Begin with a circle…

The heartbreaking, yet gradual, devastation of the human mind and spirit inflicted by Alzheimer’s disease and other dementias can be assuaged by personal caregiver time and attention. At Walnut Village, a Front Porch Community in Anaheim, California, Summer House is a secure memory support neighborhood located within the continuing care retirement community. Summer House Director AnnaMarie Barba, LVN, has traveled a diverse career path that led her to long-term care. Her experiences as an acute psychiatric nurse and her passion for the elderly brought her career to its present focus on geriatrics with a mental health perspective. Her goal is to see that every resident is as comfortable and engaged as possible.

To turn back time and have residents with Alzheimer’s or other dementias enjoy the special moments of their lives, Barba has incorporated the “relearning” process into residents’ daily care plans. “Relearning is a one-on-one adventure. I’ve found it more beneficial to work with the individual in 15-minute sessions. Any longer, and you run the risk of residents restlessness or agitation,” Barba explains. To implement this concept, Barba and the other caregivers submerse themselves in their residents’ pasts and preferences to identify special memories or talents to channel into a daily activity.

“Summer House has 13 residents with Alzheimer’s living in a comfortable, homelike household, or neighborhood, environment,” says Barba. With a 24/7 caregiver staff, relearning can take place anytime, anywhere on the unit or in its protected patio. Barba has found that relearning isn’t nearly as frustrating for the resident as being confronted with learning a brand-new activity. Families are a key to this discovery process and are kept in the loop continually.

To illustrate how the relearning works, Barba provides a few examples. “If a resident had an artistic background, I’ll provide paper, paints and brushes. At times, they’ll just look at the materials and not know what to do. But then I’ll draw a circle on the paper and something ‘clicks’ and the resident will begin to paint within the circle,” she explains.

“A relearning activity can be something as simple as a resident tying his or her shoes,” she explains. Really knowing a resident can begin by asking simple questions: “When you tie your shoes, do you use the ‘mouse ears’ or wraparound technique?” “That’s simple stuff, but if you can get a resident to do it-that’s huge,” Barba admits. After a resident puts shoes on, he or she might understand that laces are the next step, even if he or she doesn’t exactly know how to tie them.

Sharing another experience, Barba recalls a lady with moderate dementia who once owned a swim school with her husband. “Three or four times a week, I or another staff member would take her to the pool for a bit of exercise. Someone would go into the pool with her for what I thought was just a safety measure. However, she immediately began to teach that person how to swim,” relates Barba. This example demonstrates clearly how past experiences occasionally take over. Barba explained that when in the water, the woman made the connection that she was a teacher.

TIPS FOR CARING FOR RESIDENTS WITH ALZHEIMER’S

• Keep safety in mind. Residents with Alzheimer’s live in constant confusion, which can lead to accidents. Perform safety checks with door alarms, ensure that windows have a screen, and lock up products that could be potentially dangerous. Rugs, outlets, curling irons, unsecured over-the-counter medicines, etc., can lead to injuries-and even fatalities.

• Communication is key. Learn how to therapeutically communicate with residents with Alzheimer’s. Keep in mind that they get frustrated when they are unable to describe their feelings. Aggressive behavior, wandering or shouting are indications that their needs aren’t being met. Understanding how they communicate is vital. Acknowledge nonverbal cues (grimacing, clenched hands rocking of the legs, etc.). Remember, they are adults; do not talk to them like children. Reduce background noise, speak clearly, and use words that are easily understood. Address residents by name unless directed otherwise by the resident.

• Provide daily activities. Continuous daily activities are a great way to keep Alzheimer’s residents engaged. Since the disease affects each person differently, it is important to be proactive and vary daily activities. By exploring a resident’s history and learning their interests, staff can tailor an activity plan for that resident, possibly involving the arts, music, tactile activities and reminiscing. Relearning-or refreshing one’s self-is also a great activity. Provide activities that enable residents to remember as far back as they can on how to do something. If a resident becomes agitated, engage him or her in a familiar activity, which can be calming. A brand-new, challenging activity could create stress.

• Monitor nutritional intake. Often a resident with Alzheimer’s suffers a breakdown in nutrition. As the disease progresses, chewing and swallowing can become more challenging and many individuals do not recognize hunger or thirst because that part of the brain is unable to communicate that need. Caregivers should monitor nutritional intake. A mixture of dark green, leafy vegetables; fiber; and protein are daily essentials.

• Encourage families to take advantage of support group services. Caring for someone with Alzheimer’s alone is not wise. If a support sytem (family, friends) does not exist, families should contact local Alzheimer’s support agencies to meet others in the same situation and access the resources needed to be a better family caregiver.

Relearning relies on acting on tidbits of information about the resident, shaping them into simple activities, spending one-on-one time with each person throughout the day, and even at nighttime when the activity can reduce restlessness, provide redirection and improve quality of life.

“Relearning isn’t a difficult challenge to incorporate in a memory support program,” says Barba. The investment is minimal and pays off with huge results. Creativity, patience and passion are the key ingredients in supporting and enhancing quality of life for residents with Alzheimer’s and other dementias.

Long-Term Living 2011 August;60(8):46-47

Sandra Hoban

Sandra Hoban was on I Advance Senior Care / Long-Term Living’s editorial staff for 17 years. She is one of the country’s longest-serving senior care journalists. Before joining Long-Term Living, she was a member of the promotions department at Advanstar Communications. In addition to her editorial experience, Sandi has served past roles in print and broadcast advertising as a traffic and talent coordinator.