In Home Care
Providing home care for senior citizens with Alzheimer's disease can be difficult. Symptoms progressively worsen, and predicting how quickly that progression will be or which behavioral changes will occur each day is impossible. Both the person with Alzheimer's and the caregiver may have a hard time carrying out activities of daily life, such as eating, talking, sleeping, and coming up with activities to do. The following is a set of ideas that may help you deal with issues related to elder home care for people with Alzheimer's.
Daily Activities
It may be challenging to think of activities that will be possible and interesting for a person with Alzheimer's to do. Trying activities that build on present strengths and abilities is usually more successful than attempting to teach a new skill.
- Try not to set your expectations too high. It may be best to do simple activities that employ current abilities.
- Assist the person in starting the activity. Take the activity one step at a time, and praise the person each time he or she completes a step.
- Take note of agitation or frustration with each activity. If you notice a negative change in mood, gently try to help him or her with the activity or subtly change to a new activity.
- If you notice that the person enjoys a particular activity, try to make that activity a part of your schedule at a similar time each day.
- Make use of adult day care centers, which provide activities and support for the person with Alzheimer's along with relief from caregiver tasks. Often, meals and transportation are provided in the cost of using these centers.
- Communicating with the person may be difficult-both understanding and being understood may become an issue. Try to use simple words and short sentences in a calm tone of voice.
- Refrain from talking to the person as if he or she were a child or talking as if the person were not there. To help the person focus, minimize background noise by turning off the radio and TV.
- Before talking, call the person by name to get his or her attention. Allow ample time for a response, and try not to interrupt.
- When the person with Alzheimer's struggles to communicate a thought or idea, try to gently suggest a word or idea he or she seems to be thinking of.
- When asking questions or giving directions, frame them in a positive way.
- Meals and eating can be a challenge-some people with Alzheimer's want to eat too often, whereas others may forget that they should eat. Provide a calm, quiet atmosphere during meals; this can allow the person to focus on eating.
- Offer limited choices for meals and serve small portions. Several small meals throughout the day may be a better option than three larger meals.
- Using straws or lidded cups may make drinking easier. Finger foods may be easier to handle than utensils, and bowls may be easier to use than plates.
- Keeping healthy snacks in a visible place will encourage healthy eating.
- See a dentist regularly to keep the person's mouth and teeth clean and healthy.
- Many people with Alzheimer's become restless, agitated, and irritable at night, usually around dinnertime. This is called "sundowning syndrome," and some planning might be necessary to ensure that the person goes to bed early and stays in bed through the night.
- Encourage physical activity and discourage naps during the day, but allow time for ample rest-fatigue can increase the likelihood of restlessness during the late afternoon and night.
- Schedule more physically demanding activities early in the day. Try giving a bath in the morning and having large family meals earlier than normal.
- It is important to set a quiet, calm atmosphere in the evening to encourage sleep. Dim the lights, turn off loud sources of noise, and play soothing music if it helps the person.
- Encourage sleep at about the same time each night-routine may be helpful.
- Refrain from offering the person caffeine during the late afternoon or evening.
- Set up nightlights in the person's room, hall, and bathroom if darkness scares or disorients the person.
Tips for Providing Personal Care
Providing personal care for people with Alzheimer's, such as bathing, brushing teeth, or dressing, can be difficult. Below are some helpful tips to make personal care easier.
- Planning in advance for baths can help if the person with Alzheimer's finds bathing frightening or confusing.
- Schedule baths during the time in which the person seems to be the calmest during the day. Developing a routine may help.
- Consider the fact that bathing might be scary or confusing for the person, and respect his or her feelings. Remain calm, gentle, respectful, and patient.
- Let the person know which step is coming next, and let him or her perform steps he or she is capable of doing.
- Prepare beforehand. Have everything you need in the bathroom and draw the bath before he or she enters.
- Consider the temperature. Test the water temperature beforehand, make sure the bathroom is a comfortable temperature, and keep extra towels and robes nearby.
- Limit safety risks by using a handheld showerhead, shower bench, grab bars, and non-skid bath mats. Do not leave the person alone in the shower or tub.
- A sponge bath may be a good alternative between bathing instead of bathing every day.
- Getting dressed may pose a challenge; deciding what to wear, getting certain articles of clothing on and off, and fumbling with zippers and buttons might be difficult. Plan ahead to minimize the confusion and difficulty in this task.
- Schedule dressing for the same time each day so the person can get used to having it in his or her routine. Encourage the person to perform as many steps as possible, and plan enough time to allow for difficulty.
- Present a few choices of clothing each day, and if the person has a favorite outfit, you may want to consider purchasing multiple sets.
- Lay out the clothes in the order they should be put on to help the person move through the process more easily.
- Provide clear, step-by-step instructions if the person is having difficulty.
- Pick out clothing that is comfortable, easy to get on and off, and easy to care for. Clothes with elastic waists and Velcro will eliminate problems with buttons, zippers, and tying. Take note of discomfort from tight clothes or pricking from a safety pin. The person may become irritable for seemingly no reason, but painful clothing might be the cause.
- With the progression of Alzheimer's, many people may become incontinent (lose control over their bowels or bladder). This can be upsetting for the person with Alzheimer's and is sometimes a sign of physical illness. Be sure to discuss this with a doctor.
- Develop a routine for taking the person to the bathroom and follow it as closely as possible. You may want to guide the person to the bathroom every few hours, for example. Do not wait for the person to ask or tell you.
- Notice signs of the person having to go to the bathroom, like restlessness or tugging on clothing. Respond to these signs quickly.
- Try to be understanding and considerate when accidents occur. Remain calm and reassure the person if he or she is upset or frustrated by it. Keep track of when accidents occur, and try to plan ways to avoid them.
- Preventing nighttime wetting may include limiting certain types of drinks later in the day, such as drinks with caffeine. If you plan on taking the person out, be aware of where bathrooms are located and have the person dress in clothing that is easily removable. Bring along an extra change of clothes in case of an accident.
Residential Care
Many caregivers eventually find that it is too difficult to continue providing in home care. When this happens, the person with Alzheimer's will have to live in a place where care is provided at all hours of the day and night. Two types of residential care are available: assisted living and skilled nursing facilities.
Assisted living homes are set up in large apartment or hotel-like buildings or as a "board and care" home for a small group of residents. Each offers a different level of care, but most include meals, recreation, security, and help with bathing, dressing, medication, and housekeeping.
Conversely, skilled nursing facilities (also referred to as nursing homes) include 24-hour services and monitoring. They are able to provide medical care and rehabilitation for people who are very frail or are going through the later stages of dementia.
Health care providers sometimes provide different levels of care at a single site. This is called a "continuing care community," and it is set up as two buildings, usually next to each other, to allow for ease of movement between assisted living and skilled nursing facilities. Some of these communities have programs for couples when one spouse is fairly healthy and the other is disabled.
Choosing a facility can be a difficult decision to make. Collecting information about services and options in anticipation of the need to relocate can be helpful in giving you time to weigh the options and choose the facility that best meets your needs.
Doctors, friends, relatives, social workers, and religious organizations may be able to help you locate nearby facilities. If you are looking for a facility farther away, it may be useful to hire a professional care manager to help you figure out specific care needs and identify community resources.
Compose a list of questions for the staff of each facility. This might include questions about what is offered at the facilities, such as activities, transportation, or units specifically for people with Alzheimer's. Contact the residences you are interested in, and make an appointment to visit. Talk to as many people as possible while you are there, including administration, nursing staff, and residents. Take note of how the facility is run and how the residents are treated. Dropping by unannounced might also be a good idea to ensure that your first impressions were correct.
Do some research to determine whether each facility has Alzheimer's-specific programs and services. You may want to ask whether the staff is trained in dementia care and if the facility allows family participation in planning personal care.
Other things you may want to consider are room availability, cost and payment method, and participation in Medicare or Medicaid. If there is a waiting list, you may want to put your name on it even if you are not completely ready to make a decision about long-term care. When you do make a decision, be sure to understand all of the terms of the contract, including the financial agreement. Looking over the documents with a lawyer before you sign may be helpful.
Relocating will cause a substantial change for the person with Alzheimer's as well as the caregiver. Working with a caregiver can help you plan for and adjust to the move. Having a support system is important during this time.
Making visits to people with Alzheimer's is very important, even though they may not remember who the visitors are. The value lies in human connection and social activity. Some ideas for people who are planning a visit to a person with Alzheimer's disease are the following:
- Visit at a time of the day when the person is at his or her best. You may want to bring an activity to do, such as a familiar book to read or a family photo album to browse, but be prepared to give up the activity if necessary.
- Remain calm and quiet. Try not to use a loud tone of voice, and refrain from talking to the person as if he or she were a child. Be considerate of the person's personal space, and try not to get too close if he or she seems uncomfortable.
- Make eye contact and call the person by name to get his or her attention. Remind the person of who you are if he or she does not remember you.
- Do not argue with the person if he or she is confused. Respond to the feelings being communicated, and subtly distract the person by bringing up a different topic if necessary.
- Try not to take it personally if the person does not recognize you, acts unkindly, or responds angrily. The disease causes confusion that the person is responding to; it is not your fault.
Safety Issues
It is very important to consider safety when caring for a person with Alzheimer's disease. Accidents are possible even if plans are made and adhered to. A couple ways to minimize dangerous situations are making sure your home is safe and preventing the person from wandering or driving when skills decline.
Home Safety
People who are providing home care for senior citizens with Alzheimer's must examine their homes thoroughly to identify and change possibly dangerous objects or setups. The creation of a safe environment can minimize dangerous, stressful situations. Here are some things to do when preparing to provide in home care:
- Put in secure locks on outside doors and windows, especially if the person tends to wander. Install a keyed deadbolt or additional lock higher or lower on the door. A new latch or lock might help if the person can open the door due to its familiarity to him or her. Conversely, removing locks on bathroom doors will ensure that the person does not accidentally lock him or herself into the bathroom.
- Install childproof latches on kitchen cabinets and cupboards as well as places where you keep cleaning supplies and other chemicals.
- Make sure medications are labeled and locked away. Keep dangerous objects like knives, lighters, matches, and guns out of reach. Put away and secure anything that poses a threat to safety, both inside and out.
- Maintain a tidy, well-lit environment. Remove scatter rugs or other objects that might cause the person to slip and fall.
- Think about installing an automatic shut-off switch for your stove to minimize the risk of burns or fire.
- If the person goes out, make sure he or she is carrying identification and is wearing a medical bracelet. If he or she becomes lost and cannot effectively communicate, this will let people know the person's identity and alert them as to his or her medical condition. Make sure to have a recent picture or video of the person in case he or she gets lost.
- Ensuring safety is one of the most important tasks of caregiving. People with Alzheimer's sometimes wander away from their homes and caregivers, so knowing what to do to prevent wandering is of utmost importance.
Driving
After making the difficult decision that someone with Alzheimer's is no longer capable of driving, sharing the decision with that person should be done carefully and sensitively. The person may become upset, but it is extremely important to consider his or her safety as well as the safety of others on the road. Here are some ideas to help you decide whether someone with Alzheimer's should no longer drive and to guide your communication with that person:
- Look out for signs that the person can no longer drive safely, such as becoming disoriented in familiar places, driving too fast or slow, not heeding traffic signs, or becoming angry or confused.
- When you tell the person about your decision, try to be sensitive to the person's feelings, but remain firm in your request that he or she not drive. It is also important to be consistent when you have made a decision-even on a "good day," do not let the person drive.
- Ask for help from a doctor. The doctor may be seen as more of an authority figure, and the person may be more willing to stop driving. The doctor may be willing to write a "prescription" to stop driving as well as to call the Department of Motor Vehicles to request a reevaluation of the person's driving ability.
- If it becomes necessary, take away the car keys. If holding onto keys is important to the person, substitute a different set of keys.
- If nothing else seems to be working, you may want to disable the car or move it to a place where the person can no longer see it or access it.
Caregiver Support
When learning that a loved one has been diagnosed with Alzheimer's disease, you may become stressed, frightened, and overwhelmed. Some helpful tips for dealing with the new diagnosis are listed below.
- Ask the doctor questions you have about Alzheimer's, including which treatments might be the most useful in alleviating the symptoms or controlling behavioral problems.
- Certain community groups offer classes to teach caregiving problem solving and management techniques.
- Locate a support group where you can talk about your concerns and emotions. Fellow members might have ideas and resources to share based on their own experiences. If you would like to find a support group but would rather stay at home, there are many support groups online.
- Map out your schedule in order to identify times in which you can create a normal routine to make activities run more smoothly. If certain times of the day are better for the person with Alzheimer's in terms of behavior and emotions, try to plan your schedule to make the most of those times with the person. The person's behavior may change from day to day, so be prepared to be flexible and change your schedule as needed.
- Think about using adult day care or in home health care services to allow time for your own relaxation. By using these services, you can have a break from the demands of caregiving while knowing that the person is safe and cared for.
- Try to plan ahead. This may mean collecting financial and legal documents, exploring long-term care options, and figuring out which services are covered by health insurance and Medicare.
