything with sparkles, wearing the most ghoulish masks imaginable. She loves blood dripping and skin hanging. When she's wearing one of those masks, I barely notice the rest of her. The mask is everything.

Of course, we all wear masks. Those firmly-in-place smiles that hide what lies beneath. I was recently yelled at by a woman who was furious with me. I had forgotten to do something, and she was disappointed. The reasons behind my memory lapse were of no consequence to her, so I didn't try to tell her. I took my lumps and tried to apologise. Inside, behind my mask, I had plenty to say, but it stayed inside.

People with dementia often lose the social masks we cling to so tightly. It can lead them to say exactly what they are thinking. There are times when it leads to anger or aggression. The mask which will keep my mouth shut and my hands folded in my lap when I am angry, doesn't work for them. Anger can be sudden, frightening and violent. Aggression even more so. What is a caregiver to do?

As with everything involving dementia, nothing works all the time, or every time. Every intervention is used with trial and error, and often in combination. Seldom is there one "cure."

One possible intervention is medication. Let me say up front what I feel about this.

Medication is sometimes necessary. I've seen it give relief when nothing else worked. If medication is used, it should be a) not the first solution b) given in the lowest dose possible and titrated up slowly if needed c) closely monitored by a physician who has this same philosophy. Most elderly people are on many medications for other conditions, and their frail bodies react more dramatically to drugs. Careful monitoring is key.

We are going to look at some of the causes for anger and aggression, because although it may seem like it came out of nowhere, the truth is, there is often a trigger. If you can identify the trigger,  a solution may present itself.

As caregivers, aggression and anger is exhausting to deal with, and takes a huge toll on you. If this is an issue in your situation, you need support, help, ideas and hope. You may even need to look at alternative care for your loved one.

It's a difficult journey. You are not alone.



Wednesday, 9 October 2013

Caregiver Wednesdays--When the Conversation Doesn't Make Sense


This is the final instalment in my series on communication with a person with dementia.

A person with dementia lives in a different reality from yours. What is real and true and makes perfect sense to them may sound like disconnected babble to you. Or, the words and even the concepts may make sense, but you still have no idea what the person is talking about. You need to leave your reality behind for a while and enter theirs.

How do you do this? Here are a few examples.

"I'm going home, now." or "I have to catch a bus and get home. Mother is waiting."
("Tell me about your home. What does it look like? What will Mother be doing when you get there? Will she have a snack for you? What do you like to do together?)

This conversation doesn't try to convince the person that they can't go home to a house that is long gone, or a mother that has been dead for 50 years. That kind of conversation only causes agitation and anger. Instead, listen and pick up on some part of what they are saying. Turn it into a reminiscence. Gradually change the tense from present to past.

"They are stealing from me. I can't find my purse/nightgown/money"
(That must be frustrating for you. Can I help you look for it?")

Again, this listens and validates the conversation. During the "looking" the conversation could be turned to other things ("That's a lovely blouse. Do you like to shop?" and the "missing" items might be forgotten. For now. It may resurface, possibly several times a day, and the same technique would need to be used.

"Can you bring me some knitting needles and wool? I want to start knitting again" (Lady is blind.) ("Sure, I can do that. What would you like to knit? What did you used to make?")

"Is Mother okay? I haven't seen her in such a long time."
("Yes, Mother is fine. What do you like to do best with mother? Where did she used to take you? Was she a good cook?") Notice I changed the tenses. People often move in and out of the understanding that their parents are dead. This person may be able to talk about memories of her mother from the past and not remember she was thinking about her as alive a few minutes ago.

When "conversation" is disconnected words or phrases that make no sense at all, make liberal use of conversational noises "uh huh, oh really, is that right, um hmm" etc. Occasionally the person may say something where you can pick up a conversational thread.

The bottom line--respect. This is a person who deserves it, and you are able to give it by entering into their reality and communicating with them.


Wednesday, 2 October 2013

The small miracle of Mrs. B.




Today I made a cake, but my chief mixer wasn’t there to help.  She left early in the morning, and won’t be back. Although I will miss her terribly, she has left so many parts of herself with me, there are ways in which she will always be there.

I met Mrs. B. many years ago when she was living in an apartment with her husband. They were contemplating moving to the care sections because he needed more care, and she was virtually blind. Although she walked with a walker, her mobility was poor, and there were other physical issues. After her husband died, she moved into my unit, and into my heart.

She was a strong person, and fought against the physical changes in her body. She wanted to move back to her apartment. She wanted to walk independently. She wanted to knit again, and other activities that involved sight. It irked her that she couldn’t do these things. But she didn’t let it overcome her.  Her insatiable zest for life and her humour rose to the top.

Today, I put ingredients in the bowl and realised that every time I do this, she will be there. When I planned to bake, I would let her know. After breakfast, she would search in her room for her apron and arrive in the kitchen with it on. She was the “Chief Mixer.” She couldn’t chop because she couldn’t see, but she mixed with finesse. Often when we were enjoying our treats later in the day, she would turn to the person next to her and say, “Did you notice how well it is mixed?”

I’ll never eat chocolate without thinking of her and the time we made chocolate covered pretzels. She was pretty much covered in chocolate, but she had a blast. I said, “Mrs. B., people are going to eat those pretzels. You really shouldn’t lick your fingers.” She grinned at me, and slowly licked each finger.

I’ll never pass a box of Kraft Dinner in the grocery store without thinking of her. One of my favourite stories was about how, as a young bride, she couldn’t cook. She discovered Kraft Dinner (which was probably a brand new product at that time) and made it for her husband. He liked it, so she made it again. And again. After a few weeks, he complained, and she was indignant. “I thought you said you liked it!”

When I dress up for a special event at work, she’ll be there. Last Christmas, I went to talk with her, and she felt the fishnet stockings I was wearing. She liked them, but didn’t approve of my calf-length dress. “You’d better shorten it. You’ll never get anywhere with it like that.” There were days she made me howl with laughter, and other times when she left me speechless.

She followed my romance and marriage with great interest, and the nurse in her wanted daily reports about my husband’s progress after heart surgery. She gave me a wedding card that she had signed, a treasure I will always keep.

 And she wasn’t above flirting with my new husband. He brought her flowers when he came to visit at Christmas, and she was delighted. Almost every day when I came home, he would ask about her. Then I’d go to work, and she’d ask about him.

Two years ago, her daughters and I launched a campaign to get her to go on our camping trip. She loved to be outdoors, loved people, and we knew she’d have a great time. Her excuses where a mile long, but we had an answer for each one. Her daughter packed her suitcase, and Mrs. B. unpacked it. Her daughter repacked it and we kept it in another room. Right down to the last minute, we weren’t sure if she would go, but in the end, she got on the bus. I used to joke with her that there were heel marks in the carpet from where she dragged hers on the way out the door. From the first moment she was there, she loved it, as she sat in the sun and chatted with the other ladies. I still remember the look of horror on her face when I brought the (little, tiny) fish that I’d caught to show her, and the look of delight when she ate her s’more. She had such a great time, and the minute she came back, she became a “camping apostle” and told everyone she saw that they had to plan to go next year. She went back a second time, and loved it even more.

And she wrote a book! This amazing lady didn’t let lack of sight hinder her, but dictated the stories of her life over the phone to her daughter, who was her editor and publisher. I felt so privileged when she let me read it and make a copy. “I’m not sure why you would want to. It’s just my story. Nothing interesting,” she said. On the contrary, it was funny and poignant and showed her personality on every page. I treasure it.

She loved people, and enjoyed her table mates in the dining room. There were six ladies who sat at the table which my co-worker and I called (only to ourselves) the “queen table.” They pretty much ruled the dining room, and Mrs. B. was right in the centre.

So she is gone, and I am here. But every day I take with me the many gifts that she has given me.
Thanks, Mrs. B.