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Archive | June, 2017

The World Shrinks for Those with Alzheimer’s & Dementia

Alzheimer’s Dementia and dementia in general are a series of continuing losses. When individuals suffering from dementia reach the point of no longer being able to be continent, speak meaningfully, and need assistance with all aspects of activities of daily living, they may be ready for hospice care. At this point, dementia is quite advanced and brain tissue loss is advancing. Specifically, the individual has lost the ability to speak more than a half dozen different words, is incontinent most of the time, and often cannot ambulate without some type of assistance. There are other issues as well.

Many individuals will be highly distractible during meals, cannot tolerate stimuli such as noise, feel fearful of caregivers trying to give personal care, fearful of leaving a familiar facility, and may have increasing agitation. Further, loss of recognition of loved ones is common as the disease progresses. However, other modes of communication are often effective such as massage, music, aromatherapy, or just calm presence.

Background concept wordcloud illustration of Alzheimer’s disease

What does this mean for the family and the individual’s caregivers?

Those who are fearful are the most likely to refuse baths and showers, or personal care even if they are soiled or wet. If the caregiver rushes to complete the care, agitation and aggression are likely to be a problem. The individual needs to be approached calmly, and assured they are safe. The going may be slow and only partial completion of a task may take place. For example, if the individual is taken for a shower, is the area pleasant and conducive to lowering anxiety? If not, try adding soothing music, seat the patient and begin a partial bath sitting on a chair or toilet. Then move to the more intimate areas. This may decrease the fearfulness. Always assure that the individual is safe with the caregiver.

As more and more of the brain is destroyed, the individual may have problems with recognizing and using utensils to eat. They may have problems with food pocketing, chewing, and swallowing. The dining room experience may be too stimulating. Activities that are over stimulating may be a problem for the individual who can no longer process this information. Care modifications here include using finger foods, softer foods, a quiet dining area, one-to-one feeding, and allowing adequate time for the eating experience. Thickener may be added to fluids if the individual is prone to choking on thin liquids.

Avoid the phrase “do you remember….”

The process of the disease is loss of more and more brain tissue. This affects time awake; movement, ability to sit up, and ability to speak and remember. Family and caregivers need to introduce themselves with each encounter. Avoid the phrase “do you remember….” At this point, meals may be missed due to inability to arouse the individual. More and more time may be spent in bed and now attention to skin is important. Seating adaptations may need to be put in place to support trunk and head. Music is often a way to reach those at this stage as well as aromatherapy. Keeping the environment calm and not over-stimulating enhances comfort. Individuals will eat less and less and finally stop eating as the brain is extensively damaged by the disease process.

How Hospice Helps the Dementia Patient

End-of-life care is aimed at these losses. The hospice team helps family and patients to adapt and understand these changes as the natural disease progresses. Feeding tubes are not recommended as patients will often develop aspiration pneumonias and may not be able to handle the formulas for tube feeding. The process of placing a tube can be overwhelming to a patient who cannot process the experience. Avoidance of hospitalization is important as the patient with dementia’s world grows smaller and smaller. Hospital visits remove the patient from familiar surrounds, noises, and caregivers and can be quite frightening to the individual who then may become aggressive or agitated. This increases suffering for the patient and family as well as bringing more harm than good. Good end-of-life care is aimed at meeting the patient where he/she is in the dementia process and adapting to that place and walking with patient and family for the journey to the end of life. Key to good end-of-life care is education of the disease process and translating that to care interventions for the individual to maintain a good quality of life until time of death.

Caring for a loved one with Alzheimer’s or Dementia? Join our Alzheimer’s Educational Series every last Tuesday of the month. Register and learn more by clicking here.

Find local activities and information from the Alzheimer’s Association Dayton Chapter by clicking here.

nancytrimble

About the Author:

Nancy Sterling Trimble, PhD, RN, CNP, has served eight years at Ohio’s Hospice of Dayton as a Clinical Team Liaison and the focused care specialist for geriatrics and neurology 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.

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Sunflower Award Presented to Cathy Gipson, STNA

Outstanding members of the Ohio’s Hospice staff are recognized every quarter with the Bouquet of Recognition Awards. Nursing Assistant Cathy Gipson, STNA, recently received the Sunflower Award. 

Care Specialist Cathy Gipson, STNA, shared her expertise with members of a family, giving them new solutions to help care for their mother.

“We, as caretaking family members, have learned techniques from her that have helped us better take care of my mother, in her 10th year of Alzheimer’s,” according to the Bouquet of Recognition submitted to honor Cathy. “Cathy is gentle and compassionate with exceptional care. She is so patient and has such a gentle way with my Mother that puts her at ease. Even if my mother is agitated, Cathy has a gentle way of comforting her. We have been acquainted with many nursing aides for the last several years and Cathy is by far at the very top of the list of compassionate and experienced caretakers.”

We are grateful to Cathy for her commitment to outstanding patient care and for being a member of our hospice team.

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July Training Slated for New Volunteers at Ohio’s Hospice of Dayton

Ohio’s Hospice of Dayton will hold a new volunteer orientation on July 12, 2017.

Hospice volunteers play a vital role with the interdisciplinary teams serving hospice patients and their families, providing a variety of services including respite care, shopping, delivery of medications and supplies, massage, beautician and barber services and gardening. Volunteers also serve as ambassadors sharing information about hospice care, as friendly visitors and in office support roles. Volunteer training acquaints new volunteers with information on

  • History and goals of end-of-life care
  • Ohio’s Hospice of Dayton history
  • Role of Volunteers and opportunities
  • Confidentiality, infection control, and safety
  • Boundaries
  • Effective listening
  • Loss and grief

Maureen Swarts, Volunteer Services Manager, welcomes volunteers from all backgrounds and of all ages. “Volunteers give from their hearts and enable us to touch the lives of patients and families with enhanced compassion and care. They are essential to our mission of providing superior care and superior services.”

For additional information please click here.

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Honoring Personal Care Specialists During Nursing Assistant’s Week

During Nursing Assistant’s Week, we honor our Personal Care Specialists who are central to our superior care and superior services.

Mary Murphy, President and Chief Nursing Officer of the Southwest Care Region of Ohio’s Hospice explains that Ohio’s Hospice changed the title of the Nursing Assistant to Personal Care Specialists because of the critical role they play in ensuring the best quality of life for our patients. “They provide the essential daily, hands-on care in homes, nursing homes and inpatient settings,” says Murphy. “As professionals the Personal Care Specialists are instrumental in promoting and safeguarding the physical, mental, emotional, social and spiritual well-being of the patients and their families. They are indeed specialists, attentive to patient changes and needs that enable every member of the clinical team to be more effective and responsive. Their contributions form the foundation of our quality care.”

In honoring them, Murphy said “Our Personal Care Specialists are trained professionals, who collaborate closely with other health care providers to deliver superior care and services and elevate the status of their profession.”

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Survivors Help Assure Superior Care and Superior Services

 

Ohio’s Hospice of Dayton is seeking insights into quality care from a unique perspective – from surviving family members of patients served.

A Family Advisory Committee comprised of family members who have lost loved ones in hospice care convenes monthly to consider processes, programs and provide feedback on ways the community-based, not-for-profit hospice can best serve patients and families.

Becky Graham lost her husband three years ago. She is grateful to be involved in the Advisory Committee and hopes her suggestions will help other families who use hospice services when a loved

one is diagnosed with a life-limiting illness.

After both of his parents received hospice care at home in the past two years, James Webster felt he had the experience to offer valuable insights into the services and support provided.

Kathy Smith’s father received hospice care in an assisted living environment, while her aunt and mother were cared for in the home. She is appreciative that Ohio’s Hospice of Dayton rectified some issues she experienced with care. She believes her participation will help assure superior care and superior services for other families.

Norma Colussi’s mother was a nursing home resident when she became a hospice patient last year, and Paul Tudor’s wife received home care before she died a year ago. Both Norma and Paul embraced the opportunity to serve with the Advisory Committee as an opportunity to help hospice achieve ever-higher standards of care.

Patient Experience Advocate Jessica Conger says the Committee reflects a good cross-section of those who have experience with hospice care. ‘They come from different communities. Their loved ones received care in different environments. What they have in common is a loss experience that deeply impacted their lives and a desire to ensure high quality hospice care is available to others,” says Conger. “Every month we share information with them and receive feedback about educational and informational materials, communications processes, complementary therapies and other topics. The insights they offer help us refine and improve the materials we develop, our options for care and interactions with families. “

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State Officials Visit American Pride Veteran Memorial on Ohio’s Hospice of Dayton Campus

Representatives of Governor John Kasich’s office recently visited the American Pride Veteran Memorial at Ohio’s Hospice of Dayton.  Sandra Brasington, Western Ohio Regional Liaison to Governor Kasich,  was joined by Chip Tansill, Director, Ohio Department of Veterans Services and Daniel Semsel, Regional Veteran Workforce Consultant, in a tour of the Memorial and discussion of American Pride services for Veterans at Ohio’s Hospice organizations. This marked the first official visit by state officials to the Memorial.

The American Pride Memorial is a moving commemoration that includes illustrated panels dedicated to American military campaigns ranging from the Revolutionary War to the War Against Terror. Each branch of the service is represented with a flag, and the American flag flies proudly at the center of the display. The memorial also includes a computer kiosk that features pictures and stories about veterans.

By visiting www.ohioshospice.org/american-pride, community members can enter their own stories or stories about loved ones, and upload photos of Veterans, honoring their lives and service. All stories submitted will be accessible online and on display at the American Pride Veteran Memorial. The stories are searchable by name. Any Veteran from the Greater Dayton area is eligible to be included.

 

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Carnation Kudos to Heather Brandenburg

Outstanding members of the Ohio’s Hospice staff are recognized every quarter with the Bouquet of Recognition Awards. Unit Coordinator Heather Brandenburg recently received the Carnation Award. 

Heather Brandenburg works at both Ohio’s Hospice of Dayton and Ohio’s Hospice of Butler & Warren Counties as a Unit Coordinator. Brandenburg was honored by a colleague for being an outstanding team player. Nominated by a co-worker who is grateful for all she does to support the hospice mission, Heather’s nomination cited just one example of her willingness to go above and beyond. “While Heather was doing her job as a Unit Coordinator, she took it upon herself to clean a housekeeping cart. She is very helpful and I really appreciate all that she does!”

We also appreciate Heather and her commitment to superior services and collaboration to assure superior care. Thanks Heather!

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Volunteer Orientation Slated at Ohio’s Hospice of Dayton

Ohio’s Hospice of Dayton will hold a new volunteer orientation on July 12, 2017.

Hospice volunteers play a vital role with the interdisciplinary teams serving hospice patients and their families, providing a variety of services including respite care, shopping, delivery of medications and supplies, massage, beautician and barber services and gardening. Volunteers also serve as ambassadors sharing information about hospice care, as friendly visitors, pet assisted therapists and in office support roles

 

 

 


Volunteer training acquaints new volunteers with information on

  • History and goals of end-of-life care
  • Ohio’s Hospice of Dayton history
  • Role of Volunteers and opportunities
  • Confidentiality, infection control, and safety
  • Boundaries
  • Effective listening
  • Loss and grief

 

Maureen Swarts, Volunteer Services Manager, welcomes volunteers from all backgrounds and of all ages. “Volunteers give from their hearts and enable us to touch the lives of patients and families with enhanced compassion and care. They are essential to our mission of providing superior care and superior services.”

For additional information click here: www.hospiceofdayton.org/volunteers/

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“There Was No Book” – A Caregiver’s Journey

Her son says her strength is central to understanding Annie Smith’s character.   

“No matter what you do,” Lester Smith says, “when it comes to your parents, you never think you have done enough.”

 Lester has been relentless in making sure his mother gets what she needs.

 Annie was born in Georgia and moved to Dayton when she was a toddler. She and two sisters grew up in Dayton.

Lester said his mother’s health started slipping shortly after she retired from TRW Globe Motors where she worked in accounting for over forty years.  “She didn’t really get to enjoy her retirement,” Lester says. “She started having a variety of symptoms and we saw doctors all over Dayton and could not find out what was wrong.  Then we went to the Cleveland Clinic where they determined she had hydrocephalus.” No one knows what causes hydrocephalus, sometimes called “water on the brain.” Symptoms can be similar to Alzheimer’s disease, Parkinson’s disease and other illnesses. Once they had a diagnosis and began treatment, Lester said his mother improved.

Lester moved away from Dayton in 2007 and his mother relocated to New Orleans two years ago to live with her sister, Vanessa. Lester was able to visit his mom frequently in New Orleans, and over time became worried that she was declining. “I am so grateful to my Aunt. She gave of herself to allow me an opportunity to chase my dream. But there is no way my Aunt and I could provide all that my mother needed.  I could not let her die alone.”

When his mother was hospitalized in New Orleans, Lester heard the doctors say there was nothing more they could do, and it brought him to tears. That’s when he decided he had to get her back to Dayton. This was to be more of a challenge than he anticipated.

Caregivers in New Orleans felt his mother was not up to a trip of nearly over 12 hours and nearly 900 miles. But Lester insisted. “This is what my mother needs.”

Annie’s foresight made Lester’s decision easier. She had invested in long-term care insurance that enabled excellent options for her care. Lester found an ambulance service that could provide transportation. He learned of Grace Brethren Village through a friend from high school who works in healthcare. When he visited Grace Brethren he found the staff to be open and nice. He liked the fact it was small and felt it would be a good place for his mother. The ambulance trip was difficult, but his mom “was a trooper,” says Lester. He was so happy to get her home in December of 2016 just before Christmas.

With care at Grace Brethren and support from Ohio’s Hospice of Dayton, Annie’s condition has improved. He is grateful that her insurance enables her care to be covered, but is concerned about what happens if the insurance is exhausted. “It’s a real concern for anyone in this position,” Lester says.

Lester visits every day, sometimes not knowing what to say to his mother, not sure what she understands. He wishes for the times they used to share, remembering when they would travel together, “She loved the song HAPPY. I would play The Temptations for her and we’d both sing along.”

He has found a new community of friends among others who share the same responsibilities for loved ones whose health is failing. “All of my friends are going through the same thing,” says Lester. “I try to support them because I know caregiving can be a lonely job.” He can share what he has learned about dementia and its symptoms, and what steps legally and financially can be taken to ensure the best care for someone you love.

“There was no book for me to learn this from,” Lester says. “If my journey can be of help to others I am happy to share it.”

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Chaplain Tom Myers Earns Tulip Award

Outstanding members of the Ohio’s Hospice staff are recognized every quarter with the Bouquet of Recognition Awards. Chaplain Tom Myers is one of our newest recipients of the Tulip Award.

Tom Myers was presented with the Tulip Award. His nomination noted that Tom deserves this award for many reasons, but cites one in particular. “Recently, we had a patient who expressed spiritual concern to her Care Manager. She confessed feeling she was not worthy of God’s love. Tom visited with her several times but the patient remained spiritually distraught. Over time it was discovered that the patient had been baptized, but never “fully immersed”, which was extremely important to her. The Care Manager collaborated with Chaplain Tom who offered to re-baptize the patient. Because the facility where the patient resided was unable to accommodate a full-immersion experience, it was decided that they would use the local YMCA to provide a full immersion baptism for this patient. Everything was arranged and Tom was able to baptize this patient with full immersion. He not only baptized her, but brought himself an extra set of clothes and got into the pool with her in order to provide the baptism that she desired. Following her full immersion baptism, the patient was truly elated with a huge smile. Thereafter she declined quickly but remained mentally and spiritually at ease. Her family was very grateful to Tom for the extraordinary gift he gave her.”

Thank you, Tom,  not only for the gift that you gave this patient and her family, but everything that you do each day!

 

 

 

 

 

 

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