Care Partner Skill Building

Care Partner Skill Building

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Presenter: Dorothy Colby, Hale Kū‘ike Director of Community Engagement & Positive Approach to Care® Trainer

Date: 3/30/2022

Recording length: 1 hour, 15 minutes

Sponsors: Hale Kū‘ike and Catholic Charities Hawai‘i

Session:

  • Why do we keep arguing? Why can’t he find the bathroom? Why does she sleep all day? We find ourselves in challenging situations like these in dementia care every day.
  • How can we take a step back and become curious, non-judgmental dementia detectives to find out why these challenging situations keep happening?
  • We can learn how to be more effective and helpful in challenging situations by focusing our energy on the elements we CAN change vs. those we CANNOT

Uh-oh, that didn’t go the way I wanted it to! Uh-oh moments happen to us a lot when we are trying to support someone living with dementia. We are trying our best to give loving care, but still we find ourselves in endless arguments and stuck looking for solutions our challenges. If we can step back from these situations and look at them with curiosity and without judgement, we can learn from the experience. We want to turn these Uh-oh’s into Ah-ha’s

When we become dementia detectives, we learn about the brain changes that come with dementia so can start to understand the difference in how someone living with dementia perceives and interpret the world around them, including us, their care partners. We figure out how why loving offers of help might be interpreted as a threat to a changing brain. We work to see the environment through their eyes and understand why it might not be as easy to navigate as we think it is. The Positive Approach to Care®’s Six Pieces of the Puzzle tool can help us to look at all the factors that affect a person, and figuring out where we can make positive changes to help mitigate or prevent challenging situations.

Challenging Situation 001

Each of us as human beings is unique, with a unique personal history. We each have unique personal health and brain health statuses. These are the first three pieces of the puzzle that influence how we experience the world — The Person, Fitness/Health/Wellness, and Brain Change. Looking at these three pieces of the puzzle for yourself, which ones do you have influence to make positive changes? When we are young enough, the one we can make the most positive impact on the Fitness/Health/Wellness piece of the puzzle. Time is on our side.

Now thinking about those who are living with dementia, especially those who are elderly, how much influence do we have on these first three pieces of the puzzle? Who they have been does not change, though how that expresses itself may be different with brain change. We do not have as much influence over their Fitness/Health/Wellness piece as before. In general, because of advancing age and dementia, the person’s health goal has shifted curative measures to maintenance. We just want to try to have things not get worse, if we can help it. That third piece of the puzzle, Brain Change, is an important one to understand so that we can give better support. However, at this point in time, we cannot turn back the clock on dementia-related brain change.

The next three pieces of the puzzle are where we can focus our energy to make positive change — Stakeholders, Environment and Time. Everyone that touches a person living with dementia’s life is a stakeholder. You, other relatives, neighbors, the mail carrier, bus driver, healthcare professionals, they all influence how the person living with dementia experiences and responds to the world. The environment plays a big role in how successfully a person living with dementia moves through the world. Environments need to be friendly, familiar and forgiving of mistakes. The last piece of the puzzle is Time, how a person spends the hours of their day. Every person, whether they are living with dementia or not, needs meaningful engagement every day.

To learn more about challenging situations and how to move the needle on the Stakeholders, Environment and Time pieces of the puzzle, you can view our recorded webinar, “Challenging Situations in Dementia Care: Putting Together the Pieces of the Puzzle.” You can also download the workshop slide deck, GEMS printable poster, and PAC Resource Cards.

For more information about PAC, visit www.teepasnow.com.

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Presenter: Dorothy Colby, Hale Kū‘ike Director of Community Engagement & Positive Approach to Care® Trainer

Date: 3/16/22

Recording length: 1 hour

Sponsors: Hale Kū‘ike and Catholic Charities Hawai‘i

Description:

  • TV, bingo, napping…what else is possible when so many skills are lost?
  • How can we help those we love living with dementia find purpose and meaning in in their day?
  • How do we find moments of joy for ourselves as care partners while supporting someone living with dementia?

In our daily lives we all have four types of activities that fill our days — purposeful, leisure, self-care, and rest/restorative activities. As human beings we need to find a balance of all four to be healthy and feel happiness. When that balance is off, all work and no self-care for example, it can negatively affect our physical and mental health. To feel joy and to feel needed are vital to mental health. Without them we cannot thrive.

People who are living with dementia are no different. They also need to feel a sense of purpose, engage in leisure, be involved in self-care, and rest and recharge their batteries. The brain changes that come with dementia make it increasingly difficult to initiate and participate in activities that they once enjoyed.

As care partners, both at home and in long-term care, the focus tends to be on self-care and restorative activities. We are very good at making sure all the personal care needs are met (meals, bathroom, medications, etc.) and that they get sleep. It can be a challenge to plan and fit in activities that provide leisure fun and a sense of purpose, especially for an already exhausted care partner.

With advance planning and assembling a support team of family and/or professionals, it is possible to help those we care for be engaged with life and find moments of joy. Increasing opportunities for meaningful engagement starts with getting to know the person so that you can tailor activities that are interesting, do-able, and valued by the person who is experiencing so many changes due to dementia. Designing daily routines, but staying flexible, is key as well. Meaningful engagement makes a positive difference for mental health and wellbeing of the person living with dementia and their care partners.

There are two Positive Approach to Care® (PAC) tools that can help in this planning immensely — the GEMS brain change model and the Six Pieces of the Puzzle. The GEMS can help with understanding what abilities are retained throughout the dementia journey. We can then adapt activities to match what skills a person still has for success and joy. The Six Pieces of the Puzzle can help with looking at all the factors that affect a person and figuring out where we can make positive changes. We can figure out what adjustments or changes can we make to the environment, stakeholders (those around them), and how their time during the day.

To learn more about meaningful engagement for people living with dementia, you can view our recorded webinar, “Activities in Dementia Care: Filling the Day with Meaningful Engagement.” You can also download the workshop slide deck, GEMS printable poster, and the PAC Resource Cards.

For more information about PAC, visit www.teepasnow.com.

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Presenter: Dorothy Colby, Hale Kū‘ike Director of Community Engagement & Positive Approach to Care® Trainer

Date: 10/15/20

Recording length: 1 hour, 15 minutes

Sponsors: Hale Kū‘ike and Catholic Charities Hawai‘i

Description:

  • Challenging behaviors, why are they happening?
  • When these challenges arise, what can make it better or worse?
  • It takes two to tango, or to tangle. How can we learn to dance with our partner for a better outcome for both of us?

If you were to ask someone to make a list of challenging dementia behaviors it would be long — repeated questions, paranoia, wandering, using “bad” words, resisting or refusing care, losing important things, and many more. If we look at the brain changes cause by dementia, we can start to understand the difference in how they perceive and interpret the world around them, including us, their care partners. We then can start to understand how our loving offers of help might be interpreted as a threat to a changing brain and these challenging situations occur.

These challenges are not just for the person living with dementia, they are challenges for everyone around them too. We are facing a challenging situation together. If we can take a step back and look at all the pieces of the puzzle that have led up to this challenge, we can learn and make changes to help make it better, or perhaps prevent it in the future. We can learn to be good, non-judgmental dementia detectives.

As detectives we need to examine our human physical needs — the need to eat and drink, to expend or recharge our energy, eliminate waste, be comfortable and free of pain. We need to look for signs of basic human emotional distress — anger, sadness, loneliness, fear and boredom. When any these needs are not met, whether we are living with dementia or not, we experience challenging situations and distress.

We can use the Positive Approach to Care® GEMS brain change model and the Six Pieces of the Puzzle to help us with our detective work. The GEMS can help with understanding what abilities change throughout the dementia journey and how we can adjust to them. The Six Pieces of the Puzzle can help with looking at all the factors that affect a person and figuring out where we can make positive changes to help mitigate or prevent challenging situations.

To learn more about challenging situations for people living with dementia, you can view our recorded webinar, “Challenging Behaviors: Recognizing Unmet Needs.” You can also download the workshop slide deck, GEMS printable poster, and the PAC Resource Cards.

For more information about PAC, visit www.teepasnow.com.

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Presenter: Dorothy Colby, Hale Kū‘ike Director of Community Engagement & Positive Approach to Care® Trainer

Date: 10/1/20

Recording length: 1 hour

Sponsors: Hale Kū‘ike and Catholic Charities Hawai‘i

Description:

  • Dementia changes the sensory input systems. What does the world look, sound and feel like for someone living with dementia?
  • Visual, verbal and touch processing are all affected. How can we get connected despite these changes?
  • How can we become “care partners” instead of “care givers” in this dementia journey?

When we think about dementia changes, the focus is typically on memory changes. In fact, the entire brain and all its functions are affected by the diseases that cause dementia, not just the memory center. If we want to have effective communication and meaningful connections with someone living with dementia, we need to understand how other brain functions are affected.

As human beings, we want to see what is coming to feel safe. If there is a sound outside our vision, we turn and look. If we feel a touch we didn’t expect, we turn and look. When we are taken by surprise by something we see, hear or a touch, our fight-fright-flight response kicks in. Once we determine it is not a threat, then we can quickly start to relax and return to our calm baseline.

People living with dementia are no different. If they are taken by surprise, their fight-fright-flight response also kicks in, but because of their brain changes, it is much more challenging for them to process if something is not a threat and return to a calm state. If we do not want to kick off that fight-fright-flight response, we need to make sure we get a visual connection first before coming in to talk or touch.

The occipital lobe of the brain processes what we see in the world. We have a central field of active vision, and a wide peripheral awareness that is our safety vision. With all dementias, peripheral awareness narrows drastically, leaving a very narrow tunnel of active vision. The person simply is unaware of activity and objects outside that tunnel. It can be like looking at the world through a pair of binoculars. This often leads to trip and fall hazards and getting surprised by care partners touches.

The temporal lobes that process language are also affected. You might notice that a person living with dementia has trouble finding words or forming coherent sentences. This is paired with a change in comprehension. We talk and the person living with dementia hears us, but they cannot understand the content of your speech. Rhythm and musical abilities are preserved. So even though someone might not be able to speak, they can sing the words of old songs, prayers or poems they knew when they were young.

The Positive Physical Approach™ (PPA) and Hand Under Hand™ (HUH) techniques help us get connected in positive way. Their simple steps keep us in a person living with dementia’s narrow field of active vision, help us adjust our language to their changing language skills, and to get permission before touching. It is a dynamic assessment tool that allows us to build our relationship with the person we are trying to support, so that we can be “care partners” in everything we do. It helps us do “with” instead of “to” a person.

To learn more about dementia-related sensory changes, PPA, HUH and communication techniques, you can view our recorded webinar, “It’s All in Your Approach — Making Positive Connections.” You can also download the workshop slide deck and PAC Resource Cards.

For more information about PAC, visit www.teepasnow.com.