Dementia and Stimulation

The Recreation Director at Dufferin Care Centre told me about Flaghouse ( www.flaghouse.ca). They have products and catalogues for many different populations, including for people with disabilities and dementia. She showed me Snoezelen a method and products for stimulation of people, with among other things, dementia. For information on this product: http://www.flaghouse.ca/SnoezelenAL.asp

What I especially like is that it allows people to interact with loved ones who have advanced dementia. Or maybe I should say, it allows people with advanced dementia to interact with their loved ones.

From their website: The SNOEZELEN environment is safe and non-threatening. Children and adults with disabilities or other limiting conditions enjoy gentle stimulation of the primary senses. There is no need for intellectual reasoning. Participants experience self-control, autonomous discovery, and exploration-achievements that overcome inhibitions, enhance self-esteem, and reduce tension. Free from the expectations of others and away from the pressures of directed care, they recuperate and relax.
Research has shown that multisensory environments offer a wealth of benefits, often affording the participant and caregiver an opportunity to improve communications, enhance their understanding of each other, and build trust in their relationship. SNOEZELEN is a wonderful experience to enjoy and share-a place that replenishes the spirit. SNOEZELEN® is a registered trademark of ROMPA® Ltd. All

Assessing Nursing Homes

I took a tour today of a private care facility. Very nice place. Homey, but not ostentatious. People looked happy. Staff appeared warm and responsive.

On the tour, I was asking about the garden, and the person giving me the tour told me how nice it is to have such a large garden. She told me the residents help out.

On one hand, that is a fairly simple comment. On the other hand, she didn't say, " the residents do the gardening." There is a difference in ownership, and in conceptualizing how care and service is provided with a statement like that.

Do the residents " help out?" Or are the residents and families the ones who design and do the garden, with the staff and maintenance people helping them?

To me, there is a world of difference.

Making Services Accessible

I have just spent an hour or two trying to contact different facilities for a client who is looking for housing. It is absolutely amazing how difficult it is to get through to someone. If you know who you are looking for, it is easier, but still hard. I can't imagine what it is like for older people who are trying to figure things out and get information in a timely, easy way.

One facility's phone system told me to press "130," if I wanted to speak to so and so, which I dutifully did. I got a message telling me to press 130 if I wanted to speak to so and so, which I dutifully did, when I got a message telling me to press 130, if I wanted to speak to so and so, which I dutifully did, when I got a message telling me to press 130 if I..well you get the picture.

By that time, it was probably lucky for so and so, that she was inaccessible. She would not have wanted to hear what I had to say.

To me, this is not only an issue of customer service, it is an issue of providers not responding to their client base.

Any care facility, assisted living, or other seniors housing service should regularly review their telephone system to make sure it is working and that people are able to access the information and people they need.

Colloquium from the Centre for Research on Personhood in Dementia

The Centre for Research on Personhood in Dementia (CRPD) evolved in response to a recognized need for research to examine the potential of a personhood approach to dementia care practices in British Columbia. Established in July 2004, the CRPD is a trans-disciplinary research centre situated in the School of Social Work and Family Studies at the University of British Columbia (UBC), Canada. The CRPD emerged as an outcome of the Matters of the Heart and Mind: Negotiating and Assessing Personhood and Dignity Among Elderly Canadians With Dementia workshop convened at UBC in November 2000.

The concept of Personhood in Dementia is such an important one, because in a way, when we lose our memory, and our cognitive abilities, it is easy to have people not see us as a person anymore. It begs the question, not "what makes us human, " but a more intimate, and touching question--" What makes me a person."

The Centre for Research on Personhood in Dementia(CRPD) is presenting a special international colloquium

Decision-Making, Capacity, and Dementia

Wednesday May 16th 4:00-5:30pm
at the Liu Institute for Global Issues6476 NW Marine Drive, University of British Columbia.Reception to follow.

We are in the process of finalizing speaker arrangements,and will send a notice with more details in the coming week.

Although this colloquium is free and open to the public,we are asking people to RSVP crpd@interchange.ubc.caby Wednesday May 9th.

For more information about this unique colloquium(including directions and parking),or the Centre itself, please visitwww.crpd.ubc.ca


Feel free to forward this notice)

About Guilt

A client of mine whose mother died in a nursing home recently was telling me about what helped her out with her feeling of guilt. She lives far away and only came back here about twice a year. She came back during the last couple days of her mother's life.

" It was when I saw how caring the staff were--how they came into the room and told me stories and shared their sorrow about my mother. It made me see that she was in a place where people cared about her, and that she wasn't alone. It made me realize I hadn't abandoned her, and she was better off there than she would have been in her own home."

So care, when it works, works well

Housing Types

Quick review of the types of housing that is available. Terms vary sometimes and even providers mix up what they are doing. However:

Supportive Housing: Where there are minimal services, including dining room and one to three meals a day. Usually also includes recreation and emergency call systems in units. Units are usually apartments of some kind. Care and nursing services not included.

Assisted Living: Same as Supportive, but Care services to help with ADL (Adtivities of Daily Living) are included . These can include help with bathing, dressing, medication reminders, toileting. In B.C. people ae supposed to be able to direct their own care, and have a maximum need for two services. All asssited living in BC has to be registered with the Assisted Living Registrar . Does not include nursing care. Usually, there is a supervising nurse on staff.

Residential Care: Where nursing care is part of the services provided. Will include help with all ADL, plus help with transferring ( getting from bed to a wheelchair or on and off the toilet, for instance). In the U.S. they call this skilled nursing care when there are rehabilitation services available. These are what are covered by medicare and medicaid.

Campus of Care means a situation in which all or two or more of the above levels of housing are available within the same complex, either in the same building, or in different buildings or wings on a campus type of layout.

Medications Medications Medication

Oh, did I mention I wanted to say something about medications?

I was watching 20/20 the other night, and there was a segment on pharmacies. It showed many people going to pick up medications who were not given counselling and even some people who bought an over the counter medication which was contra-indicated with the prescribed medication were, in most cases, not being warned.

Over medication, undermedication, and mis-medication is one of the greatest challenges for caregivers and older people themselves. Medication problems lead to delirium, hospitalization, broken hips, depression, confusion, and death. It is essential that medication taking be monitored. There are phone services you can use, there is equipment that can be gotten which dispenses medication.

All medication should be reviewed regularly. Medications can build up easily in an older person's system. Nursing homes and assisted living housing may not review adequately all the medications.

People MUST talk to their pharmacists about new prescriptions and changes of prescriptions. The pharmacy has to know if someone is taking over the counter medications, herbal remedies, natural whatevers, and chocolate.

Okay, maybe not the chocolate.

But the others can all have interactions with prescribed medications and they can vary enormously in quality.

Caregivers need to be the advocates for their loved ones in a care facility, especially around medications. So you have to know what they are on, why, the dosage, possible side effects. If they are medications for psychological reasons or agitation, they should regularly be reviewed.