Missing too long

I can't believe it's been two months since I blogged. At StilMee we've been busy with presentations, trainings (there is one in Tiverton Rhode Island on June 11), and welcoming a new coach for Plymouth and Cape Cod. I'm also re-entering the psychiatric nursing field in an effort to regain patient contact. My first love is psychiatry; I learned so much about behavior management psychiatric nursing. I plan to work with elders with mental health issues and dementia. I can practice and perfect my skills in working with this population. My goal; to empower each to be in control of his or her own life to the greatest safest extent possible.
We coaches are working on a 'memory' handout which I'll add to the blog. It discusses the types of memory (working, episodic, semantic and procedural), their normal function, the impaired function and the appropriate approaches/interventions that will help the person function better. To whet your appetite for new knowledge, the working memory and episodic memory are impaired in memory loss, the procedural and semantic can be tapped with cues both visual and auditory. I'll share more as I get the handout edited and checked for accuracy and readability. I promise I will blog before another 2 weeks has gone by. I'll share my new journey into psyciatric nursing; what I am learning and what the patients are teaching me about what they need.
Good to be back.. I just returned from eight days bare boating (the boat is bare, not the sailor and first mate!) It was a restful and exciting time to relax before the next leg of my journey into caregiving...Bev

Mental Illness and dementia

I have been asked more than a few times to speak to the prevalance of dementia in the aging person with mental illness. Looking online, I see little to help me. I've connected with a few mental health doctors to help me. Remembering my years of nursing in mental health units I'm not sure how much dementia I saw co-existing with mental illness. I remember at Deaconess Hospital there were people admitted to figure out whether the behaviors were from depression or dementia. Often once the depression cleared with treatment, there was little sign of dementia. I know people with late life depression are more prone to dementia, but I wonder about other disorders people suffer with for years, like bipolar disorder, schizophrenia and personality disorders. If anyone has experience in this field more recently than 10-15 years ago (like mine), let me know. Comment on this posting. I will continue to research this subject

Time Slips

I read in the Dementia Weekly last week about an activity for persons with dementia called Time Slips. The idea is to free the person from having to recall anything but what he or she wishes. This activity captures imagination. The example given was that the leader took a picture of something, in this case the Marlboro Man, and asked the participants to make up a story about him. "Do we call him Smokey?" What does he do for work? and so on. The activity lasted one hour with rapt attention. Nothing said would be wrong. It was a fun activity and called on creativity and what they wanted to remember. Great idea!

Siblings and Caregiving

Home Instead Senior Care's March newsletter addresses the challenges for siblings to share the care of a parent. It starts off "Sharing isn't always easy for sibs who grow up under the same roof. Divvying up the toys, bedrooms or vehicles may have been a challenge at your house, and sharing the daily chores could have led to familly conflict as well. Some things never change." The article goes on to say that 43% of families 'elect' one primary caregiver. In only 2% did sibs share the care.
There is a website for such families that offers good advice. www.solvingfamilyconflict.com
It is funny that this comes out this month as my team and I are taking a full day to study how families operate differently and how this impacts the crisis of an Alzheimer diagnosis. With many years of experience working with families in crisis, this was a welcome request from the team. I've been very impressed that none of the coaches has gotten entangled in a family's dysfunctional responses to crises. They are able to stand back, listen, and observe how individual members view their part in the caregiving and gently offer suggestions based on the members' willingness and abilities. One of the coach's families has routine conference calls with her to address present challenges. The family of brothers comes with an agenda. This makes it easier for the coach to be helpful NOW.
I think of caregiving involvement like a marriage. Each has to give 100% of what they are able to give. Regular conversation about changes, flexibility, planning together for 'what if' situations (like illness of the primary caregiver), and honesty about what each will offer are all great steps towards successfully working together.
If you have tips on how your family has worked together well or not, let us know. I know for my caregiving experience with my mom, each of my 2 sisters had a role that she could and was willing to provide. It was all clearly spelled out, making expectations clear. It helped a great deal and minimized bad feelings.

Communication

What is communicating anyway? It is everything we do or say that conveys a message to another. It may be a word, a look, a position of the body or an action. Think of all the ways we convey our wants, needs and feelings to others.
Like a child is, a person with a cognitive disorder is a very keen observer of behavior. As a caregiver we need to remember that affect is contagious. Smile and the world smiles with you the song goes. A smile goes a long way toward working well with a person who has a hard time making his needs known. Taking time conveying something to that person is essential. Speak slower, simpler. Maintain eye contact. Relax your body. Watch what you do with your arms and hands. Are they conveying the message you want? Crossed arms denote impatience. Arms relaxed by your side with your hands outstretched palms up denotes invitation. You can change a potentially volatile situation around by adjusting your body stance.
What about your words. Are they spoken sharply or softly. You've got to eat now is less inviting than Come with me; I've made something good to eat.
Don't beat up on yourself but observe how you relate to your family member with Alzheimer's. This is called cognitive awareness; studying yourself and your behavior. If you find your approach evokes a negative response (fear or irritation), try a different softer approach and see what the difference is. In working with mentally ill persons I learned I could work more easily with them when, aware of their being distracted by voices in their head or having negative thinking, I could minimize their angst by my approach. Relax; go slow. Slow down to the speed of LIFE; theirs.

Caregiver Education a Must

I can't believe it has been almost a month since my last entry. Between tending to my family's needs and preparing for trainings and presentations, I've just let the time get away from me. The response we are getting for the need for education in working respectfully with those people with memory loss is both gratifying and a bit overwhelming. I've studied Alzheimer caregiving for so long I go to give a talk and think, 'surely everyone already knows this'. And then I find out that is not true. As a nurse I wondered how people managed their illness once home. Do their caregivers know what to do? Do they know how to care well? For example, having a baby in a hospital and having a nurse fetch bring him to you every 4 hours is a lot different from having that baby 24/7 and fitting the rest of your life in. I saw families take home someone with mental illness from the units I worked on and decided they needed education about the illness. I started a Family Educational Service. It was so well received, I did the same for families caring for someone with Alzheimer's. The difference of course is that the person with a cognitive disorder often cannot be fully participating in decisions about care. They often don't believe there is anything wrong with them at all. This is where education about how a person with dementia thinks is so very important. When families learn this they are so enlightened as to the reasons behind the changes in behavior. It lightens the load of guilt, frustration and anxiety. If you haven't read my book Matters of the Mind...and the Heart, do so. You will learn how people with memory loss think differently but they are still there. The mind is not the same as the brain. The brain is an organ. The mind is everything the person is. We must learn how to tap the mind, the person's personhood.

A Born Caregiver?

Are there born caregivers do you think? There are people who seem to just come forth to help, to care when they see the need. Most mothers are like this, never ceasing being a mother to her children even if they are 40 or 50 years old!
I won't be posting for a week, for example because I'll be in Michigan with my 44 year old son having surgery to repair damage to his neck during a rollover accident last June. Does he need me there? I'm not sure, but I know I need to be there to support, comfort and be a present familiar face.
I honor Alzheimer caregivers who did not volunteer for the job of caring, but found themselves elected either by the majority (usually siblings) or by default. Most seem to be willing to learn how to care well and listen to the instruction a coach gives them. That is why I wrote my book Matters of the Mind...and the Heart and why I continue to do this work. I've got 5 empathic knowledgable women who continue to help caregivers understand and manage this disease. I see that they are natural caregivers for their own family as well. I guess there are born caregivers. Thank God for them.
I'll be writing again after February 4th. Until then care well.