Tuesday, April 29, 2014

A Free Class at the Alzheimer's Association

Good day all.  It's been a very busy time and my posts have dropped off.  I'll be posting again in the next day or two but here is a quick notice about a free class at the Alzheimer's Association in San Diego.

The Alzheimer's Association is offering a class on "The Basics: An Orientation to Dementia and Memory Loss"

This is a FREE orientation class designed specifically for families and care partners who are new to living with and caring for someone with memory loss, dementia or Alzheimer’s.

Following a 60 minute presentation, this class offers attendees an opportunity to:
- Ask questions of professionals
- Get connected to community resources
- Begin planning for the future

Next Class: Thursday, May 1 • 10:00AM - 11:30AM
Alzheimer's Association San Diego/Imperial Chapter
6632 Convoy Court, San Diego, CA 92111

Register online at: REGISTER 

If you are interested in classes but do not live in San Diego, see what your local Alzheimer's Association office has to offer.  There are also many wonderful support groups in every community so please do avail yourself of these resources if you have a loved one living with dementia.  They can be a lifesaver.

Don't hesitate to get in touch if you have any questions.  Visit us online at www.altagolden.com or call 858-779-9254 to talk with us about In-Home support, Day Programs, or even if you just have a question. We're always here.

Take good care and have a wonderful day!  Laura Barish

Sunday, April 20, 2014

The Importance of Touch

Good morning all.  I've been off line for a few days on vacation in Florida.  I'm posting this blog from the Tampa airport, preparing to come home.  Today's topic is about the importance of touch.

As a caregiver, one of the things that I have observed is that as we age the amount of physical touch in our lives seems to lessen. One of my favorite sights is to see an elderly couple walking down the street holding hands. Unfortunately it is not something I see with any frequency. The issue of lessening touch is compounded when a spouse dies, leaving behind a grieving husband or wife.  We have several clients who are or were married for 60 years or more.  The hole left behind by the loved one's absence is profound.

What is also lost is consistent touch. Sometimes that touch is as simple as a hug or kiss goodnight, intertwining of fingers while sitting together on the sofa, or the comforting feel of the weight of another person beside you in bed at night.  Many times the surviving spouse doesn't feel comfortable inviting another partner into their life--either the grief is too great, there is a sense of betrayal if they have another companion, or they simply choose not to.  This lack of partnership also frequently means a lack of touch.

A few years ago a friend of mine lost his wife of 60+ years.  She had been ill for several years and he had become a full time caregiver--especially in the last year of her life.  About a year later I got to meet his new companion and watch them holding hands in the back seat of the car.  I was so happy to see that he was allowing love and touch back in his life.

In working with clients, I personally feel that they are happier when they have a peaceful, loving, touch-filled life.  I've started to deliberately add more touch into the lives of the clients I work with and I encourage appropriate touch by our other caregivers as well.  Many times this is just a hug or rub on the back; but that's all that's needed.  Touch is healing and grounding.  It lets people know they are connected and cared about.

One of our clients is a 90 year old woman whose husband died many years ago.  She is very disabled with arthritis and other impairments and she has gained a reputation of being impossible to work with (we inherited her from another agency). We have 3 wonderful caregivers supporting her 7 days a week but I end up going in when one of them is not able to make a shift.  What I have learned about her is that she has not had loving care in a long time. To a large extent she has pushed this away but I'm chipping away at her.  This started with direct eye contact and, as she has gained trust with me, I have added in rubbing her back and massaging her legs to help with ongoing leg pain.

I add appropriate touch in whenever I can.  Many times it is just a touch on the shoulder or back as I am passing by on my way to one chore or another.  The change when she is with me has been enormous.

On my first day in working with this client she insisted that I could not wear my boots In her house. I took them off and, after being yelled at for the next 15 minutes I told her that she needed to understand that this yelling was not acceptable.  There was a grudging peace for the next 6+ hours of the shift. Each visit became a little easier but the real changes came when I started using touch to calm her when she began to yell.  Then I started thanking her for a good day together and, it truly was!  On Tuesday I went in to introduce a new caregiver and she was positively peaceful. 

My mother was quite ill last year and one of the things she asked for was to be touched. I had all of her caregivers rub her arms and legs and this care and attention made a huge difference and helped in her recovery.  I have even noticed that I am much more peaceful when I am in a relationship with consistent touch.

What is it about touch that is so important?  For one thing, it raises endorphins levels in the brain, which gives a greater sense of well being.  Touch also causes our brains to release oxytocin and serotonin, which enhance our sense of comfort.

As a caregiver I have to make sure that the touch I use is appropriate--especially when working with a client of the opposite sex: but touch is a great tool and an important part of caregiving.  If you are new to caregiving and want to know what is appropriate, think about the level of touch you would use with your own parent or grandparent and never exceed that level.

That's it for now.  My plane is about to take off so it's time for me to sign off.  More tomorrow.  Have a wonderful Easter Sunday!  Many blessings to you.


Monday, April 14, 2014

Protecting your Parent or Loved One - Telephone Vulnerability

Happy Monday to all.  The past week has been very busy and I haven't had the opportunity to write as much as I would have liked.  I'm taking a bit of a divergence from the series on dementia support because I think it's important to get the word out.  Tomorrow I'm going to talk about Validation and Redirection but tonight let's discuss protecting your loved one from phone scams.

Issues with phone scams have become an increasing problem for our older adults.  This ranges from aggressive and unscrupulous sales practices to coercive and fraudulent calls that defraud older adults of money.  I discussed one of these in a blog posted in March where someone claiming to be a grandchild begs for money to get out of trouble. The money is sent OCONUS via Western Union and all the while the grandchild is safe at home.  Please warn your loved ones--these calls are ALWAYS bogus.

Another issue is related to aggressive sales people targeting older adults and calling up with a "great deal", which may include buying memberships to travel agencies, discount coupons, or anything else they think they can get away with.  They will call again and again in violation of the Do Not Call list.  The tactics are unscrupulous and ruthless.

The first question you may ask is, "How do they know how to target my mom or dad?".  It's actually quite easy.  Anyone can buy a mailing list that includes the individual's name, address, phone number, and age.  I purchased one of these lists in the past so that I could send out a mailing to older adults in San Diego to let them know that we are here.  Unfortunately, there are few restrictions on who may obtain a list and how it may be used.  While the purchaser may be required to sign a document that the list will only be used in certain ways, someone who is looking to defraud an older adult is going to ignore these restrictions.

So, what can you do to protect your loved one?  There are a number of things to try.

1. If the phone is a published number, you can try changing the number and making it an unpublished listing.  This will help but as soon as you sign up for anything that requires that you give a phone number, you are at risk of this new number getting back out in the public domain.

2. Sign up with a service like Nomorobo (www.nomorobo.com).  The acronym stands for No More Robocalls.  This type of service allows you to block the sales calls while still allowing calls in from doctors, family members, and friends.

3.  A third option is to have all incoming calls forwarded to a cell phone that is not in control of an older adult who may have cognitive impairment.  This will allow your loved one to still make outgoing calls without being targeted by unscrupulous people.

Education is critical but, when all else fails there are things you can do to protect yourself and your loved one. If you find yourself target you also have the ability to call the police or Adult Protective Services.

I hope you have a wonderful start to the week.  Many blessings to you!

Laura Barish

Saturday, April 12, 2014

Survey to help the lives of people with dementia

I received this request from Jytte Lokvig of The Alzheimer's Creativity Project. Please consider taking a few minutes to help by doing the survey--link below.

CCAL-Advancing Person-Centered Living is working with the University of Buffalo-Institute for Person-Centered Care on a research project funded by the Retirement Research Foundation.  One of the aims of the study is to gather feedback from a geographically diverse group of people about what they feel is important and/or needed concerning dementia care in America.
The aim of the survey is to develop agreement on priorities for dementia care, research, education, and funding from the perspectives of people living with dementia, family care partners, and advocates for people with dementia. As someone with knowledge about dementia, we invite you to take part in this study.  It is easy to participate and will not involve much of your time.
There will be at least one more round of the survey as we build agreement. We hope that you will participate in the multiple rounds. We will ask you for your email at the end of the survey so we can send the next survey to you. Your responses and any other information you provide will not be linked to your email. The research has been approved by the Internal Review Board at the University of Buffalo.
A written survey and a pre-addressed, postage-paid envelop can be mailed to you if you would prefer this method instead of completing the survey online.  Please call the number below and leave your name and address.
We will combine the views of everyone who takes part in the survey.  We will use the information to help inform federal policymakers about what people feel is important and needed concerning dementia care to better inform and shape their priorities.
Your response by April 25, 2014 would be appreciated.
To take part online click on this link:https://www.surveymonkey.com/s/CoalesceandConnect
To request a paper version contact:
Dr. Davina Porock
Director, UB Institute for Person-Centered Care
Or email ipcc@buffalo.edu.
Thank you for helping us make your voice be heard!
Karen Love, Founder, CCAL-Advancing Person-Centered Living
Davina Porock, PhD, Director UB Institute for Person-Centered Care


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Tuesday, April 8, 2014

The Journey of Dementia

Good day all.  As you can see from the title of this blog entry, like all things in life the experience of dementia is a journey--for both the individual and their loved ones.  We learn and grow from journeys, we experience joy, and we grieve.  Sometimes the journey is wonderful and other times it feels like an absolute nightmare.

Living with dementia can be heartbreaking but it can also give you the opportunity to provide your loved one with the greatest gift you have--your time and love.  Patience is key.  Second is an attitude of non-resistance. 

Let's first talk about love.  Today in the Memory Center, AltaGolden's Adult Day Program, one of our clients said he had a confession to make.  He told everyone that he thought his wife was going to leave him because he has dementia.  His wife reassures him daily of her love and devotion, but I think that this fear is common when one spouse has such a significant and degenerative condition.  We have another client who has expressed similar concerns.  These feelings of insecurity permeate many aspects of the life experience when you have no control over your ability to remember events, people, or how to do things.  Even the ability to communicate, remember words, and form sentences becomes a challenge.  Add to that our natural tendency to want to "assist" by completing someone's sentence for them when they are having trouble finding the right words to express their intent.

One of our in-home clients has mild cognitive impairment and it often takes her several seconds to pull out the right word.  Several seconds doesn't sound like much but try counting to yourself, on-thousand, two-onethousand, three-onethousand, and so on up to ten.  It's actually a fair amount of time, but it sometimes takes that long for this woman to pull the words out of her head.  And she hates it if I try to help her with the word.  I have learned to just be still--eventually the words come.

This idea of stillness can be very important.  Today we had a client that became disoriented as to his location and wanted to go home.  Nothing we did could console or convince him to stay so Nora walked outside with him and during that walk she validated his feelings and gave him the space to become peaceful again.  By the time his ride came to take him home he and Nora were standing arms around each other like old buddies and he was peaceful again.  Nora was very non-resistant and accepting and this allowed our client to also be non-resistant and peaceful.  We have learned that the more you push against the desires of someone with dementia the more they will push back.  Being gentle, consoling, accepting, validating, and peaceful is important--even tho, at times, it is very difficult.

There are times when I am working with someone and I will just be in prayer.  There is one particular prayer that I especially like--partly because it reminds me why I am here and why I have chosen to be a caregiver.

The Prayer of St Francis
Blessed spirit (my personal beginning)
Make me an instrument of thy peace
Where there is hatred let me sow love
Where there is injury, pardon
Where there is doubt, faith
Where there is despair, hope
Where there is darkness, light
Where there is sadness, joy

Oh divine master
Grant that I may not so much seek
To be consoled as to console
To be understood as to understand
To be loved as to love
For it is in giving that we receive
It is in pardoning that we are pardoned
And it is in dying that we are born into eternal light

This prayer serves as a reminder that I am here to serve and sometimes that service lies in stillness.  Disorientation, agitation, anger, and despair are all common emotions we see in someone with dementia and these same emotions end up being mirrored in the family and caregivers.  It can be very difficult to remain peaceful when the world around you feels like it is falling apart.

I've mentioned this in the past but it bears repeating.  The most important thing the family caregiver can do for themselves is to get a respite break.  Have another family member come in to take care of mom or dad/husband or wife, hire a caregiver, send your loved one to a day program, have them go for a few days to a residential community.  Whatever you do, make sure that you are doing what is needed to regroup, allow yourself to be peaceful, and rejuvenate.  We've had spouses come to the support group and they have been very reticent about turning their partner over to a caregiver.  They are exhausted--emotionally and physically--and increasingly isolated from friends and activities due to the demands of their caregiving responsibilities.  I tell each of them the same thing.  You must take care of yourself! 

Stress is incredibly debilitating and can cause myriad health and emotional problems.  It can also make you quicker to anger and not allow you the peace needed to face each new day.  Give yourself permission to rest and have a break.  Give yourself permission to go out with your friends.  Early in the dementia progression your loved one will be able to participate in outings with your friends.  As time goes on this becomes increasingly difficult and eventually your loved one will self-isolate or your friends will distance themselves.  Have the honest discussion with your friens that you really need them in your life but also remember that you need to have what I call your "adult time" with them.  This is not a betrayal of your love or devotion to your partner or parent--it is simply self-preservation.  You must survive this experience and you want to survive it in the best physical and emotional state possible.

So please, take care of yourself and let that be OK.

And don't forget to make cookies--I've even give you the recipe!  I had to end on a lighter note--it is my nature.  Be well, friends.  We're all in this together.  One planet, many people, no islands.

Wednesday, April 9th is AltaGolden's monthly dementia support group at the Memory Center from 5-7pm.  Let us know if you'd like to come.  If you can't make it, we're here every month.  I'm also working on getting support groups going at some of the local churches and synagogues.  Let me know if you would like to to start a group in your community.

That's it for now.  Be well and many blessings to you always.  Laura Barish


Friday, April 4, 2014

Great Recipe - Wheat Free Peanut Butter Granola Cookies

Happy Friday all.  I know I promised to continue our blog on dementia support but sometimes comfort food must take precedence.  I've been trying to minimize/eliminate wheat in my diet but I am a carbo-queen and must have cookies.  To that end, I've been working on creating a peanut butter cookie recipe that would make my heart sing.  Last night I think I hit the mark. 

First you'll need to make the granola.  Take rolled oats and add in whatever nuts, coconut, cinnamon, and seeds you would like.  Add in real maple syrup and mix until fully coated.  Put onto a lightly oiled cookie sheet with sides and bake at 350 for about a half hour, stirring every 10 minutes until the mixture is golden brown.  Take out of the oven and let cool.  Once it's cool you can add in raisins, dates, cranberries, or whatever other dried fruit you like (don't bake the fruit as it will get dry and hard).  You may not want to put the dried fruit into the cookies however.

This granola is great in the cookies, on yogurt, for cereal, on ice cream, etc.

Now for the cookies.  First the ingredients:

·      ½ cup butter
·      1 cup peanut butter
·      1 cup sugar (You may also substitute agave. I use organic sugar.)
·      2 cups almond flour (Cheapest from Trader Joe’s)
·      1.5 cups granola (oats/maple syrup/peanuts - you can also add walnuts, pecans, coconut, and whatever else prior to baking the granola. Add dried fruit after baking.)
·      2 eggs
·      1 tsp salt (optional)
·      1/2 tsp+ baking soda
·      1 tsp vanilla (optional)
·      ½ cup of chocolate chips (or more if you like)

Cream soft butter and peanut butter together (easiest if butter is already soft). Mix in eggs and sugar and then add the rest of the ingredients. Use a fork to flatten the cookie -- dip the tines of the fork in powdered sugar to keep the fork from sticking to the cookie.  Bake at 350 for 12-14 minutes or until golden brown.

These are very crispy and wonderful.  Enjoy!

I'll continue the dementia series tomorrow but don't be surprised if I periodically become overcome by the need to enter comfortfoodland.  If you have a great wheat-free or paleo recipe you'd like to share please send it along.  I'll be adding a recipe page to our website that will have all of these.

Have a great start to the weekend!  Laura Barish   www.altagolden.com

Caregiving for Someone with Dementia

Greetings.  I hope it's been a wonderful week for you.  Things have been pretty busy on this end but good.  Today I want to talk about what it means to be a caregiver to someone with dementia.  On the next blog I'll share direct experiences.

Being a caregiver to someone with dementia is one of the most challenging things you will ever do.  It can also be one of the most rewarding while being simultaneously heartbreaking.  You watch while your loved one slowly loses who they are.  Your husband, wife, sister, brother, mother, or father are still there but no longer have the ability to fill the role in your life they have played for many years.

Each person experiences something slightly different although there is a lot of commonality.  What is common is that the individual with dementia develops agitation and frequently becomes depressed and disoriented.  They may not know where they are and eventually they will not know who you are.

Incontinence is common--sometimes because they forget they need to go to the bathroom and sometimes because they don't understand what the feeling of urinary or bowel pressure means. I'm sure there are other reasons as well but these are what I've experienced.

Sundowning is prevalent and this causes agitation and disorientation.  I've known some people to use full spectrum light bathing and they have said that this helps.

Simple tasks become increasingly difficult and the caregiver will need to assist with everything from dressing and bathing to cooking and eventually even feeding their loved one.

As the individual with dementia declines the stress on the caregiver increases as they take on more and more personal management of the loved one.  What is also very common if the husband or wife is the caregiver is that they will feel it is their job to be there 100% of the time for their loved one and their stress steadily rises. 

When people come to our support group we frequently tell them that it is critical for the caregiver to take care of the caregiver. They spend so much time as a caregiver that they forget to take care of themselves.  In order for for the caregiver to be a true support they must take care of their own needs and this includes general respite, rest, adult time with friends, and treating themselves regularly to something special such as a massage, manicure, or movie.  Some caregivers will feel that this is selfish.  It is not selfish and giving yourself a break is critical.  When we talk about respite care, this is all about the caregiver having a respite from the 24-hour stress of living with this condition.  Some ways you can give yourself respite include:
  1. Hiring a caregiver to come over a few hours a week so you can go out.
  2. Sending your loved one to an Adult Day Program like AltaGolden's.
  3. Sending your loved one for a few days to a residential facility that offers short term respite. 
 Respite is a critical part of being a caregiver.  It's one of the reason that we will have a minimum of two caregiver assigned to a client with dementia.  Even professional caregivers get burned out when working full time with a dementia client.

So, what are some of the tips and tricks.  First, be non-resistant.  It is very common for someone with dementia to make an assertion about something that is not logical or not factual or they will want to do something that is not sensible or safe.  Our natural reaction is to try to convince them that it is a bad idea and they need to do something different.  You will very quickly find that this won't work.  You will hit a brick wall as your loved one digs their heels in. 

What do you do?  Validate and redirect.  Validate their feelings and redirect their attention to another topic.  The more you try to force or convince the more resistance you will encounter and the more agitated both you and your loved one will become.  If you validate their feelings and then direct their attention to another topic you will have an easier time of things.

Another trick I have used is to ascertain how long the individual will remember a conversation and, if they are resistant to something I will wait a few minutes and then try something else.  We had a client that wanted to move her mother up north to a memory care community closer to home.  She called me up to discuss how I felt she should tell her mother about the change.  We discussed several options but I also told her that her mother's loop was about 5 minutes so if one approach didn't work she could just wait 5 minutes and try another.  When she found the one that created the least amount of anxiety she could stick with that approach each time they need to discuss the move.

The "loop" I just referenced is common.  Sometimes it is simply the length of time the individual can retain information.  Sometimes there is an actual repetitive looping of a story.  Several years ago we had a client who would get onto a negative story and then loop that story again and again to the exclusion of any other conversation.  Every time he got onto a negative story and then started looping it we immediately changed the subject.  His short term memory was such that he didn't even realize that we had changed the subject.  After about a month we got feedback from the man's next door neighbor that he was able to hold a conversation with the man for the first time in two years.  We broke the looping pattern. The son said his relationship with his Dad had improved for similar reasons.

Over the next few days I'll share more tips, discuss safety issues, and talk about activities. 

If you are enjoying these blogs please leave your comments and/or questions and "follow" the blog.  You may also visit us on Facebook, LinkedIn, and Twitter.  Just about every day I tweet activities from our Day Program.  You may also visit our website for more information.

If you are interested in the support group it is the second Wednesday of the month from 5-7pm at the Memory Center.  The group is meeting this coming Wednesday, it is free to all, and no reservation is needed although we do appreciate a call to let us know you are coming.  We serve coffee, tea, and snacks. Call 858-779-9254 for more information or visit us online at www.altagolden.com.

Take care and have a great weekend!  Laura