Adult day care for Alzheimer’s Archives

The last two months I’ve talked about a lecture that I attended, “Understanding the Person with Dementia: How to Communicate Effectively.” It was presented by Susan Stone who is with the Alzheimer’s Family Day Center (AFDC) in Fairfax, Virginia and does outreach and education. Communicating with a person with Alzheimer’s disease (AD) is a challenge which takes patience and understanding. This is a continuation of her lecture and the final in the series of three articles.

To communicate with a person with Alzheimer’s disease (AD), we need to understand their world. There is no point in arguing or correcting. The patient’s reality is not your reality so join the individual where he is. Simply acknowledge the statement and emotion behind it even though you know that it’s incorrect. Avoid asking questions that they cannot answer. Allow them to reminisce.

Make positive statements. Try going through the day without saying “no.” Difficult? Avoid pronouns like it, he, she. And use very simple explanations. Details often overwhelm them and can cause increased anxiety.

Here are some strategies to consider.

  • Offer guided choices. They are losing their right to make choices so say something like “chocolate or vanilla” and they will likely remember the last word.  The speaker humorously added that if there are only two choices and you want the chocolate one, offer the chocolate one first followed by vanilla since they will probably choose vanilla.
  • Write it down and use labels. During the late stages, labels won’t help, but during earlier stages of AD, they will help.
  • Validate emotions rather than facts.
  • Avoid overstimulation.
  • Model appropriate behavior.
  • Fill in lost words, although this depends on the person.
  • Turn your questions into answers.
  • Use events to measure time.

Listening is extremely important. Learn to read body language to figure out what the person is trying to communicate. Is it pain, frustration, fear, pleasure, boredom? Survey the environment as well to see what’s going on. Focus on the person and listen. One AD patient said,

I have taken time to put words together and I may be unable to repeat it.

Another AD patient said, I’m doing the best I can. They may overhear you talking about them so be careful. The ability to understand what is being said outlasts the ability to speak effectively.

The understanding the person has might come from body language and tone of voice more than from the words that you use. Use humor gently and never at the expense of the individual. But humor is everywhere; just keep looking for it.

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Last month I talked about a lecture that I attended, “Understanding the Person with Dementia: How to Communicate Effectively.” It was presented by Susan Stone who is with the Alzheimer’s Family Day Center (AFDC) in Fairfax, Virginia and does outreach and education. Communicating with a person with Alzheimer’s disease (AD) is a challenge which takes patience and understanding. This is a continuation of her lecture.

As we age, we all experience age-related brain changes, but for Alzheimer’s disease (AD) patients, the changes may be a lot more pronounced. They include:

  • Impaired hearing – especially higher frequencies
  • Lessened ability to determine the location of sound
  • Decreased vision
  • Slower thought processing
  • Slower in adjusting to light changes. (She suggested going into their bedroom earlier and opening the blinds).

Along with age-related brain changes, there are definite communication changes in dementia. They include the following:

  • Word finding problems (initially nouns and pronouns)
  • Frontal lobe damage
  • Word salads (stringing a lot of words together that don’t make sense)
  • Perseveration (repeating words over and over)
  • Mis-naming (but getting close) (An example she gave was someone trying to say Dairy Queen and used the word “king”).
  • Returning to original language (first to learn and last to lose)
  • Loss of ability to recognize and understand words

When approaching a person with dementia, use the person’s name and casually introduce yourself. Approach the person from the front and make sure you have eye contact. Touching the person also helps them to maintain attention. There’s less human touch as a person gets older so touching is important.

Finally, here are tips for initiating conversation.

  1. Speak slowly and clearly. Use e-x-p-a-n-d-e-d speech, but by all means treat them with dignity and not as though they are a child.
  2. Pause at the end of thoughts to give them time to process.
  3. State one request at a time.
  4. Always explain what you are going to do.
  5. Use lots of hand gestures.
  6. Watch the person closely for their reaction. Anxiety leads to anxiousness to regression.

Next month I will continue with more tips.

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A couple of years ago, I wrote about a wonderful Alzheimer’s disease (AD) resource in Fairfax County, Virginia located about 15 miles south of Washington, DC, the Alzheimer’s Family Day Center (AFDC). Not only are they a day care center for AD patients, but they have excellent programs for caregivers. I recently attended one such program on communicating with Alzheimer’s patients.

Titled “Understanding the Person with Dementia: How to Communicate Effectively,” it was presented by Susan Stone who is with AFDC and does outreach and education. Susan is an excellent communicator herself and interacts with the audience extremely well. I want to share some of her thoughts in this article and I will continue next month.

Because communication is only 7% verbal and the rest nonverbal, it is important to not limit your communication to just words. People with Alzheimer’s prefer not to talk on the phone and initiating phone calls is difficult. They have difficulty keeping up with conversation and may not understand your words. Their attention span is limited and they may have trouble finding the correct word. Furthermore, they may pick up only every three to four words.

For example, the conversation may sound like this:

___ WANT ___  ___  ___ GET ___  ___  ___ TAKE ___  ___  ___ . WE ___  ___  ___ APPOINTMENT ___  ___  ___  ___ WE ___  ___  ___ BEFORE ___  ___  ___ HOME.

NOW ___  ___ HURRY.

Here is the entire message:

I WANT you to GET up now and TAKE a good shower. WE have a doctor’s APPOINTMENT at 11:00 and WE can have LUNCH before we go HOME.

NOW please just HURRY!

Getting angry and adding a sharp tone of voice is not going to make this message any easier for the AD person to decipher. Here are some suggestions Susan offered:

  • Restating key words will help.
  • Give one direction at a time.
  • No rushing – time does not mean anything to an AD person.

Here are further suggestions repeating just the key words.

  • Get up. (Offer your hand).
  • Shower.

This is all the person needs to know at this point. They don’t really need to know about the appointment and having lunch is too far in the future to mention it now. You want them to take a shower and all they might remember is having lunch.

More suggestions will be coming next month. I hope this gives some understanding as to why communication is so challenging for those with dementia.

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Caregivers of Alzheimer’s disease patients have one of the toughest jobs in the world and yet sometimes one of the most rewarding. Stephanie Jewett, RN, MBA, in an article in, offers the following tips for caregivers in a home setting.

  • Find something they love to do and keep that favorite thing going everyday, i.e. take a walk in the park, watch their favorite television show or read articles in a magazine. Go to the Internet and learn more about their favorite subject.
  • Keep life simple; follow a schedule everyday. Eat at particular times, keep hair appointments to one specific day a week, and enjoy a meal out once a week, on the same day.
  • Get lots of rest – take a nap if one feels tired, but don’t sleep the day away. Get up at the same time each day, bathe and then have a nutritious breakfast each and every day!
  • Go through scrapbooks and old pictures, reminding them of family members — their names, ages, etc.
  • Get a dog or a cat so that the patient has some responsibility and company in the home. Pet therapy is one of the best methods known to keep a person happy and healthy.

As a caregiver, your top priority is to take care of yourself so that you will have the strength and stamina to take care of your loved one. So the tips for your Alzheimer’s disease patient apply to you as well. Take good care!

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Continuing my highlights of Alzheimer’s Care with Dignity by Frank Fuerst, in today’s post I list 6 caregiver products that Fuerst considers specifically helpful for people with dementia. You may be able to get them free or at a reduced cost. Ask your contacts such as members of your support group or see if it’s a Medicare-qualified item.

Consult his guide for a complete list, but the following are those that solved major physical and psychological challenges for him. Having gotten them sooner he feels would’ve prevented a good deal of stress.

  1. Bathroom transfer bench
  2. Geriatric chair
  3. Plastic runner
  4. Hand-held shower
  5. Stair lift
  6. Wheelchair

A bathroom transfer bench is one where two legs remain inside of the tub with suction cups and two legs are outside of the tub.  It comes with a backrest. Since the person remains seated while bathing, a hand-held shower works well. (Hand-held showers work well for cleaning the tub as well).

A geriatric chair is like a wheelchair except that it is larger and more comfortable. Get one with a tray that can swing down and out of the way.

Plastic runners will help to keep your carpet in good condition in case of accidents. They have spikes on the bottom to hold it in place. Not all plastic runners are alike even though they may look alike. Since you need to walk on the runner, a softer plastic might be more  comfortable than a stiffer one. Use them in areas where there are likely to be accidents such as from the bed to the bathroom and in eating areas.

Stair lifts are expensive, but might still be a less costly alternative to other home alterations. Fuerst suggests that you check the Internet. One source is for more information. They also sell used equipment and will buy back equipment, but don’t expect to recover much of your purchase price.

Finally, wheelchairs are available everywhere, but if you’ve never ridden in one, they are not exactly comfortable. Be sure to add a cushion, preferably a high quality gel cushion as mentioned in this post.

Caregiving at a Glance

The Alzheimer’s Family Day Center has a wonderful booklet for Alzheimer’s disease caregivers called Caregiving at a Glance. It’s designed with tabs that you can simply slip your finger under and get to the information you need. Sample topics covered include:

  • Sleeping
  • Bathing
  • Car and Home Safety
  • Activities … What to do Between Meals
  • Hostility and Aggression

On the topic of “Wandering,” for example, they suggest you register your loved one with the Safe Return program sponsored by the Alzheimer’s Association. You can call them toll-free at 1.888.572.8566 or on the Web at

“Troublesome Behaviors” is another section of this booklet. This covers a wide gamut, but they talk about things like screaming, repetitive phrases, or picking at clothes, tearing paper into tiny shreds, and other behaviors that develop in the middle to the late stages of the disease.

This wonderful resource is available at the Alzheimer’s Family Day Center by calling 703.204.4664 or e-mailing them at AFDC@alzheimersfdc@org.  The booklet is free – one copy per person. It was published with the permission of the Alzheimer’s Association. The project was supported, in part, by a grant from the Administration on Aging, Department of Health and Human Services, Washington, DC, 20201.

Alzheimer’s Family Day Center

Alz_FamDayCareLocated in Fairfax, Virginia, the Alzheimer’s Family Day Center (AFDC) is the only adult day health center in the Washington, DC metro area for adults with Alzheimer’s disease in the mid to late stages of Alzheimer’s and other related dementia. For those in the early stages, the Social Club meets for a half-day once a week. Founded in 1984 by visionary Dr. Lin Noyes Simon, AFDC just celebrated its 25th anniversary. As a founding director of the first and only dementia-specific day-care center in Northern Virginia, Dr. Simon turned a concept of care into a viable nonprofit business that increases the quality of life for people with dementia and their families.

Alzheimer's Family Day Center

Alzheimer's Family Day Center

Part of the mission of this organization is education. They offer training programs for caregivers and they practice and improve the skills and techniques in their programs. They also offer classes for caregivers on many aspects including medical, legal, financial, community resources, how to build coping skills.

The Alzheimer’s Family Day Center is a full care facility providing breakfast, lunch, and two snacks each day. Additionally medical services and transportation are provided. They can accommodate up to 34 participants with a 1:4 staff ratio. Fees cover 40% of their budget; fund raising and grants cover the rest. Scholarships are provided for those that cannot afford the fees. Level II care for the middle stages of Alzheimer’s and runs from $730 to $1533 per month, depending on the number of days the client attends. Level III care for late stage dementia ranges from $830 to $1743 per month.

On the day I visited, the group was actively engaged in a game. One aide was seated right outside of the restrooms ready to assist while another sat right outside of the game room also ready to assist. Another staff member was cleaning the bright dining room. It’s a very pleasant facility with an upbeat staff.

Nancy Dezan, Executive Director, said day care is not for everyone. People think that their loved ones won’t like it, but once they attend, they think it’s the greatest thing since sliced bread. She asked me why I thought my family never sent my father to day care. Well, they tried it, but my mother (as my father’s primary caretaker) felt it was so much work to prepare him to go out. Furthermore, they had to be ready when their transportation arrived. Nancy said this was a typical answer for many families.

To see how you can help, visit the AFDC Web site.

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Alzheimer’s Disease Educator: Nancy Dezan

Nancy Dezan at Positive Aging Fair

Nancy Dezan at Positive Aging Fair

I first heard Nancy Dezan speak about Alzheimer’s disease at the Positive Aging Fair in early fall. Her topic was “The Mind, Body & Spirit of Brain Health.” I heard her again speak on “Reducing Your Loss of Memory” at the Aging and Wellness Conference and Expo in McLean, Va, about a month later. Nancy is the dynamic Executive Director of the Alzheimer’s Family Day Center, the only adult day center in Northern Virginia devoted completely to the care of Alzheimer’s clients. She is an Alzheimer’s disease educator with an extensive background in Alzheimer’s and an excellent public speaker.

In her speeches, she assured us that forgetting a person’s name soon after being introduced is not a “senior” problem; it’s a problem of not concentrating. In normal aging, everything slows down; cognitive ability slows down around 40.

If you lost your keys every day, that is not necessarily a red flag. But if you don’t know what to do with the keys, that’s a red flag. Everyone with Alzheimer’s knows something is wrong and they feel vulnerable. Hence, they put keys in odd places like the freezer because they know that the keys are valuable, but since there’s no short-term memory, they can’t remember where or why they put it in the freezer.

She referred to the Nun Study which showed that nuns who were always exercising their brain fared the best, not necessarily those that were the most intelligent, because it sparked new neurons. She offered many tips on how to keep the brain healthy as well as the body. What is good for the normal person is good for one with Alzheimer’s as well. She mentioned four risk factors — blood pressure, cholesterol, obesity, and diabetes. High levels of stress can affect the brain and it is especially important for caregivers to reach out and ask for help.

In my next post, I will introduce you to the Alzheimer’s Family Day Care Center.

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