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Caregiving Gems
Teepa Snow, MS, OTR/L, FAOTA
1© 2010 Teepa Snow. All rights reserved. Use only with permission. Presentation at Home Instead Senior Care of Sonoma County sponsored Dementia and Alzheimer’s event, March 22, 2010, at the Scottish Rite Masonic Center in Santa Rosa, CA.
Beliefs
• People with Dementia are Doing the BEST they can
• We must learn to DANCE with our partner
• We are a KEY to make life WORTH living• What we choose to do MATTERS• We can change the WORLD with help• We must be willing to CHANGE
ourselves• We must be willing to STOP & BACK OFF
2© 2010 Teepa Snow. All rights reserved. Use only with permission. Handout at Home Instead Senior Care of Sonoma County sponsored Dementia and Alzheimer’s event, March 22, 2010, at the Scottish Rite Masonic Center in Santa Rosa, CA.
How Can We Become Better Care Partners?
Let go of the past to be in the MOMENTGo with their FLOW
Be willing to try something newBe willing to learn something differentBe willing to see it through another’s
eyesBe willing to fail & try again 3
Caring for Someone with Dementia…
What Works BEST?
4
The Basics for Success…
• Be a Detective NOT a Judge• Look, Listen, Offer, Think… • Use Your Approach as a Screening
Tool• Always use this sequence for CUES– Visual - Show– Verbal - Tell– Physical – Touch
• Match your help to remaining abilities 5
Positron Emission Tomography (PET) Alzheimer’s Disease vs. Normal Brains
G. Small, UCLA School of Medicine.
Normal Early Alzheimer’sAlzheimer’s
Late Alzheimer’s Child
6
Normal Brain Alzheimers Brain7
Learning & Memory Center
HippocampusBIG CHANGE
8
Understanding Language – BIG CHANGE 9
Hearing Sound – Not Changed 10
Sensory StripMotor Strip
White Matter Connections
BIG CHANGES
Formal Speech & Language
CenterHUGE CHANGES
Automatic SpeechRhythm – Music
ExpletivesPRESERVED
11
Executive Control Center
Emotions Behavior JudgmentReasoning
12
Vision Center – BIG CHANGES13
Some Basic Skills
• Positive Physical Approach• Supportive Communication• Consistent & Skill Sensitive Cues– Visual, verbal, physical
• Hand Under Hand – for connection– for assistance
• Open and Willing Heart, Head & Hands
14
First Connect – Then Do
• 1st – Visually• 2nd – Verbally• 3rd – Physically
• 4th – Emotionally• 5th – Spiritually - Individually
15
To Connect
Start with the Positive Physical Approach
16
Your Approach
• Use a consistent positive physical approach– pause at edge of public space– gesture & greet by name– offer your hand & make eye contact– approach slowly within visual range– shake hands & maintain hand-under-
hand–move to the side– get to eye level & respect personal
space– wait for acknowledgement
17
A Positive Approach(To the Tune of Amazing Grace)
Come from the frontGo slow
Get to the side,Get low
Offer your handCall out the name then WAIT…If you will try, then you will see
How different life can be.For those you’re caring for!
18
Supportive Communication
• Make a connection– Offer your name – ”I’m (NAME) ”… “and
you are…”– Offer a shared background – “I’m from
(place) …and you’re from…”– Offer a positive personal comment –
“You look great in that ….” or “I love that color on you…”
19
Support to ‘Get it GOING!’
• Give SIMPLE & Short Info• Offer concrete CHOICES• Ask for HELP• Ask the person to TRY• Break the TASK DOWN to single steps
at a time
20
Give SIMPLE INFO
• USE VISUAL combined VERBAL (gesture/point)– “It’s about time for… “– “Let’s go this way…”– “Here are your socks…”
• DON’T ask questions you DON’T want to hear the answer to…
• Acknowledge the response/reaction to your info…
• LIMIT your words – Keep it SIMPLE• WAIT!!!!
21
Now for the GEMS…
DiamondsEmeraldsAmbersRubiesPearls
22
Diamonds
Still ClearSharp - Can Cut
Hard - Rigid - InflexibleMany Facets
Can Really Shine
23
Diamonds• Know Who’s in Charge – Respect
Authority• Can do OLD habits & routines • Become more territorial OR less aware
of boundaries• Like the familiar – FIGHT CHANGE• Can pull it together to make you look
bad• Know how to push your buttons• Want to keep roles the same• Tell the same stories ask the same ?s
24
Emeralds
Changing colorNot as Clear or Sharp - Vague
Good to Go – Need to ‘DO’Flaws are Hidden
Time Traveling
25
Emeralds• Think they are FINE• Get emotional quickly• Make mistakes – don’t realize it• Do over and over OR Skip completely• Ask – “What? Where? When?”• Like choices• Get lost in past life, past places, past
roles• Need help, DON’T know it or like it!
26
Ambers
Amber AlertCaution!
Caught in a momentAll about Sensation
Explorers
27
Ambers
• Get into stuff• Fiddle, mess, touch, taste, dig, tear,
fold…..• Move toward action and noise OR
away• Sensory tolerance• Sensory need• Mouth, fingers, feet, genitalia• Can’t figure it out… react physically
28
Rubies
Hidden DepthsRed Light on Fine Motor
Comprehension & Speech Halt
Coordination FaltersWake-Sleep Patterns are
Gone
29
Rubies
• Fine motor stops• Hard to stop and hard to get going• Limited visual awareness• One direction – forward only• Can’t figure out details – but do copy
us• SLOW to change• On the go or full stop• Use music and rhythm 30
Pearls
Hidden in a ShellStill & QuietEasily Lost
Beautiful - LayeredUnable to Move – Hard to ConnectPrimitive Reflexes on the Outside
31
Pearls
• Can’t move• Not aware of the world around – most
of the time• Problems swallowing• Hard to get connected• How we touch and help matters• SLOW!!!!• Varies a LOT
32© 2010 Teepa Snow. All rights reserved. Use only with permission. Presentation at Home Instead Senior Care of Sonoma County sponsored Dementia and Alzheimer’s event, March 22, 2010, at the Scottish Rite Masonic Center in Santa Rosa, CA.