Use your DSB Supplement to enrol in the Diploma of Dementia Care Leadership

The Dementia and Severe Behaviour Supplement (Australian aged care funding) can be used by aged care organisations in Australia to improve staff skills, and you can do this by enrolling in the Diploma of Dementia Care Leadership. This nationally recognised  qualification is for  leaders and those who are in roles that require leadership and who feel they need to learn how to be a better leader and to know more about modern dementia care.

McCarthy Learning has developed a Diploma of Dementia Care Leadership which is to be launched with our first intake this July 2014.

Let’s face it, most undergrad courses or entry level courses do not prepare you with adequate knowledge about dementia – most of you have probably learned what you know on-the-job.

Now is the time to consider a professional  training program that is designed to be practical and give you the knowledge you need to be an excellent leader and have the most up-to-date knowledge of best practice dementia care.

The Dementia and Severe Behaviour Supplement provides $5,894.75 for each eligible resident. If your organisation is receiving this supplement for some of your residents suggest to your manager that they support you to improve your leadership skills by enrolling you in the Diploma of Dementia Care Leadership.

The course is delivered in six blocks of  face-to-face learning for 3-5 days every two months for a year, with online learning and workplace projects.

Cost of the course this year is $7,000. Next year the cost will increase to our usual price of $9,000.

Offered in all capital cities of Australia.

Contact Karen Carver at McCarthy Learning 03 9431 0311 or find more information at www.mccarthypsychology.com.au

Happy Mother’s Day to all the mothers with dementia in Australia today

Happy Mother’s Day to all the mothers with dementia in Australia today who are anxious about their children, who believe they have to be home with their children, who cannot remember their children’s names or faces anymore, who cannot remember their husband’s name, who become upset when they are reminded that they are mothers because they realise they have forgotten, who are anxious because they think there is something they have forgotten to do, who think they are young and need  their own mothers.

Happy Mother’s Day to you and to those wonderful people who care for you.

Responsive behaviour and dementia

This short video is a good introduction to responsive behaviour. We used to call it ‘difficult’ or ‘disturbed’ or ‘challenging’. Responsive is a much better term that captures the fact that the person with dementia (just as you and I do) respond ti stimuli in our environment or from within ourselves that cause us to act. So in that sense the person with dementia is no different to you and me.

[vsw id=”kTFuw65SrZI” source=”youtube” width=”425″ height=”344″ autoplay=”no”]

 

How Sundowning affects me

This is a first person account of sundowning by Barry Pankhurst (copied with his permission as below)

Some time ago on another website called ‘Talking Point’ I was asked the following question and I quote:

 

(Barry could you explain how you feel whilst Sundowning, does anything trigger it or does it just happen like clockwork?)

 

Well as there were so many ‘New Members’ I thought it might be a good idea to post the thread again for easier reading rather than searching as sometimes new comers want answers immediately…
The easy answer would have been to just to say yes (It happens like clockwork) but I think the subject is far more complex than that as it seems that Sundowning as it’s called can affect people with our illness at different times of the day, “in fact” a similar thing can also happen at the beginning of the day when the sun is rising, although the latter part of the day when the sun is setting seems to be the most significant time…
One thing I should explain is that here in Indonesia and some other parts of ‘Asia Sun Rise and Sunset’ occurs at about the same time everyday of the year, by 6am its broad daylight and by 6pm it’s getting dark unlike European countries when during the summer you have extended hours of sunlight from 4am-9pm which in itself could have some significance as to when a person starts to feel the effects of Sundowning?
But how does it make me feel: I think the best way I could describe it is to say that it causes a similar feeling that I can still remember after having had a nervous breakdown some years ago that at the time resulted in extremely deep depression.
For me it normally starts at around 3-4pm when I start to feel very lethargic and just seem to be wandering around the house utterly lost in my own world mumbling to myself or sitting in a chair drifting into daydreams (in fact my dear wife Sumi says she can now tell what time of day it is without looking at the clock) I fell as though the end of day is trying to drain every last bit of energy out of my body, all my limbs become extremely weak and I find it very difficult even to go for our walk but still go in a effort to ward off the Sundowning effect, I can become incredibly short tempered and loose all sense of rationality and sometimes become verbally aggressive and argumentative, you feel as though the whole world is against you and that whatever you say or do is wrong so I don’t like to be posed any questions at this time of day not even (what do you want for dinner) and I certainly don’t like to have any visitors at this time not unless they want their heads bitten off as my mind is at a total loss of any comprehension, all I want is to have my dear wife by my side but she now realizes that it’s best to talk to me very soothingly and I’m sure that she now just agrees with everything I say in an effort to keep me calm and also makes sure the house is kept peaceful without any excessive noise to further confuse my mind (Bless her as she has so much patients with me) as I start to feel as though I have the whole weight of the world’s problems upon my shoulders and everything becomes a effort so much so that my wife now has to help me bathe and get dressed as I’m so agitated and shaky…
So there is nothing that actually triggers the Sundowning apart from the setting of the sun as it descends towards the horizon which makes it feel as though its automatically starting by itself, but if it’s not handled with sensitivity then there could be untoward repercussions, also I should add that not everyday is the same as some can be worse than others and sometimes I can go for a few days without feeling any effects of Sundowning and the other strange thing is that even the weather conditions at the end of day can have some influence if its overcast I feel much better and responsive but if it’s a strong bright crimson sunset that we get out here then the draining affect starts much quicker, in fact, I get much the same affect when I go into a shop that has to brighter a neon, or flashing lighting…

Read of the reality when I’m Sundowning

This is written on actuality not supposition from when my dear wife Sumi and I went for our end of day walk it’s not just a one off situation or sensation for me it’s more of an occurrence day after day that totally shatters me!
It was just 4-30pm as the sun starts descending over the horizon when lethargy takes a grasp of me and the Sundowning affect ‘tolls the knell of my end of day’ so I’m writing this down trying to express the depths of my ‘true inner feelings’ at that exact moment in time…

My whole body aches as the muscles try to maintain some equilibrium, and as we go for our walk every faltering step I take being like that of wearing shoes made from concrete that’s slowly setting and intensifying in weight, which makes me weigh heavily on my walking stick and Sumi’s arm otherwise I feel I could just pass out from utter exhaustion as my mind is consumed in a dense obscure cloud of disorientation and bewilderment, my limbs are trembling so much I don’t know what to do with them to ease the tremor… my vision has become blurred as my eyes feel heavy wanting to sleep and escape from the sun’s setting draining sensation, so Sumi tries talking to me to take my mind of the horizon as my eyes have become mesmerized following the sun’s descent and harsh rays… but I can’t comprehend what she’s saying, I try to reply but any form of words and speech are held tight within me so all I do is mumble something incoherent which then makes me frustrated and I become really irritated and tetchy with her, the slightest little noise is more like thunderbolts slamming into my ears and making me very anxious and extremely jumpy…

The further the sun sinks away… the further I go into despair of doom and gloom… and sometimes it gets me to the point of saying to Sumi: (I’ve had enough of this, maybe it would be better if it all ended now, and I did not wake up again) as I can almost sense death waiting round the corner taunting me when in this daily living hell of Sundowning, I can see the tears glistening and running down her cheeks as she holds on more tightly to me saying ‘please don’t speak like that’ but I seem to be oblivious to her own anguish as my whole being is so distraught by the time of day that I just want it to come to an end…

As I said those where my exact feelings made from notes one evening, but as I type them out the next morning I had little recollection of that moment in time… it’s as if it never existed… as this morning I feel a completely different person still full of determination and the spirit of fighting this terrible illness, but when Sundowning strikes it takes us into a completely different world of anxiety within dementia…

I will be very interested to know what others people’s observations are with Sundowning as it’s another part of the illness that doesn’t affect us all in the same way.

 

Please feel free to copy this to your friends or on your own Blog sites as it might help other people to better understand how Sundowning can affect a person who has any type of dementia…

 

Barry,

Living in Indonesia with mixed dementia, (Alzheimer’s LBD and Parkinson’s disease)

Some Sundowning Tips to ease the anxiety

“Sundowning” is a state of increased agitation, activity and negative behaviors, which can happen late in the day through the evening hours. It used to be thought that Sundowning was caused by the lowering light and shorter days. However, research now indicates that being overly tired may have more to do with Sundowning. Here are some suggestions on how to minimize the negative behaviors associated with Sundowning:
1)
Make sure that your Loved One is well rested: I know that this is easier said than done. It does help though if you can get your Loved One to take a nap just before their normal period of Sundowning. If they cannot or will not nap, an hour quiet time (reduced stimulation and activity) will work. Turn off the TV, turn on some soft music and then sit and do a quiet activity such as painting or sketching. Sit and talk quietly with you loved one for an hour as it can help to make them relaxed.
2)
Limit outings and activities to the morning hours: Generally the individual with Alzheimer’s disease is better able to tolerate outings, activities and increased stimulus during the earlier part of the day. Plan your trips to the grocery store, involvement with kids, visits to day care and so forth during the earlier part of the day. This should be followed with a time of decreased stimulus and quiet time to allow your Loved One to wind down and relax.
3)
Decrease the length and amount of stimulus: Even during the earlier part of the day the individual with Alzheimer’s disease can only tolerate so much stimulation and commotion. Take steps to eliminate over-stimulation such as television, children, and any noise making item, quick movements and many things going on at one time. Sometimes excessive stimulation cannot be avoided. When that happens, allow your Loved One to have a quiet area to retreat to.
4)
Identify and minimize physical discomfort: Other types of physical discomfort can also play a part in Sundowning. Hunger; being wet or soiled, feeling cold/hot and other sources of discomfort can increase agitation, especially in the late afternoon and early evening. Light snacking during the day can be helpful. Apples and other fruits can help replace lost energy – even if your Loved One is pacing back and forth, that does not mean they have an endless supply of energy. Make sure that your Loved One’s personal needs are attended to and that the climate is at a comfortable level.
5)
Identify and treat medical ailments: Many ailments can contribute to Sundowning and agitation. Arthritis can be one of the most common causes. An over-the-counter painkiller as recommended by your Loved One’s physician before the time of Sundowning might be of great benefit. Urinary Tract Infections, flu / colds, asthma, allergies and other conditions are all medical ailments that can contribute to Sundowning. It is always a good idea that when your Loved One first begins to exhibit Sundowning or when Sundowning becomes common to take them to the doctor to make sure that there is nothing ailing them.
6)
Be observant to possible causes: Many times there are triggers to agitation leading to Sundowning. I now find that the noise from a hand phone tone can affect me more when I’m Sundowning so It’s best to set the phone to just a vibrate mode. Provide your children with a separate area to play as quietly as possible. Mirrors can also become a trigger as well due to light reflections. Watching to see what is going on, what events are happening and who is present prior to Sundowning can help reveal some causes (and solutions).
Sometimes no matter what we do Sundowning will happen. If we cannot prevent it we can help lessen it or at least make it less unpleasant for our Loved Ones and those around them.
7)
Provide a private “time out” space for your Loved One:
8)
Keep the house as quiet as possible to avoid aggressive Sundowning episodes, turn off unneeded lights, turn off the TV/radios and either go to a quiet corner or go and sit outside for a moment but always be close at hand.
9)
Check with the doctor: If Sundowning is particularly troublesome; you may need some extra help with prescription medication. Talk with the doctor to let him know of the behaviors, time of day and how you’re Loved One is behaving before Sundowning. He may be able to help you by prescribing a medication to help ease the symptoms.
Medication is a last resort and may take several attempts with different drugs and doses to find the right one that will work for your Loved One.

If medication does not help, do not become discouraged, relay the information to the doctor and he may either adjust the dosing or change the medication.
10)
Keep things simple: Keep the surroundings as simple as possible. Be sure your Loved One’s walking paths are clear from clutter and obstacles. Low furniture such as coffee tables and footstools can make it difficult for your Loved One and become a source of frustration. Keep knickknacks to a minimum and the tops of tables, television shelves and other surfaces as clear as possible.
Mirrors and pictures can often become unfriendly visitors that the individual with Alzheimer’s disease cannot understand. Complicated, noisy appliances are also frustrating to them.
Avoid changing things once you have things simplified since changes of any kind can be extremely frustrating for someone who has dementia.

Maria Montessori and repeated questions

“If we observe them closely, we notice that they do not listen to the answers given to them but simply keep repeating the questions. What seems to be an eager curiosity is in reality a means of keeping a person they need near at hand” – Maria Montessori 1914.

Maria Montessori was talking about children. However, this is equally true of older people living with dementia whose memory difficulties and problem solving makes them insecure and uncertain. And so they seek out attachment figures who make them feel secure and safe, calm the uncertainty and anxiety that memory loss provokes.

Othering and empathy

Professor Simon Biggs from the University of Melbourne School of Social and Political Sciences spoke at the Better Practice Conference in Adelaide this week. He spoke about human rights and

old_and_young_2x2ageism in Australia. The human rights perspective has not been brought to bear on ageing much to date and this is especially true of aged care.

Several things struck me about his presentation. Firstly he spoke of “rights holders” and “duty bearers”. The older person is the rights holder and we are the duty bearers who have a duty to uphold or protect the person who holds the right. It made me think of the situation I have face in the past when families and others overwhelm the older person and essentially cajole them into going into aged care. This is a failure of our duty to uphold their right to agency, to choice. Even cognitive impairment does not take away a person’s right to agency, choice.

The other point he made was that we have difficulty with empathy for older people (and this especially true of our relationships with older people with dementia) and we “other ” them. We make them into an “other” who is different, not like “us”. Kitwood referred to the work of Martin Buber who spoke of an “I” “Thou” relationship in which the other person is not made into something different but is recognized as a subject, a person like me.  However, when we engage in “othering” we have difficulty with empathy, with recognizing elements of our own experience in the other person treat the person who is old, who has dementia as if they are not like us, have little in common with us, are essentially different to us.

I remember coming to grips with this problem in myself some years ago when I realised that I could not picture these older people as once young, once like me, smooth of face and strong of limb. I concentrated on trying to make this connection and it helped me to engage with the older person as a person with outlooks, perspectives, experiences and feelings like mine, hopes like mine.

Simon Biggs said that empathy is the antidote to othering. What do you think?

 

Living with a person who has dementia

Talking with a group of carers of people living with dementia today. Ordinary people faced with a journey of up to a decade of struggle with difficulty that they did not volunteer for or expect. Most taken by those facing support of a spouse with early onset dementia – young ones at home, Dad behaving oddly, workmates noticing, finally his golfing partner and doctor coaxes him to come for an assessment. Now they have a name for the oddness and can sort out what the next decade or more will hold. Plans for retirement and dreams of an old age together are ashes in her mind.

They want to know how to deal with the lack of motivation, the refusal to shower, the odd eating habits that are so new and confusing for the children. They are teenagers and don’t understand why Dad is embarrassing them more than usual. he seems oblivious. He is unaware that his behaviour has caused a seismic event in the lives of his wife and children. And he cannot help them for the first time in his life when they need him the most.

She is relieved when I say its OK to let him sit if that is what he wants. Make sure he has a balance of exercise and rest but don’t impose activity on him when all he wants to do is sit. His amotivation is causing him to sit and be difficult to get going,resistant to her urgings to talk, to walk, to go out together. She knows it would be good form him but her efforts are exhausting her. Now she can let him sit if that is what he wants to do. Its a matter of balance and not imposing her ideas of what he should be doing when all it does is create distress for her and resistance in him.

Another has a husband how goes to the post box and the back gate several times a day. Is he unsafe? Is she worried about him? Not now but it used to make her mad angry with him. Now its OK.

One won’t have a shower. Is he incontinent? or does he smell? or is his skin breaking down? If not then consider not pushing him to have a daily shower. Maybe change his clothes each day and check his skin if possible as you go. But don’t push the issue. Pick your battles. The goal is hygiene, so think about a way to achieve that . Maybe a basin wash or one of the newer chemical solutions that mean he doesn’t have to have water on his skin if that is what he doesn’t like.

If the issue is physical safety then you need to act. ie. If the person is walking into traffic or about to use a knife or machinery unsafely you have to intervene. But if it is not that urgent, be strategic and pull back, let the moment pass and think coolly about it. Perhaps talk to someone else about it. And then respond.

I hope some of this helps. Most of this comes from their collective wisdom.

If oyu have ideas yourself please share them here.

Bernie

 

 

Animal Assisted Therapy for people with dementia

Dogs and cats have been used in modern dementia care with excellent results of improved levels of agitation and engagement. Despite concerns among some staff that they might cause infections or be dirty and need to be cleaning up after them, animal assisted therapy has become a core part of most dementia care settings.

Some dementia care homes have a “live in” animal who lives with the residents and is very much part of the furniture. This is usually a cat whose presence is quiet and gentle. Cats have even been noted to choose to sleep on the bed of residents who are close to death, becoming a local signal for increased palliative care as end-of-life approaches. This is sometimes interpreted as a comforting presence and many cats are maintained in dementia care environments with great affection.

The Eden Alternative makes explicit their emphasis in having animals as a core part of daily life. Local aged care homes in Melbourne that embrace the Eden philosophy have been known to have visiting donkeys, goats and other farm animals. These visits have caused great delight and much talk for days after the event. Animals large and small can be integrated into the life and rhythms of an aged care home. This should be moreso in regions where animals were a part of every day life such as country aged care homes.

But is it necessary to have a live animal? Can’t you just have a stuffed toy? Or a robot? A study in 2009 examined the effectiveness of a live dog versus a robotic “pet”. They compared the effect of a person, a person accompanied by a live dog, and a person accompanied by an AIBO (Sony’s computerised robotic “pet”), on behavioural indicators of social interaction among female nursing home residents with dementia. All three types of visits stimulated residents to initiate conversation, touches, and looks at other individuals (human, dog, and AIBO) and provided contacts with the outside world. Both the live dog and AIBO stimulated resident social interaction beyond that stimulated by the visitor alone. The AIBO induced longer looks and more resident-initiated conversation than the live dog and provided a positive source of social interaction. While all three types of visits  stimulated nursing home resident social interaction, the success of the robotic dog in stimulating social interaction by dementia residents suggests that it may provide a viable alternative to live animal visitations.

Somehow though there is something more pleasing and satisfying in terms of an ongoing relationship with a real animal, particularly with a dog. Other animals provide pleasure and stimulation simply by being there for brief periods and if that is possible in your home it it likely to have real benefits to the residents.

There are organisations such as Delta Pet Partners and Lead the Way that will provide trained animals and trainer owners to come to your aged care home for visits that can be safe and enjoyable for all.

So no matter if it is for a short time or a long term arrangement, having access to animals should be seen as a normal part of life in an aged care home for people living with dementia.

We have no commercial connection with either of the groups below but they may be able to help you find more information and resources.

Delta Pet Partners

http://www.deltasocietyaustralia.com.au/

Delta Society Australia Limited
Shop 2, 50 Carlton Crescent
SUMMER HILL NSW 2130
Ph: (02) 9797 7922
Fax: (02) 9799 5009

 

Lead the way

http://www.ltw.com.au/

Phone: 03 9761 0973

Mobile: 0408 376 531

Fax: 03 9739 8220

Postal Address:

PO Box 8046

Ferntree Gully Vic 3156

Life within reach for the person with dementia

Putting ‘life within reach’ is important for people with dementia who may not be able to remember where things are if they cannot see them. 

Fill their world with opportunities for stimulation and pleasure by filling drawers and cabinets with objects that trigger memories and offer interesting moments for remembering and doing.

Life needs to be within sight and reach to be of use to people who mostly have a “present” to live with. The past may be less obvious or available to them even though it may be influencing their every choice and preference.

Label drawers on the outside or have glass doors on cupboards to  allow the person with memory loss to see what is there, avoiding the moment of confusion and overwhelm that can cause angry rage or sad tears or both.

Hope this helps.

Bernie

Life Matters Radio National talks dementia with Bernie McCarthy

Download this mp3 file (link below) to listen to Bernie McCarthy talking with Richard Aedy on Life Matters on Radio National today. They are discussing Bernie’s recently published book Hearing the person with dementia: Person centred approaches to communication for families and caregivers.

Radio National interview 25052011