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8 Tips for Keeping Connected to Those with Dementia

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Loved ones with dementia or Alzheimer’s benefit from interaction with others. Sometimes we may not know how to best communicate with those experiencing memory problems, which occurs with every form of dementia. Here are some tips for interacting with people with dementia:

  • Conversation with people with dementia will vary dependent on where they are; early stage versus late stage. A key issue with dementia is loss of the ability to plan, reason, and execute a plan. Thus if you ask a yes or no question and it requires reasoning, often the answer will be no, not because they are saying no, but because they cannot decide.
  • Keep conversations simple and stay away from questions except as it pertains to real time: Are you hungry, thirsty, or in pain? Keep each question as a single subject and then wait for an answer. Do not change the question, but if not answered, ask exactly the same question again.
  • Stay away from “do you remember?” In dementia, early on, people do know their memories are worsening, so asking this may increase their frustration.   When looking at pictures, ask what the person thinks is happening in the picture rather than asking them to try to identify the person. This taps into imagination and decreases the stress of trying to remember.
  • Try to keep the environment calm and free of lots of stimulation. When wanting to communicate, turn off the TV and help the person focus to the conversation. Over stimulated persons with dementia may become agitated, aggressive or withdraw.
  • As dementia worsens, the person’s world will get smaller. They often end up in a single room due to inability to cope with the wider environment. This tells you that more stimulation is not what is needed, but that there is an increase in fear due to unrecognized surroundings.
  • Do not yell, shame, or corner a person with dementia. They are adults and often that is known to them. Also, do not use reality orientation. If you ask them how old they are, they may give you a clue as to what period of time they think they are in. It is easier to go to their reality than to drag them into our reality.
  • If they have forgotten who you are, be who they think you are, or introduce yourself at every visit and who you are. If they have forgotten you, do not take it personally. They just cannot remember.
  • Engage the senses as dementia frequently affects left brain function first. Sensory experiences are in the right brain. Aromatherapy, massage, music, quiet environments, lower lights help.

About the Author:

Nancy Sterling Trimble, PhD, RN, CNP is a geriatric Adult Nurse with over 30 years of experience. She has served as a faculty member of Indiana Wesleyan University, Capitol University and Wright State University. Nancy has also contributed numerous articles to clinical publications.

nancytrimble

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Remembrance Walk Honors Memories of Loved Ones and Benefits Ohio’s Hospice of Dayton

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Members of the community are invited to take part as individuals or as part of a team to honor the memory of a loved one at Ohio’s Hospice of Dayton’s 3k/5k Remembrance Walk on Saturday, October 22, 2016.

The annual event involves the entire community in celebrating the lives of loved ones. Proceeds will enable Ohio’s Hospice of Dayton, a 501c(3) not-for-profit organization, to provide superior care and superior services to all patients with life-limiting illnesses, regardless of ability to pay. Programs supported by the Walk include:

Indigent Care – Hospice services are available to everyone in the greater Dayton community regardless of ability to pay.

Hospice House In-patient care options – In addition to serving patients in their homes, extended and assisted living facilities, Ohio’s Hospice of Dayton offers in-patient care at the Dayton Hospice House, providing intense care for patients experiencing medical situations or symptoms that cannot be managed in the home or facility setting.

Complementary, Focused & Palliative Care – Donor dollars enable patients to receive services such as highly specialized disease-specific treatment for hospice patients, and palliative care for patients with significant pain and symptom control issues. Massage, art, music and occupational therapies are also provided to assure an improved quality of life for patients.

Community wide Grief Support Services – We provide Grief Support Services at no cost, regardless of whether our hospice services have been used

Contact: Marsha Bernard, Ohio’s Hospice of Dayton Foundation, 937-258-5537, or email mbernard@hospiceofdayton.org or register here.

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7 Questions to Ask When Choosing a Hospice

Someday you or someone you love is likely to need hospice care. Before you arrive at that day as a crisis, it’s advisable to consider what is important in choosing who will provide your hospice care. You do have choices, and your choice is a critical factor in what services you receive. It affects not only services provided to the patient, but to those left behind. Below are important questions to ask when deciding who will provide your hospice care:

1. How long has the hospice been in operation?

According to a major consumer publication, hospices with over 20 years of service demonstrate stability and reliability of service.

2. Is the hospice Medicare-certified?

If the patient is a Medicare beneficiary and wants to use the hospice benefit, Medicare certification is required to enable costs to be covered.

3. Is the hospice accredited and state-licensed?

Hospices with Accreditation (JCAHO or CHAP) have been reviewed by an impartial organization and accreditation indicates they are recommended as having good standards of care.

4. Does the hospice offer services beyond those that are required by Medicare?

Many services are not required by Medicare, but may be highly valuable to patient care and comfort. Not all hospices permit patients to continue with radiation and/or chemotherapy for cancer. If a patient wants to continue to receive these therapies to reduce the size of a tumor and reduce pain, it’s important to know whether the hospice permits such therapies.  Some hospices would not be able to afford to do this but others could.

Similarly, some hospices provide an array of comfort therapies such as massage, music, art, pet and similar non-pharmaceutical interventions that can significantly improve patient quality of life. These alternative, holistic treatments are also worth considering as you weigh whether a hospice can meet patient needs.

5. Is inpatient hospice care available?

Patients receiving care in their own home may develop complicated symptoms and need to have inpatient care to control symptoms or pain. Caring for someone with a serious illness can be exhausting for caregivers, who sometimes fall ill themselves. Some hospices offer “respite” care, enabling the patient to be cared for in an inpatient environment to allow the caregiver a break of up to 5 days. Not every hospice can meet the need for inpatient care. It’s an important option for the comfort of the patient and the caregiver.

6. Are the doctors and nurses certified in palliative care?

Specialized study in palliative and hospice care is a demonstration of expertise in addressing the needs of hospice patients.

7. Does the hospice offer grief support services?

Grief support services are available at no cost from some hospices, and continue for up to a year following the loss of a loved one. An array of services tailored to address the needs of various family members is a good indication of strong bereavement support for family members left behind.

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What is “Normal” When Talking about Grief?

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Intense grief can be a new and frightening experience. Most people feel like strangers in unfamiliar, uncharted territory when experiencing grief for the first time. Fear of “going crazy” may prevent the griever from asking others if this experience of grief is normal.

The truth is that people grieve differently and one person’s experience may look very different from that of another.

Though everyone grieves in a unique way, certain thoughts, emotions and behaviors are almost universal to acute grief. Following are some of the most common:

  • Overwhelming sadness and tearfulness
  • Feelings of emptiness and loneliness
  • Difficulty with concentration and memory
  • Problems falling and/or staying asleep
  • Changes in appetite
  • Lack of energy and/or motivation
  • Decreased interest in things that formerly held your interest
  • Desire to withdraw socially from others
  • Restlessness and/or increased anxiety

Just knowing these grief symptoms are normal may be enough to calm your fears. However, if you still have questions about your grief journey, attending a support group may help. Listening to the stories of other grievers can assist in understanding your own grief symptoms. Grief support services are available at Ohio’s Hospice of Dayton through Pathways of Hope. Contact Pathways of Hope at 937-258-4991.

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Nursing Honor Guard Recognizes Caregiver for Career Contributions

20160819_152108_resizedAthleen Buhrman spent her nursing career providing care for residents of nursing facilities. Now she is a resident of Brookhaven Nursing and Rehabilitation Center. Honor and appreciation ceremonies were recently held to recognize Athene by the Nursing Honor Guard of Ohio’s Hospice of Dayton.

The Nursing Honor Guard is comprised of volunteer nurses who conduct a ceremony to honor patients who are nurses. Dressed in traditional and historical uniforms, the Honor Guard recognizes the nurse for her commitment to caring and providing compassion to patients.

“Nursing is giving of one’s self to enhance the lives of others,” Honor Guard member Joanne Dole said in recognizing Athleen. “After raising your children, you went to nursing school to acquire your LPN degree. You spent your nursing career working in nursing facilities lovingly caring for their residents. We want to formally acknowledge your many years of service as a nurse. Know that your accomplishments can only be measured in the lives you affected through dedication and perseverance. Thank you for all ou have given to the nursing profession.”

As a nurse, Athleen served patients at Brookhaven. Her son reports that when she moved into Brookhaven Athleen told the staff “I love it. I love my coworkers. This is the best place I ever worked.”

The Nursing Honor Guard presented Athleen with a pin and ceremony thanking her for her service. “It is our honor to express our respect for you as a nurse and our gratitude for the care that you have given.”

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Exchanging a Bear Hug

20160712_145601_resizedOhio’s Hospice of Dayton volunteer Judy Cole has touched the lives of hundreds of patient families over the years by creating handcrafted Memory Bears from the belongings of loved ones who have passed away. For the past two years, she has been making Memory Bears for another group – kids attending the grief program of Camp Pathways.

Judy was presented a framed thank you card signed by the Yellow Group campers who received her Memory Bears as souvenirs of Camp Pathways 2016 – along with a bear to call her own. We like to think of it as an exchange of bear hugs.
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How Hospice Helps Caregivers

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Hospice care is a philosophy that embraces family members, providing care for them along with hospice patients. We recognize that a life-limiting illness impacts everyone in the family circle. That’s why support for family caregivers is a major focus of our care and services.

We provide caregiver education and resources to help caregivers who are attending to patients in the home.

  • A nurse is available by phone 24/7 to answer questions.
  • Our extended hours staff is available to assist when needed.
  • Our trained volunteers support caregivers with errands, household chores and more. Volunteers are friendly visitors who listen and provide emotional support. They can also sit with a patient to give caregivers a short break from their duties.
  • Our Personal Care Specialists help with patient care, including feeding, bathing and personal grooming.
  • Our social workers help with emotional support for caregivers, and identify community resources that can help meet family needs.
  • Our chaplains support family members and patients, respecting individual faith traditions and keeping the family connected with their faith community.
  • Grief support is provided during patient care and in the months following the loss of a loved one.
  • Our Hospice House can provide more extended respite care for patients when caregivers need time to refresh or to attend to their own healthcare needs.

Our hospice team is attentive to the toll of caregiving and helps to make sure caregivers practice self-care. We can help develop strategies to assure caregivers:

  • Maintain a sense of wellbeing
  • Are getting the rest they need
  • Are addressing their own health concerns
  • Are getting a break when they need one

Most importantly, hospice care can help caregivers spend more quality time with their loved one by sharing and easing the load of responsibilities and demands caregivers face. Hospice care assures that caregivers are not alone in their commitment to love and care for a seriously ill family member.

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Social Workers Essential for Holistic Care

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In 2015, the social workers at Ohio’s Hospice of Dayton made 11,933 visits to patients and families. Social workers play a central role in holistic hospice care that addresses the physical, emotional, psychological and spiritual needs of patients facing the end-of-life and of those who love them and are facing loss.

Social workers focus on enhancing quality of life concerns for patients, families and caregivers. Among other things:

  • They help families connect with valuable community resources, including meals on wheels, in-home caregiver support and financial assistance.
  • They educate and inform family caregivers so they feel confident in caring for their loved one.
  • They help patient and family openly discuss their fears and concerns.
  • They help smooth the way when patients need to transition from one living environment to another.
  • They serve as advocates for patients, helping to identify and plan so patients can achieve their end-of-life goals.
  • They assist with completing advance directives, insurance claims and with funeral planning.
  • They help assure that children receive the services and support they need when facing the loss of a loved one.

Social workers are knowledgeable and comfortable working with ethnic, cultural, and economic diversity. They are familiar with and can help patients and families as they navigate complex health care systems.

While accomplishing all these things, social workers also provide emotional support and understanding as families face the difficult challenge of saying goodbye and learning to live with a new ‘normal’ after the loss of a loved one.

 

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PARO – A Positive Substitute for Pet Therapy

Some people complain that technology can be dehumanizing. Those people have not yet had the privilege of meeting PARO.

PARO is the nickname of an advanced interactive therapeutic robot that is being used at Ohio’s Hospice of Dayton with patients. Designed to look like an adorable baby harp seal and covered with synthetic fur, PARO is loaded with sensors in his long whiskers and entire body, enabling him to react to sound, light and touch. PARO blinks his eyes, moves his head, makes sounds and reacts as a real animal does when interacting with a human. PARO evokes the same emotional pleasure as a pet therapy animal but can serve patients in situations where real animals cannot.

Ohio’s Hospice of Dayton added two of the baby seal robots to the clinical team a few years ago as part of an innovative approach to patient care. For patients in settings that do not permit animals, such as nursing homes, PARO is a tool to encourage patient interaction.

Occupational Therapist Angelene Volpatti highlights how PARO affected one patient. “The patient was well-educated and confined to a wheelchair in a nursing home. Her children were literally all over the country – Alaska, Florida and Washington state. They spoke frequently by phone, but conversations were limited mostly to what the patient had to eat and how she was feeling.

During our first meeting I discovered the family were animal lovers and always had pets. Pet therapy was not offered by the nursing home, so we brought PARO to visit. The patient responded to PARO just like she would a pet, speaking to him and petting him, smiling and enjoying PARO’s reactions. She immediately relaxed and was less physically contracted. The conversations with her children became more rich, as she talked about PARO and together they reminisced about pets.”

Research with PARO has shown that patients experience a reduced heart rate, reduced blood pressure and are more calm after interacting with the robotic seal. They engage in more social interaction. Such positive outcomes, without the potential side-effects of pharmaceutical interventions, are convincing evidence of the value of robotic therapy.

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Compassionate Touch Contributes to Compassionate Care

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“Touch is the most prominent language in the caregiving relationship. Every act of caregiving involves touch. It is an action that validates life and gives hope to both the giver and the receiver. The healing of touch is reciprocal.”— Irene Smith

Among the complementary therapies provided to Ohio’s Hospice of Dayton patients is soothing, relaxing massage therapy. Licensed Massage Therapists Amy Fluty, Amy Green and Jo Monroe have concentrated on enhancing their massage skills to better benefit hospice patients. First they focused on earning certification as Compassionate Touch Practitioners. “In the fall of 2015 we took Compassionate Touch classes 1 and 2 to earn certification,” explains Amy Fluty. “We learned a hands-on approach for those in eldercare and hospice. Compassionate Touch combines focused touch, compassionate presence and sensitive massage and specialized communication skills. We were extremely fortunate that the owner of Compassionate Touch, Ann Caitlin, LMT was our instructor.”

In the spring of 2016 the trio traveled to San Francisco for Class 3: Compassionate Touch (Everflowing) Hospice certification. The program is taught by Irene Smith, a pioneer in hospice massage who worked with U.S. hospice innovator  Elizabeth Kubler-Ross at the beginnings of hospice care. “Irene Smith, CMP, is the founder of Everflowing technique,” Fluty explains. “Her educational outreach program is dedicated to teaching mindful touching as an integral component to end of life care.”

The massage practitioners learned the special tactile needs of dying persons and to present skills, techniques and personal practices for adapting touch and massage into a dying person’s care. “We learned ways to achieve more comfort at the bedside and clarify feelings concerning death and dying,” Fluty says. “Our role has the greatest value when we can provide a calm and compassionate treatment that reduces the need for medication, eases anxiety and adds to patient comfort.”

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