Seminar 21

ADL Strategies for the Caregiver

for the Resident with Dementia

Linda Riccio

11/19/2015

11:00 AM - 12:00 PM

KBN: 5-0002-707-241-1217

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Linda Riccio, OTRLinda Riccio, OTRLinda Riccio, OTRLinda Riccio, OTR

VP of Clinical OperationsVP of Clinical OperationsVP of Clinical OperationsVP of Clinical Operations

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Be SocialTell a Story…..

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Form a relationship first

Then work on task attempt

� Word Retrieval Issues

� Difficulty Multi-tasking

� Performs best with old familiar routines, needs assistance with new routines

� Difficulty with financial affairs, judgment

� Will not acknowledge Will not acknowledge Will not acknowledge Will not acknowledge the need for helpthe need for helpthe need for helpthe need for help

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� Social Butterfly

� Pleasantly Confused

� ADL independent, with lack of thoroughness

� Typically displays “bed head”

� Stays in the “comfort zone”

Care Challenges:Care Challenges:Care Challenges:Care Challenges:

Doesn’t notice errors

“Someone stole my purse.”

Safety issues Safety issues Safety issues Safety issues

“I won’t participate if I don’t feel comfortable”

“Talks the talk” but doesn’t “walk the walk”

Benefits from structure, lists, Benefits from structure, lists, Benefits from structure, lists, Benefits from structure, lists, routines, and schedulesroutines, and schedulesroutines, and schedulesroutines, and schedules

� Tunnel vision

� Living in the past

� Old familiar routines – does well

� New routines: problems!

� Likes to “fiddle” with their hands

Care Challenges:Care Challenges:Care Challenges:Care Challenges:

If I can’t relate. . . . agitation or “shut-down”

Sun-downing and diurnal rhythms

If I can’t find something to “fiddle” with. . . I will go looking

If I can’t understand what is happening. . . I’ll react

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� Delayed thought processes –60-90 seconds

� Agitated if hurried

� Demonstrational and Visual Cues (no language)

� Go SlowGo SlowGo SlowGo Slow, , , , Use Visual CuesUse Visual CuesUse Visual CuesUse Visual Cues

� Postural insecurity

� Looking through binoculars

� Doesn’t pay attention to objects or people in environment

� Finger foods

Care Challenges:Care Challenges:Care Challenges:Care Challenges:

Combativeness during ADL’s

I can’t relate… so I decline quicker

Complications from lack of activity, poor intake

� Overcoming Gravity

� 60 – 90 second delay: Go slow, use visual cues

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ConnectConnectConnectConnect

1.1.1.1. VisuallyVisuallyVisuallyVisually

2.2.2.2. VerballyVerballyVerballyVerbally

3.3.3.3. PhysicallyPhysicallyPhysicallyPhysically

4.4.4.4. EmotionallyEmotionallyEmotionallyEmotionallyRemember…..

Go slow! Go slow! Go slow! Go slow! Wait for the elder to respond…

Use social gestures

The right cuesThe right cuesThe right cuesThe right cues

Early: structure, routine, schedules to guide performance outcomes

Middle: need for familiar routines

� Early: 2 step directions

� Middle: use short phrases with noun/verb combos, step-by-step directions with mirroring

� Late: visual cues & demos, one word, one step, hand-over-hand assist

Late: visual and tactile cues, go slow, hand-over-hand assist

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Familiar activities and daily care routines can occur with ease for a person with dementia, when new and unfamiliar routines may cause confusion and agitation. Below is an interview format to complete with the resident and their family to determine how to plan daily care routines to incorporate the resident’s preferences, habits, and life story. Resident: __________________________________ Date: ____________________

1. Sleep / Wake Cycle:

Wake-Up Time: ______________ Rely on an alarm clock to wake up? Yes No

Morning Routines before dressing / grooming: ______________________________________ ___________________________________________________________________________ Nap Times: _________________ Nap Routines: _________________________________ Usual Time to Go to Bed: _____________ Bedtime routines: ____________________________________________________________ ___________________________________________________________________________ 2. Self-Care Routines: Usual order of completing the following activities (1 = first activity upon arising, 2 = second, etc.)

______ Bathe ______ Shave ______ Brush Teeth ______ Use the toilet ______ Comb Hair ______ Take medication(s) ______ Apply Make-Up ______ Read the paper ______ Dress ______ Make / drink a cup of coffee

______ Feed the pets / animals ______ Watch TV news / weather / sports ______ Eat breakfast ______ Other: ___________________________ 3. Bathing: Preferences (check those that apply):

a. Shower Tub Bath Sponge Bath

Care AreaCare AreaCare AreaCare Area Care StrategyCare StrategyCare StrategyCare Strategy

BathingBathingBathingBathing

Dressing /Dressing /Dressing /Dressing /GroomingGroomingGroomingGrooming

Eating/Eating/Eating/Eating/

SwallowingSwallowingSwallowingSwallowing

ToiletingToiletingToiletingToileting

Transfer /Transfer /Transfer /Transfer /MobilityMobilityMobilityMobility

CommunicationCommunicationCommunicationCommunication

& Hearing& Hearing& Hearing& Hearing

Meaningful Meaningful Meaningful Meaningful ActivitiesActivitiesActivitiesActivities

Resident____________ Dementia Stage_______ Room ________ Date_______

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MODERATE ASSISTANCE:

Resident performs 50% and caregiver performs 50%

BEHAVIOR:

• Handles objects a lot

• Repetitive actions

• Will not start activity

• Lost ability to focus on goal or reason for doing task, but still is interested in materials

• Unpredictable with social contact, may be physically or verbally abusive

COMMUNICATION / COGNITION:

• May be able to imitate action if demonstrated, but requires 1:1 start/stop

• Use of objects is automatic

• No focus on the end of the task

• Speech is often without focus, word finding problems, difficulty paying attention to

conversations. No reaction to new information or mixes new information with past

information.

• Will need repetition to follow verbal directions

GROOMING:

• Will need reminders to perform grooming with assistance for thoroughness

DRESSING:

• Will need reminder to change clothing, with assistance to correct errors (inside out, open

zippers, shoes on wrong feet, etc)

BATHING:

• Will need assistance for thoroughness. Will not initiate bathing tasks (You need to put the

soap/cloth in their hand and help them guide their hand to wash themselves).

FEEDING:

• Able to feed self but requires supervision for intake, food temperature, cutting food, etc

TOILETING:

• Requires escort to arrive at location

• Unaware of dirty or smelly clothing

• Will not e able to start/stop task independently

• Cannot be left alone in bathroom, unable to focus on end of task

PRECAUTIONS:

• Will not recognize need for help; unable to follow safety measures or be aware of danger

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The top 8 strategies for successThe top 8 strategies for successThe top 8 strategies for successThe top 8 strategies for success

1. Focus on the person, not on the task

2. Maintain dignity and privacy

3. Slow down, explain every step

4. Use a sensory connection

5. Keep the Elder warm

6. Help the Elder feel safe

7. Keep the Elder free of pain

8. Help the Elder feel in control

� Rescuing when behavior starts

� Consistency

� Focus on feelings

� Eliminate competing stimuli

� Remember cultural issues

� Hand-over-hand technique – “chaining”

� “Bridging” with a sensory connection

� Distraction: singing, food, talking

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Need appropriate cueing

for movement

within the environment

� Middle StageMiddle StageMiddle StageMiddle Stage: Elders can’t remember to toilet, can’t remember to hydrate, can’t find the bathroom.

� Urge & Stress Incontinence: increase fall risk

� If you ask “Do you need to go to the bathroom?” The answer will be No. Try instead: “Let’s go for a walk” or “I need your help”.

� Late StageLate StageLate StageLate Stage: 2 minute standing tolerance enables incontinence garment change without having to go back to bed (therapy!)

� Install grab bars, toilet rails, raised toilet seats

� Picture of a toilet on the bathroom door – elders with mid and late stage need the visual cues.

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� Rotate plate half-way through meal

� Intermittent Verbal Cueing

� Old familiar routines…. mealtime socialization

� Pre-meal programming

� Pre-meal coffee time

� Activate the hunger center

� Finger foods

� Real food

� Strong preference for sweets

� One item at a time

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Cognitive Leveling Cognitive Leveling Cognitive Leveling Cognitive Leveling Best Ability Best Ability Best Ability Best Ability to Functionto Functionto Functionto Function

ADL Care Strategies ADL Care Strategies ADL Care Strategies ADL Care Strategies Cueing Strategies Cueing Strategies Cueing Strategies Cueing Strategies

Examples of Collaborative Care

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Linda@Vertistherapy.comLinda@Vertistherapy.comLinda@Vertistherapy.comLinda@Vertistherapy.com

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