Alzheimer's Caregiver Manual

Alzheimer’s

Caregiver

Manual

For families and caregivers of persons

with memory loss from Alzheimer’s disease and other dementias

house of welcome adult day services specialized programs for persons with memory loss 1779 winnetka road, northfield, illinois 60093 • phone 847.242.6250 • fax 847.242.6275 • www.nssc.org

TABLE OF CONTENTS

Introduction 1

Memory and Aging 2

Is it Alzheimer's Disease? 4

Early Memory Loss 7

Person-Centered Care 8

Communicating Effectively 13

Behavioral Changes 16

Managing Activities of Daily Living 21

Staying Active and Involved 26

Caring for the Caregiver 31

Resources 36

Bibliography 38

House of Welcome Adult Day Services back cover

INTRODUCTION

This manual is an effort to put together helpful information, in a concise and easy- to-read format, for families and caregivers of persons with memory loss from Alzheimer's disease and other dementias. It is hoped that the information in this booklet will be of some assistance. In addition to the formal sources of information listed in the bibliography, information in the manual comes from many years of professional experience at the House of Welcome (HOW), North Shore Senior Center’s specialized adult day services for persons with memory loss, as well as personal experience with my own mother, who died from Alzheimer’s disease. Knowing and working with these families and individuals is a privilege. They are our best teachers. Julie Lamberti, LCSW, Director House of Welcome Adult Day Services 1988-2014

The information and advice presented in this manual apply to persons with memory loss from Alzheimer’s disease and other dementias and these dementias are found in both men and women. For ease of writing, the terms Alzheimer’s disease, memory loss and dementia are often used interchangeably and the he/she and his/her pronouns are alternated by chapters.

MEMORY AND AGING

“How do I know if it’s Alzheimer’s physical illness, some medications, disease? Can memory loss just be part vision and hearing problems, alcohol, of getting older? When do I know it's a and poor nutrition. Memory may be problem?" more affected in older people, because Memory and Aging These are they may have more of these factors good questions because there are operating at any one time. common, normal changes in our Reasons People Forget There are memories as we age. And, there are also many reasons you may forget many factors that affect memory in something, whether you are young or people of all ages. There are also old. You didn't pay attention to it. You indications when there is a serious didn't really hear it, understand it or problem that needs attention. care enough to remember it. You got Many of us have anxiety about distracted by something else or you our own memories. You should know didn't need to remember it. You may that most people over the age of 65 do also forget it if the memory is too similar not suffer from severe memory loss or to other memories, or you don't know cognitive impairment. If you don't much about something and have little develop a disease that damages the with which to associate it, or you don't brain, like Alzheimer's, most brain have enough cues to retrieve it. functions remain intact throughout life. Common, Normal Changes in The aging brain does lose cells and Memory as We Age Most of us have changes in some ways, but it also noticed changes in our memories as we continues to have a good capacity to have aged. There are changes that are compensate, recover, and rewire itself— common and normal and nothing to not as well as a baby's brain, but it can worry about. Although very short-term still do a pretty good job. Think about it, memory seems to remain much the though. A teenager has more brain cells same (remembering a phone number to than an older person, but would you dial just after looking it up), short-term want a teenager as a Supreme Court memory (recent events) seems to Justice? diminish. We just seem to have a harder Factors Affecting Memory There time adding information to our memory are many factors that affect memory in and recalling recent events. people of all ages—stress, inattention As we age, it's harder to pay and distraction, anxiety, depression, attention to more than one thing at a loss and grief, inactivity, lack of time. We are more easily distracted. It organization in daily life, fatigue, takes greater effort to learn something

new. We can learn new things, but it those that the disease process takes longer. It becomes increasingly damages. more difficult to access familiar names There's research focusing on and vocabulary words on demand, that nutrition, certain medications and other is, retrieval is slower, especially for factors such as lifestyle, attitude and names. outlook, and their effects on memory. It is believed that some memories Other research on maintaining and fade over time, for example, foreign protecting cognitive functioning relates language vocabulary words we learned to keeping mentally active, which may in high school. And, memories change have a protective effect. Common sense over time. They are overlaid with other tells us it sure can't hurt to keep active experiences. They change as you and involved and stay engaged in remember and retell them. That's one activities new and old. Clearly, it's of the reasons two people at the same important to maintain good health— event recall it differently later. However, especially cardiovascular health— there's no change in vocabulary, through proper nutrition, exercise, and judgment, comprehension and general avoiding smoking and excess alcohol. information, which add up to wisdom. For persons who are not Keeping Our Brains Fit There's a experiencing a disease process, there lot of research into why and how good are a number of tips, strategies and cognitive functioning is maintained into techniques for improving memory. They old age. Some studies have indicated include concentrating on what you want that one's level of education is a to remember, making lists, forming predictor. It's thought that education associations, getting organized, increases the number and strength of developing habits and routines, writing connections between brain cells. This things down, rehearsing, using rhyme may help older people maintain their and rhythm, and using acronyms. There mental functioning and may also delay are also a number of memory the symptoms of Alzheimer's disease enhancing courses offered in the when it is present, because there are community more connections to compensate for

IS IT ALZHEIMER’S DISEASE?

Is it Alzheimer’s? Although most people wife, an ongoing problem may become experience changes in memory as they more obvious to unaware family age, these changes should not interfere members. with the ability to function What is Alzheimer's Disease? independently. When you start to see First and foremost, Alzheimer's disease changes or behaviors that are a threat is not part of normal aging. Serious and to safety or interfere with a person's chronic memory problems are not ability to be independent, these are normal at any age. Alzheimer's disease indications that the process is not is one type of dementia. Dementia is a normal and you need to intervene and group of symptoms that characterize a take action. number of diseases or conditions. It is a For example, your husband gets decline or impairment of memory and lost for four hours driving home from other intellectual functions that is the grocery store he has frequented for serious enough to interfere with a twenty years. Or your father, who took person's independence and ability to meticulous care of the family finances perform normal activities of daily living. for the past forty years, is now What's important to remember is that repeatedly bouncing checks and not there is a disease process that is paying bills on time. You may find moldy damaging the brain and this is what food in the refrigerator or no food at all causes the cognitive changes you see. in spite of your mother's reassurance What used to be called "senility" we now that she is eating regular, nutritious know is Alzheimer's disease or other meals. Burnt pots may be found in the dementia and not a natural cupboard. consequence of aging. Families, or the person himself, Symptoms In addition to memory sometimes note subtle changes and get loss, symptoms of the illness include the feeling that something isn't quite loss of language functions; inability to right. Often a person in the early stage think abstractly, use good judgment and of Alzheimer's disease will become make good decisions; disorientation to more withdrawn at social gatherings or time, person and place; mood and give up interests and hobbies for no personality changes; and changes in apparent reason. Sometimes a crisis, behavior. for example, a hospitalization, brings to Causes/Types of Dementia The light a developing problem. After the more the medical/scientific community death of a spouse, who has been learns about dementia, the more compensating or covering up for his complex a picture emerges.

There are many reasons for often broken down into 3 stages lasting dementia, the most common being from 2 to 20 or 25 years. The average Alzheimer’s disease (AD). Other causes life span after diagnosis is 8 years. of dementia include Mild Cognitive The early stage/mild dementia Impairment (MCI), Vascular Dementia, lasts from 2 to 4 years and leads to Dementia with Lewy Bodies, diagnosis. The most common early Parkinson’s Disease, Frontotemporal symptom is short-term memory loss. Dementia, Creutzfeldt-Jacob Disease Also present is mild confusion and (CJD), Normal Pressure Hydrocephalus, disorientation, mild communication Huntington’s Disease, Wernicke- difficulties (words and names), impaired Korsakoff Syndrome, and brain injury. judgment and inability to make sound Evaluation A small percentage of decisions, and some personality and people with symptoms of dementia behavioral changes (depression, have a treatable condition, such as withdrawal, hypersensitivity, depression, malnutrition, thyroid suspiciousness). For example, the disease, acute or chronic infection. person forgets to pay bills and has Sometimes medications can cause problems handling money, has difficulty memory problems and confusion. For cooking, loses things, gets lost driving these reasons, a thorough evaluation by familiar places, takes longer to do an internist, neurologist or psychiatrist chores. is always recommended. With a good The middle stage/moderate evaluation—medical history, mental dementia is the longest, lasting from 2 status evaluation, physical and to 10 years after diagnosis. All the neurological exams, lab tests and symptoms of the first stage become sometimes psychiatric or other progressively worse and there begin to evaluations—other reasons for the be some difficulties completing cognitive problems are ruled out and activities of daily living (dressing, probable Alzheimer's disease is the bathing, eating, etc.) There may also be diagnosis by exclusion. Studies have increased behavioral changes. For shown that these diagnoses are 80 to example, the person repeats questions 90% accurate, although a diagnosis of and stories, has difficulty expressing Alzheimer's disease can only be self verbally, has problems with reading confirmed by an autopsy of the brain. comprehension, confusion about people Frequency of Dementia Currently, and relationships, may gain weight, has Alzheimer’s disease affects more than 5 visual-perceptual problems, refuses to million Americans and this number is bathe, wears the same clothes all the rising. Of people age 65 and older, time. about 10% have Alzheimer’s disease. The late stage/advanced The incidence increases with age with dementia is 1 to 3 years. During this an estimate of about 45% of those age stage, the person becomes totally 85 and older. dependent and often requires nursing Stages Alzheimer's disease is home care. For example, the person

sleeps a great deal, has severely limited very complex and there may be many verbal expression or may be mute, has different types caused by a variety of difficulty swallowing, loses weight, has influences. limited mobility. Treatment In terms of medical Keep in mind that these “stages” treatment, drug research studies are in some ways artificial and should continue. Drugs approved by the FDA to be viewed as guidelines. Each person is treat Alzheimer's disease are available. unique in his or her progression through None cure the disease or entirely stop the illness. the progression. They may help some History In 1906, Dr. Alois persons for a period of time. However, Alzheimer, a German physician, treatment is individualized and options presented his findings of a brain should be discussed with the person’s autopsy of a 56-year-old woman who physician. had died with dementia. He described The other "treatment" is the neuritic plaques and neurofibrillary psychosocial/behavioral/environmental tangles (degenerating brain cells) that —in other words, all the things are still the diagnostic signs looked for caregivers can do to support quality of during brain autopsy to confirm life and optimal functioning for the Alzheimer's disease. In 1910, the person with memory loss. This is the disease was named for Dr. Alzheimer. essence and heart of dementia care. For some time, it was thought to be Although there is a general found in younger people only and called decline and progression through all of pre-senile dementia. The signs of the stages and symptoms of Alzheimer's dementia or "senility" in older people disease, each person is unique in how were thought to be normal, from some he or she presents with this illness. No unknown cause, or "hardening of the one can tell you exactly what the future arteries." It wasn't until the late 1960's will be for your family member, although that British physicians determined that you can be told what to expect. And, in what we called "senility" in older people spite of the cognitive changes and was primarily due to Alzheimer's losses, your family member will still be disease. capable of relationships and meaningful Theories There are many theories activities. Through all of this, it is about causes of Alzheimer’s disease, important to remember that “the person but no one knows for sure. There seems comes first” (to quote from Tom to be genetic involvement in some Kitwood’s philosophy of person- forms of the disease and there does centered care), the need for ongoing seem to be some genetic predisposition quality of life, and that there are people for the illness. However, current and programs to help you and your thinking is that Alzheimer’s disease is family through the process.

EARLY MEMORY LOSS

As information about Alzheimer’s Educational/support groups for disease has become increasingly persons with early memory loss and available, more and more individuals their families and friends are a great are seeking evaluation and being source of information as well as coping diagnosed early in the disease process. techniques. They can help with learning Early diagnosis presents many about current medical and research challenges and opportunities for the information, legal and financial person, as well as family and friends. planning, changing roles and It’s difficult to exactly define early responsibilities in social and family memory loss, and, as in other stages of relationships, daily living skills, problem the disease process, no two persons solving and community resources. are exactly alike. In general, though, Group activity programs specially persons with early memory loss may be designed for persons with early memory very much aware of their diagnosis and loss address these issues in addition to the cognitive changes they are providing socialization and stimulation. experiencing. They may be able and In the early stage, as in all stages even eager to talk about their situation of memory loss, learning about the and be involved in future planning. They illness, finding support, and planning for may be involved in making and the future, while continuing to be active preparing for changes necessary as the and involved and maintaining a quality disease progresses. They may be able of life are important. to continue to function with some All of the information in this degree of independence for a period of manual applies and can be adapted to time. Their independence and control persons with early stage memory loss. over their lives should be encouraged (It is important here to distinguish and respected unless it presents safety between early memory loss and early- concerns for themselves or others. This onset or young-onset memory loss, is where it can get tricky, as issues which refer to the age of onset, about driving, managing money, or generally under 65 years old, not the being alone begin to emerge. stage of dementia.)

PERSON-CENTERED CARE

Person-centered care, a philosophy and Actually, person-centered care approach to caring for someone with has been practiced in many settings by memory loss from Alzheimer’s disease many individuals for a long time— or another memory disorder, is reflected families, friends and professional in all of the advice and information in caregivers with good instincts and good this manual. hearts who have learned, through Good caregiving requires a good experience, training and education, foundation involving our understanding what works well in understanding, being of the other person, our attitudes, our with and caring for persons with feelings, our philosophy and approach dementia. It has also been to care. If these aren’t right, nothing will conceptualized by many—Virginia Bell work quite as well. and David Troxel’s Best Friends Person-Centered Care The Approach to Alzheimer’s Care, Carly philosophy and approach of person- Hellen’s Activity-Focused Care, Jitka centered care was developed by Dr. Zgola’s Relationship Approach to Care, Thomas Kitwood, a social psychologist in addition to Tom Kitwood. with the Bradford Dementia Group at What is Person-Centered Care? the University of Bradford in Bradford, The premise of person-centered is really England, and is presented in his book, quite simple. Persons with dementia are Dementia Reconsidered: The person persons like you and me with all the comes first. Person-centered care came same needs, wants and desires. Those into vogue a few years ago, although of us who care about and for them need there’s actually nothing terribly new to keep this first and foremost in our about it for those of us involved in good minds, and it is up to us to adapt to dementia care for many years. However, changes in them to provide the best there is something special about the quality of life we can and to see that way he articulates and conceptualizes those needs, wants and desires are it. His writing is unique. Kitwood was an satisfied as fully as possible. Anglican priest before he became a Kitwood implores us to see a social psychologist and that really person with dementia as a person first. comes through. There’s a passion and That is, we should see a PERSON with spirituality in his writing that is dementia, not a person with DEMENTIA. inspirational. So, this information may Person-centered care maintains not be new to you, but hopefully it will and upholds the value, dignity and validate and energize you. And, perhaps respect of the person, recognizes and you will discover a few new insights. honors the individual, despite the level

of cognitive impairment. as a person. This includes being Person-centered care sees so- greeted cheerfully, making good eye called “problem” behaviors as attempts contact, using a person’s name, at communication—letting us know what listening. At HOW, when our is needed or what is wrong. We participants arrive, they are greeted caregivers should see these situations with a warm, “Hello, Bill, how are you? as opportunities for communication We’re so happy to see you.” It makes a with the person. difference. Recognition doesn’t have to Person-centered care believes all be verbal—good eye contact and smiling behavior has meaning—all action is are ways of connecting. A variation on meaningful. recognition are memory/life story Person-centered care attempts to books. In providing recognition, provide for the needs of the person. caregivers need to see each person What do Persons with Dementia with dementia as a person first—a Need? What do persons with dementia unique individual. There’s a saying, “If need according to Kitwood? you’ve met one person with dementia, They need comfort—support, you’ve met one person with dementia.” warmth, tenderness in times of anxiety In my work at HOW, I’ve met hundreds and need. of people with dementia and no two are They need attachment—to be in the same. They are individuals just like relationships with others, to be bonded you and me—they are you and me—with with others, perhaps even more than unique histories and personalities, and the rest of us. good caregivers need to be able to see They need inclusion—to be part of and appreciate this. things, to be part of the group, to feel Negotiation—allowing persons like they belong. with dementia as much control as They need occupation—to use possible and appropriate; consulting their abilities, to work, to play, to help, them about their wants and needs; to be involved in activities. giving them some power and control. At They need to have a sense of HOW, we invite participants to join in on identity—we need to hold their activities, but never force them. We ask memories, life histories and their pasts for their input into the daily schedule of for them and to respond to them in the activities. Give choices that can be present as unique, valued persons. managed, for example, “Would you like Persons with dementia have apple juice or water?” You must always limited ability to get their needs met. It take into account the level of ability and is up to us to help them. not overwhelm the person with Kitwood’s Twelve Types of decisions, but as much as possible, give Interactions In his book, Kitwood lists choices. In negotiation, caregivers need 12 types of interactions that comprise to forget about their ideas of what good dementia care. needs to be accomplished and how, Recognition—being acknowledged and ask, consult and listen to the

persons with whom they are working. massage. For these types of activities, Collaboration—“working together” caregivers need to be comfortable with with the person. Rather than doing touch and sensuality. things to and for a person, join together Celebration—of holidays, special to get it done. For example, when a occasions or of spontaneous joy. This person can no longer dress can become difficult and forgotten if independently, lay clothes out and give you are feeling overburdened and burnt cues for dressing, or have your spouse out. Don’t give up your celebrations. help with dinner by chopping carrots for Modify and adapt them so they are the salad or setting the table. At HOW, manageable, but continue them. In we do everything together. It takes celebration, caregivers need to be able longer, and as a family caregiver you to put work aside and be open to joy can’t always do this, but do it as much and grateful for the moment and the life as you can. We all need to feel like we they have. are still competent and capable. With Relaxation—the need for time out, collaboration, good caregivers allow as recharging our batteries. People with much control as possible and refrain dementia may need more of this, from imposing their will. One of our because of the increased difficulty participants once told us, “I love coming handling stimulation. Often people with here. It gives me a place to come and dementia need another near them or something to do. We all need something touching them to relax. It’s important to to do.” remember this need for time out and to Play—which Kitwood defines as plan for it. Caregivers themselves also activity that “has no goal that lies need to be able to slow down, let go, outside the activity itself.” In other and take a break. words, have some fun. We probably do Validation—acknowledging a this best at HOW when the children visit person’s reality and feelings, trying to for our intergenerational programs. It’s understand his or her experience and easy to play when children are around. responding back in a supportive way. Play games. Tell jokes. In play, It’s empathy to the highest degree. caregivers need to be able to be open When someone is upset and asking for to the fun of the moment. his or her mother and looks scared, Timalation—is a British word for acknowledge it. “You seem scared. sensory stimulation activities, for Mothers are great at making us feel example, aromatherapy or massage. safe. Tell me about your mother. Was These activities can provide contact, she good at making you feel safe? I’m stimulation, reassurance and pleasure sorry she can’t be here with you now, in a direct manner without a lot of but I’m here and you are safe with me.” expectations or demands on the With validation, caregivers need to be person. These activities work well in the able to connect and be open to the later stages, but are appropriate at any experience and feelings of the other stage. You can do hand or foot without their own presumptions.

Holding—Kitwood’s metaphor for to be able to accept what the person “providing a safe psychological space,” with dementia gives and allow allowing the person to safely feel and opportunities to do so. The caregivers express emotions, including fear and are the receivers. anger. When someone is upset, ask him I think we can all agree that or her what’s wrong. Acknowledge person-centered care is a good thing. feelings and frustrations, don’t deny or It’s a good thing for persons with dismiss them. When someone is fearful dementia. Heck, it’s a good thing for all or angry about the changes in his or her of us! memory and mental functioning, Good dementia care is simple, it’s validate this fear or anger, and offer basic, and it’s about what’s really reassurance. With holding, caregivers important in life. But it’s not always so need to be able to tolerate the feelings easy to do. and emotions being expressed, while At the risk of stating the obvious, offering reassurance. it’s all about the quality of our Facilitation—Kitwood says is interpersonal interactions. The details “enabling the person to do what of how we relate to persons with otherwise he or she would not be able dementia are exceedingly important. to do, by providing those parts of the Good dementia care is action—and only those—that are demanding on the caregiver. Kitwood missing.” In other words, don’t do what talks of British society and culture as they can do for themselves. Only not naturally inclined toward good intervene as necessary, but do provide dementia care. I think this also holds the structure, support and assistance true in our culture. Although these are needed so they can do things broad generalizations about our themselves. With facilitation, the dominant culture, we tend to be caregiver needs to be responsive to the thinkers, problem-solvers, highly valuing direction and action of the person with people for their intellectual capacities dementia. It’s a delicate balance of and accomplishments, and status is being sensitive to what the person related to wealth and material needs without going too far. possessions. We rush around; we’re Creation—creative expression, overstimulated; we’re distracted; we’re spontaneous singing or dancing. disconnected. Creative arts therapies are very Quite to the contrary, persons effective in dementia care. They are with dementia need our time, our failure-free. With creation, the caregiver attention, our love, our compassion, accepts and acknowledges creative and our presence. Other cultures view gestures and actions of the person with dementia differently. Some Native dementia. American communities call persons Giving—the person with dementia with Alzheimer’s disease “time expressing concern, affection, and travelers,” and they are treated with reaching out to others. Caregivers need special reverence.

Qualities of Good Caregivers What difficulty with and what are their does it take to be a good caregiver? strengths. Who are good caregivers? What are In summary, person-centered their qualities? care is about being a good, caring Good caregivers must have the human being in relationship with ability to be present for the person another person. It’s basic, it’s simple, receiving care. They must be it’s about being present and available emotionally and psychologically emotionally. It’s about knowing people available. For persons with dementia, as individuals, who they are, their the here and now is where it’s at. We history, their personalities, their need to be there with them. We don’t strengths, wishes and needs. It’s about have to “do” so much as “be.” We must accepting people for who they are and be willing to give of ourselves—our time, where they are at, providing support attention, caring and compassion. and validation, working together with We need to know and understand them, providing autonomy and control persons with dementia by as appropriate, celebrating and having understanding their personality styles fun, and accepting what they can give and coping skills. We must know their back. life histories, likes and dislikes, and As Kitwood said, good dementia special memories. We need to know care “may become an exemplary model about their physical health and of interpersonal life, an epitome of how limitations. We need to understand their to be human.” cognitive limitations—what do they have

COMMUNICATING EFFECTIVELY

Alzheimer’s disease and other reminded of a story about a woman who dementias affect a person's ability to seemed unaware. A neighbor spoke communicate. It's important to about the woman to her husband in understand the changes and adapt our front of her as if she was not there, and manner of interacting with the person. the woman began to cry. Clearly, she Early Memory Loss Early in the understood. illness, vocabulary shrinks, the person Techniques There are techniques will have trouble finding words or use that can enhance communication with wrong but similar words. She may the person with memory loss. become quiet or withdrawn or make Approach the person from the comments that may seem irrelevant. front making eye contact. Address the Moderate Dementia Later on, person by name, identify yourself and there is further vocabulary loss and your relationship and explain why you difficulty naming things. The person are there. For example, “Hi, Mom. It’s may not be able to fully understand your daughter, Julie. I’m here to visit what is read or spoken and may be with you today.” aware of her own language mistakes Express your message in simple, but unable to correct them. straightforward terms telling the person Advanced Dementia In the what you want her to do, not what you advanced stage, vocabulary is very don't want her to do. For example, not limited. There is extreme difficulty in "Mary, don't sit there." Instead say, speaking and the person cannot self- "Mary, sit here." correct. She may appear mute. She Give the person choices and a probably cannot understand the written sense of control as much as possible word, and it is unclear how much she and appropriate, but don't give choices understands of what is spoken. when the person can't make them or A word of caution—at any stage, there really is no choice. For example, even though it may appear as though “Sylvia, would you like apple juice or someone is unaware or unable to water?” Or, “Sylvia, here’s some juice understand, you must never assume for you to drink.” this and never speak as if the person is Avoid inappropriate questions not there. You should still include her in and never ask a person if they conversations, speak to her as an adult remember something. That is, don't ask and as if she is able to understand, and questions that the person may not be never say anything in front of her you able to answer, putting her on the spot. would not want her to hear. I am Provide her with cues and information

in your questions or comments. For Don't say, "Now, you know your mother example, "Ida, you raised five children. has been dead for 15 years." Say, "Your I’ll bet that kept you very busy.” mother was a wonderful person, wasn't If your mother asks about she?" Or, "Tell me about your mother." breakfast that was just eaten half an Or, "Your ride will be here at 3:00," if hour earlier, never respond, “Don’t you she is waiting for someone to pick her remember that you just had breakfast?” up. This is called "validation therapy" Reminding her that she did, in fact, rather than "reality orientation" and it have breakfast will only make her feel works better. Correcting the person only badly. You might offer a snack or say, makes her feel badly. You may bring her “We’ll be having lunch soon.” around to reality gently, but do not be Divide tasks into simple, step-by- confrontational about it. step directions. For example, "Unbutton Keep your sense of humor. Don't your coat...Take off your coat...Hang up be afraid to laugh. Once, I was helping a your coat." Use your judgment in woman in the bathroom and we were breaking down the steps based on the struggling to get her slacks down needs of the person. because they were a bit tight. Both of us Use nonverbal communication, were uncomfortable and tense. Finally, I cues and all senses. Touch is important said, "Boy, Sally, these are some tight and helpful. Point to things and pants!" (What woman can't relate to her demonstrate. pants being too tight?!) We laughed Match your tone of voice, facial together at the situation and both of us expression and demeanor with what relaxed. you are saying, and remember always Encourage reminiscence. The to speak to the person as an adult, person with memory loss remembers being aware of your tone of voice. the distant past better. It was a time Conflicting verbal and nonverbal when she was functioning well, so she messages are confusing, and persons feels good talking about it. with dementia are often very sensitive Identify and acknowledge the to nonverbal messages. person's feelings if she is angry, sad or Speak more slowly than normal frustrated. Offer acceptance and and give the person time to process reassurance, comfort and empathy. I information. Repeat a question or believe that a person with memory loss request again using the exact same knows that something is wrong even if words. If this doesn't work, try different she denies it. If someone is upset, ask words or a different approach. what’s bothering her or try to articulate Avoid rational explanations and it for her. If she seems anxious but can’t don’t argue or correct the person. speak the words, say, “You seem Accept the person's reality and try to anxious about something. I’m here with understand what she is trying to you to be sure everything is ok.” communicate. For example, you are Hallucinations and Delusions asked, "When is my mother coming?" Sometimes the person with memory

loss will have hallucinations (seeing, common courtesy. These are general hearing, feeling or smelling things that guidelines. Use your intuition, creativity are not there) or delusions (thinking and your relationship with and things that are not real). If it is not knowledge of the person you are caring upsetting to her, go along with it. You for. Try different approaches. What can also use distraction or redirect the works for someone else may or may not person when this happens. Don't work for you. Try and try again, because confront her or try to rationalize. After a what doesn't work today may work long afternoon of football on TV, one of tomorrow. our participants asked her husband Above all, remember that persons upon retiring to bed, "What are we going with memory loss are still persons to be to do about all those football players treated with love, dignity and respect. downstairs in the family room?" Her Put yourself in their shoes and imagine husband replied that they would see what it must be like. It’s really themselves out and his wife turned over unimaginable, but think about what it and went to sleep. must be like to be living in a world that If hallucinations and delusions is becoming ever more strange and cause the person to be frightened or confusing, and to be losing the roles agitated, you may want to speak to her and responsibilities and relationships doctor about medication. you once thrived on. To try to Late Stage Communication understand, show respect, allow as Communication in the late stage is still much independence as possible, and important. Talk to the person as you give love are just a few small ways we normally would. Share information can all make this illness a little more about family. Touch is very important. bearable. Be aware of sounds, facial and body With all of this, we learn from movements as her way of each other and from the persons we communicating with you. care for. A lot of this is common sense and

BEHAVIORAL CHANGES

The person with Alzheimer’s disease or he is going through in terms of the other dementia will experience challenges of caregiving. Sometimes behavioral changes. It is important to the best solution to this problem is to remember that these changes are the have the doubting person spend a good result of the person’s effort to chunk of time caregiving. compensate for or adapt to the changes General Principles There are in his mental functioning. It's difficult to some general principles to keep in mind predict the course of behavioral when dealing with changes in changes for individuals because each functioning and behavior. person is so different, but there are Alzheimer’s disease can cause common trends and themes. changes in behavior that are not Completely unmanageable or violent purposeful on the part of the person. behavior is the exception. Often, When someone refuses to bathe, it's behavior identified as “troublesome” is not because he doesn't want to or has the result of the environment or the become "slovenly." It's probably manner in which the person is being because he is frightened of the treated, and can be avoided. experience, anxious because he's not All behavior is an attempt to sure how to do it anymore, or communicate. Persons with dementia embarrassed to accept help with such are doing the very best they can and an intimate area of personal care. probably working a lot harder at it than You may need to let go of your the rest of us. We need to try to concerns about some of these changes understand their behavior. in behavior. When someone is seeing Social skills usually remain intact people who are not there and having a for some time. The person will "rise to friendly conversation, he is not upset, the occasion" and tend to function at but you may be. Another person may his best when in public or with remove his dentures at the dinner table. "strangers." Isn't this true for all of us? He is not upset, but you may be. You At HOW, we meet with participants need to ask yourself if it's worth getting before they enroll in the program. upset or if it's something to get used to. Frequently, the family member will The caregiving environment has a speak to us after the visit and report significant impact on a person’s that their loved one functioned much functioning and behavior. This is a very better than usual. Because of this, important concept. Good caregiving others often don't understand or believe techniques can make a world of the caregiver when he describes what difference. Learn as much as you can

about them. This booklet is a good start the group. and you already know a great deal Techniques Good communication yourself, but there are many good techniques are imperative. These have sources of information. There are books been discussed at length previously. to read, literature from the Alzheimer's Maintain a calm, patient, loving Association, educational seminars. manner. Get the person's attention Support groups are a great source of before speaking to him. Maintain good sharing of coping skills. eye contact. Speak simply, but keep It's important to make the your tone of voice as though you are environment trusting and secure, speaking to an adult, not a child. Avoid allowing as much freedom and too many questions or directions at one independence as possible. Use the time. Provide simplified and modified person's remaining strengths and step-by-step instructions when assisting abilities. When a person feels with tasks or giving directions. Speak comfortable and secure, when he feels more slowly than normal and give the like he is able to do things for himself person time to process the information and others, when he feels accepted and and respond. understood, he will feel good and will Try to anticipate behavior instead function at his best. Isn't this how any of of reacting to it. For example, when you us would react? The point is that people go out to a restaurant to eat, remove with Alzheimer's are people and we the clutter from the table—salt, pepper, need to keep this in mind at all times. sugar, condiments, etc. This may We must remember that person and prevent the person from pouring salt relate to that person. into his coffee. Look for the meaning behind the Keep things simple, structured behavior. Try to understand why the and routine. It's important to have a person is doing what he is doing. With predictable schedule. Even if the person this information, you will be able to doesn't remember what he did a few intervene more effectively. hours ago, there seems to be a One morning, a participant was at familiarity and comfort with a regular our front door refusing to come in. One schedule and routine. At the same time, of our staff went out to assist his wife, you need to be flexible. If something who thought her husband might be just isn't working, you need to have plan afraid that someone in our group was "B." going to hurt him. This gentleman had Try not to criticize or correct. This been experiencing paranoid delusions just makes the person feel badly. Go as part of his illness. Our staff member along with what he says, even if it isn't asked him if he was afraid. He right. If your husband thinks he still responded that he was and she works, let him think that. We had a reassured him that he would be safe gentleman who came to HOW whom we inside and no one was going to hurt "paid." He thought he was working for him. With that, he relaxed and joined us—would not attend under any other

circumstances—and it made him feel be here at 3:00 and then ask him to good. help us serve juice. If someone is doing something Use reassurance and praise. It that needs to be changed or stopped, makes the person feel good and don't don't say, "Don't do that." Say, "Do this." we all function better when we feel For example, if you want the person to good about ourselves. But don't overdo sit in a different spot at the table, say, it. People are sensitive to being "Bill, would you please sit here," instead patronized. of, "Bill, you know that's not your usual Proper rest and nutrition, regular place." physical activity and exercise are Avoid logical explanations when important. They relieve stress and the person is no longer able to reduce restlessness. understand them. Don’t argue or Keep the physical environment confront. Present things in a manner simple, consistent and safe. Remove that will be comfortable and reassuring clutter and have clear pathways and for the person. For example, if your wife safe places to pace or wander. Avoid insists that the children still live at too much noise or too many things home, don’t correct her. Engage her in going on at once. Overstimulation can reminiscence about your family life. If cause anxiety, confusion and agitation. your husband resists attending a day Keep the person active and program, don’t discuss it at length. On involved in life. He needs to feel useful, the day he attends the program, tell him productive, to have roles and you are going to bring him to visit his relationships. Adult day programs can friends. If your father anxiously asks help meet these needs. where his mother is (who is long Afternoons and evenings are deceased), tell him she’s not here now sometimes more difficult, so plan and talk to him about her, what she was restful, calming activities and routines. like, and what she meant to him. Tell Keeping the person active earlier in the him that you know that she was a day also helps. comfort to him and that you’ll try to Addressing Particular Behaviors provide similar comfort. Following are some tips on addressing Don't tell the person about plans particular behaviors. ahead of time. It only makes him Catastrophic reactions occur anxious and he's likely to be up at 2:00 when a person becomes extremely a.m. getting ready for that doctor's upset. Look at the environment for what appointment you told him he had. might have triggered it. Were there too Use diversion. When a behavior many questions or too much stimulation becomes troublesome, distract or divert or was the person unable to perform the person to another activity. One of the requested behavior? Diffuse the our participants gets anxious around reaction by removing the stimulation or leaving time and repeatedly asks to go the person from the situation. Use home. We reassure him that his ride will diversion or change the subject. If

appropriate, use touch. recognize danger and/or take When a person is experiencing appropriate action or seek appropriate confusion or disorientation to person, help. Ask yourself, “Would my husband time or place, use reassurance. When a recognize an emergency situation and person is agitated, restless, pacing, would he be able to react appropriately, moaning or crying, he may be bored, for example, evacuate, get help or call sick, tired or frightened. Try to calm and 911?” reassure. Regular activity and exercise Paranoid behavior can reflect can be preventive, as can a structured feelings and reactions as the person daily routine. Minimize confusion or loses cognitive functions and control overstimulation in the environment and over his life. He may misplace things or eliminate caffeine. misinterpret the environment. He may Sundowning is restlessness, be covering up for his losses. Do not anxiety, and agitation in the afternoon argue, confront or use rational and evening. It may be due to fatigue or explanations. Do not talk behind his lower light. Do more demanding back as this only feeds paranoia, and activities early in the day. Again, regular include him in conversations, tasks and activity and exercise can be preventive. planning as appropriate. For example, if Quiet, calming activities like soft music he is concerned you are stealing his or massage may help. money, have him “help” you with paying Pacing or walking about may the bills. Put valuables in a safe place represent the need to be active. The and have extra keys, glasses, etc. person may also be looking for Check the wastebasket for lost items. something or someone or may be Maintaining the person’s dignity and bored. Have a safe area for the person respect will help him feel more to walk or pace. Guide the person back competent and secure and may prevent with diversion. Try to determine the some of these problems. meaning behind the behavior—just ask! Hallucinations are seeing, An identification bracelet is an absolute hearing, smelling and feeling things that necessity for safety. Also keep a recent are not real. Try to understand what photo on hand and notify neighbors and they might mean to the person. Do not police of the risk of wandering. You may rationalize, correct, confront or argue. If need to install a door alarm. Again, the hallucinations are not upsetting to keeping the person active can help. the person, you need not do anything. If Supervision becomes necessary the person is upset, offer protection and when the person is at risk of wandering reassurance. Be sure there is no off unattended. It is difficult to know medical cause, such as medications or when this will first occur. Therefore, no illness. If you think there might be a one should be left unsupervised who medical problem and the person would be at risk if he left the house continues to be disturbed, you should alone. Another rule of thumb is that no talk with his physician. one should be left alone who cannot Delusions are believing things

that are not real. Again, try to medicine. You are laughing with the understand the meaning behind them. person and at the situation. It can Accept his reality and use reassurance. release tension and diffuse an Reason and logic probably won’t work. uncomfortable situation. Remember, there are solutions to Remember that phases change these difficult situations. Sometimes it and pass. This is especially important takes awhile to figure them out. A lot of when you are going through a difficult trial and error and intuition are involved. time. As the illness progresses, behavior Trust your instincts and use your will change. knowledge of the person. Remember A word of caution—behavioral that what doesn't work today may work changes can be caused or complicated tomorrow or in the next few minutes, for by conditions other than the dementing that matter. Don't be afraid to try and illness, such as medications, problems fail. You will have many opportunities to with vision or hearing, a cold or the flu, try again. infection (for example, a urinary tract Keep your sense of humor. infection), pain or physical discomfort Sometimes people have difficulty that the person cannot communicate to seeing the humor in their situation or you, depression or fatigue, dehydration feel it is disrespectful, but it is so or constipation. Any sudden or dramatic important to be able to laugh change in behavior should be evaluated therapeutically. I am a true believer in for one of these problems. laughter sometimes being the best

MANAGING ACTIVITIES OF DAILY LIVING

Assisting with activities of daily living, General Principles General including personal care, can be one of principles in personal care are the most difficult aspects of caregiving. consistent with other areas of It seems childlike and embarrassing to caregiving. need assistance with these activities, Maintain the person's and it's difficult for both caregiver and independence and self-esteem to the care receiver. It takes away a person's greatest degree possible. Remember independence in private and intimate good communication techniques. areas of care. There can be Recognize the person's limitations, but resentments and discomfort on both more important, recognize her abilities sides. and encourage her to do what she can As roles change, it is important to for herself. Early on, reminders and remember that they are role changes, cues will suffice. Later, more assistance not role reversals. The person you are will be necessary. You will need to caring for is still your spouse or parent, adjust as the person changes over the not your child. With these role changes, course of the illness. there are new things to learn. Men may Make things easy for the person. need to learn to help with makeup. For example, instead of several utensils Women may need to learn to help with on the table, put only the fork by her shaving. plate. As with other behaviors, there will Provide for personal and physical be changes from day to day. One day safety. Get a medical ID bracelet for your family member may be able to your family member and keep a recent dress without assistance, and the next photo on hand. Proper clothing and non- day, she may need some help. It's skid shoes are important. Glasses and important to remember to monitor and hearing aids, when needed, are assist as needed, but not to take over. important. Keep cleaning supplies, The person feels better when she is as medications and anything harmful or independent and involved as possible. toxic locked up or clearly out of reach. Of course, all this requires a good deal Remove scatter rugs, furniture that tips of patience and time. Sometimes you or can be tripped over (coffee tables), won't be able to do it because you have and loose cords. Lower the thermostat to be somewhere or you're just too tired! on your hot water heater to avoid burns.

Look at the environment. Altering prior habits, making it as normal and the environment can alter behavior. familiar as possible. Allow the person to Think of it as a prosthetic approach, do as much for herself as possible. providing aides for the person's losses. Use plates with no pattern on Camouflage to reduce access and them—the person may try to eat accent to increase access. For example, "flowers" off the plate. A solid line paint the door and frame the same around the edge is good, however, color as the wall if you want to because it defines the plate area. discourage access. If you want the Placemats or tablecloths should be person to notice a door or doorway, plain. The plate should contrast in color paint the trim a contrasting color. with the table or table covering Use labels, pictures and signs to underneath so it can be easily seen. orient or give the person instructions. Give the person one utensil at a Put a sign on the bathroom door. Have time. Remove clutter from the table to an easy-to-read calendar and clock. avoid problems like salt being poured Have good lighting. Night-lights can help into coffee. Too many different foods on the person find the bathroom at night. a plate can be confusing. Present one Keeping overhead lights on at night can food at a time. If there are several foods be disorienting. The person may think on the plate, ignore the order eaten. it's time to get up and get dressed if she Eating dessert first is just fine! awakens during the night and all the Use "real" silverware. Plastic may lights are on. be bitten off or break. Paper cups may Keep the environment simple and be squeezed and liquid spilled, so "real" consistent. Remove clutter and glasses and mugs are preferred. Fill distractions. Remove mirrors when the them only 3/4 full. person becomes confused or frightened Offer a balanced diet and by her reflection. Reduce noise. It can nutritious snacks. Sandwiches that stick be overstimulating. Keep to a routine as together (tuna salad, melted cheese) much as possible. This can be are easier to manage. Sometimes it comforting and the person will become helps to cut them in four sections. familiar with a routine. Of course, you Do not force the person to eat need to be flexible when things are not and allow plenty of time. Cues may be going as expected. needed to get the person started or In all areas of personal care, keep her going. For example, put a fork remember that sometimes it's easier to in her hand and say, "Eat your dinner." do things for your family member than Or, hand her a section of sandwich to help her do it for herself, but it's saying, "Eat your sandwich." You may vitally important for her to maintain need to repeat these reminders skills for as long as possible. Just do the throughout the meal. best you can. Serve finger food when it Eating Structure food and the becomes too difficult to use utensils. eating experience to mimic the person's This is less demeaning than feeding

someone and you can provide a dental exams are important. nutritious diet with finger foods. Bathing Follow old habits and Actually, you can make a sandwich out schedules. Do not discuss whether or of just about any meal. For example, not a bath is needed, simply proceed as meat loaf, peas and mashed potatoes if it is taken for granted—a "matter of can easily be put between two slices of fact" approach. Take one step at a time bread. Use chicken nuggets, French and simplify things. Use the person's fries, cut-up fruits and vegetables, and help and talk her through it. For other bite-size finger foods. This also example, "Put your foot in the tub. Put can allow the person to wander while your other foot in the tub. Sit down. eating. Here is the soap. Wash your arm..." If Watch for swallowing difficulties, the person is really agitated, stop and which are common, especially as the try later. If possible, bathe at a time disease progresses. You may need to when both of you are not tired. If remind the person to swallow. Semi-soft appropriate, showering together can foods and thicker liquids are easier to work. swallow. Mixed consistencies are Remember how frightening and difficult (crunchy cereal and milk). Offer embarrassing this experience can be. fluids between meals. Dehydration can Consider alternatives—hiring someone be a problem, as she may not realize or sponge baths. Daily bathing or she is thirsty. showering is not usually a necessity. Forget about moderate weight Agencies or individuals can be hired for gain, which is common in the middle a fee to come in regularly for bathing. stage. She forgets she's eaten. There is This often works well because the also a theory that the part of the brain worker has the appearance of a nurse. that tells the person she is full doesn't Never leave your family member work. Many people with memory loss unattended in the bath or shower. seem to crave sweets. However, weight Bubble baths and oils can be slippery loss is common later in the illness, so and cause infections. Bath stools and you shouldn't worry unless there is a grab bars help with safely moving in and health problem or the person is out of tub or shower. One woman found extremely overweight. Buy clothing with that singing with the person helped her elastic waists! through her bath. Another woman found Mouth Care Check dentures to be that putting food coloring in the bath sure they are comfortable and fit well. water helped. Remove and clean them daily. Give Dressing Simplify, structure and step-by-step instructions for brushing supervise. Decrease choices of clothing. teeth. One family member told me that Remove clothing that is not appropriate, his wife had no idea what to do with her for example, winter clothing during the toothbrush until he just touched it to summer. Coordinate clothes in the her lips, and then she was able to closet or have all mix-and-match outfits. complete the task on her own. Regular When the person cannot choose, lay

clothes out in the order to be put on. manicures or hair done regularly can be Later, step-by-step cues and assistance a treat and an activity for the person. will be necessary. Buy jackets and coats They are also activities that others may a size or two larger. They will be much be able to help you with. It can be a easier to put on and take off.Eliminate focus for a visit by a family member or accessories such as belts, ties, volunteer. Simple, attractive hairstyles scarves—keep it simple. Replace can make daily grooming easier. Of buttons, buckles and zippers with Velcro course, you need to balance good or elastic. Tube socks can't be put on grooming with being flexible. Don't wrong. Jogging outfits and slip-on shoes make it too hard on yourself or your are easy to manage. There are stylish family member. knit ladies' outfits with elastic waists Foot care can be done by a that are washable and easy to put on. If podiatrist. Under certain circumstances, your family member loves a certain Medicare may cover this service. outfit, buy several alike so she can wear Toileting Although it's difficult to it daily. predict when problems with toileting will You should keep in mind old begin, they are inevitable. Initially, the habits when thinking about clothing, but person may start having occasional don't assume the person can't change. accidents. When this happens, there We had a participant who had worn are steps you can take that help. Be many layers of undergarments for sure the person knows and remembers years. They became too difficult for her where the toilet is. Mark it with the to manage in the bathroom, so we word, "toilet." Be sure clothing is easy to suggested to her family that they reduce manage. her undergarments to underpants only. Sometimes the person may wait This way, she could continue to function too long to get to the bathroom and independently in the bathroom. then has trouble getting clothing Although they were skeptical, they tried. undone. Notice her usual schedule and They removed everything from her remind her according to that schedule. drawers except underpants without If this doesn't work, try a schedule of saying anything to her and she got upon rising in the morning, every two dressed with underpants only. Although hours during the day, after meals and she did comment for the first few days before bedtime. At some point, asking that something was "missing," she the person if she needs to go doesn't adjusted without a problem and was work and you should just take her. She able to be independent in the may say no but really need to go. Look bathroom. for other cues, for example, Grooming Hair, nails, foot care restlessness. One HOW participant used and makeup are important to the to say she needed to go home when she person and those around her. Grooming needed to use the bathroom. contributes to self-esteem and to how As time goes on, more than others treat the person. Getting reminders will be necessary. Cues may

also be needed or step-by-step Install grab bars and an elevated toilet assistance and instructions in the seat if necessary. bathroom. A HOW staff member As much as you can, respect the discovered that one participant only need for privacy. At HOW, when we are needed his belt buckle undone and he not sure if someone needs help, we could then complete toileting "peek" through the door. independently. Sleeping Sleep problems are very Eventually, the person may lose difficult, because caregiving on little complete control and become sleep is at least twice as hard! Too incontinent. Then you will need to use much daytime sleeping or not enough adult incontinence products. There are activity and exercise can cause sleep many varieties at your local pharmacy. problems. So can caffeine, illness, pain, There are also catalogues from mail hunger, side effects of medication, order companies or information on the agitation from upsetting daytime Internet that have pictures and describe events, disturbing dreams and a variety of supplies. Some will send you depression. All of these causes should samples to try out. be considered when sleep problems Remember to keep in mind that occur. problems with incontinence can be To avoid sleep problems, try to related to medical problems, for prevent too much daytime napping. example, a urinary tract infection, some Keep the person active. Have a regular medications, even dehydration. Be sure exercise and/or walking program. to consider this, particularly when Eliminate caffeine and alcohol. Do not incontinence problems begin suddenly. talk about the next day's plans or lay There are other tips that help with out clothing. Avoid upsetting activities in toileting. Use a toilet seat that contrasts the evening. Have a bedtime routine. in color with the background so the Try soft music or a massage. Be sure person sees it easily. This is a visual the person is comfortable in bed and cue. Removing or covering the mirror in not hungry or cold. Sometimes the bathroom may help if the person disrupted sleep patterns are due to the thinks someone is in there with her dementia itself and nothing seems to when she sees her own image. For work. Consider letting the person be up safety, remove the lock from inside the at night and provide a safe place to door or have a key readily available. wander or hire a nighttime aide. Limit fluids a few hours before bedtime. Usually these problems pass and However, do not limit fluids to prevent the person sleeps more as the accidents. This can cause dehydration. dementia progresses.

STAYING ACTIVE AND INVOLVED

When a person develops Alzheimer's usefulness, support self-esteem, disease or other dementia, often one of provide pleasure, and provide the sense the first signs is withdrawal from regular of continuing to have roles and being activities. Family members will part of life, family and community. comment that the person stopped doing Alzheimer's disease doesn't mean an certain household tasks, such as yard end to enjoying life. Each person has work, cooking or cleaning. The person special qualities and abilities. Make use stopped going to bridge or golf or lost of them. One of our participants doesn't interest in longstanding hobbies, like go in much for music, games and other reading, crocheting or watching sports recreational activities. However, he's on TV. the first to help with setting the table for As cognitive functions become lunch and cleaning up afterwards. He impaired, it becomes more and more thinks of our program as coming to difficult for the person to independently work and it gives him a lot of initiate and complete activities of all satisfaction. kinds. So, he withdraws from them, Think of everything as an activity. frequently with excuses to cover up the If you think of the morning dressing and real reason. This can lead to feelings of grooming routine as an activity, it may uselessness, boredom and depression. be easier to accept the time it takes to It is important to keep the person help the person do as much as he can active and involved in life. For all of us, for himself, even though you could get it much of our day is filled with routine done in half the time by doing it for him. activity. We often complain about it, but Remember, it's the process, not think about having day after day with the outcome. If you think of it as a nothing to do. There are many ways to purposeful activity for your husband to keep the person active. It's not always empty the dishwasher, you may not easy and often requires a great deal of mind so much if he puts some of the energy and patience, but all you can do dishes in the wrong cabinet. You can is the best you can and following are move them later when he won’t see some ideas. you. General Principles Your family Exercise is extremely important. member needs to be involved in It's important for persons with memory purposeful, meaningful and pleasurable loss for the same reasons it's important activities that provide a feeling of for all of us. It keeps us feeling better,

tones and strengthens muscles, helps put the napkins next to the plate or lay maintain mobility, promotes out the silverware. cardiovascular fitness, alleviates stress Activities should be fun. Games and depression, and reduces anxiety. and sports can be adapted so the Essential Elements for Making person can do them with success while Activities Work Remember good keeping them adult in nature. Practice communication techniques. Approach putting in the living room using one of from the front. Get and maintain eye those gadgets that shoots the ball back contact. State your message in simple when you hit it into the center. terms. Speak slowly, concisely and Activities should be ones that can unambiguously. Give the person time to be broken down into simple steps and respond. Give both verbal and adapted to the person's skills. Cooking nonverbal cues. Use body language. is a great activity for this. There are Praise and reassure, being careful not many simple steps. It's familiar, adult to over praise. Communicate that you and pleasurable. are enjoying yourself—it's contagious! As much as possible, activities Daily planning and routine are should be failure-free. Keep things important. Have a specific routine for simple. You don't want to frustrate the each day and introduce and perform person or make him feel badly because regular daily activities in the same way he can't do what you're expecting of each day. Familiar routines provide a him. feeling of security. Activities should be repetitive. Simplify the environment to Repetition provides a feeling of minimize confusion. Remove clutter. competency. Reduce noise. Activities should rely on habitual Think about the person's social skills. Skills learned in years past and medical history, likes and dislikes, remain longer. Although the person will strengths and needs, in order to enjoy familiar activities, he can also capitalize on remaining interests and enjoy new ones if they are presented skills. If a person loved to cook, have well. Many men who come to our him help you with dinner. A former program have never cooked or helped golfer may enjoy hitting balls at a driving out in the kitchen, yet they really enjoy range. these activities at HOW. I think it's Take all necessary safety because they do it with success, feel precautions. An ounce of prevention is like they're accomplishing something worth a pound of cure. Bingo chips may and feel needed. be misperceived as candy. At HOW, we Activities should provide sensory use poker chips, which are much larger. stimulation. But, don't overstimulate. Criteria for Successful Activities Loud music, bright colors, and a lot of Activities should have a purpose or be movement are stimulating. Soft music, productive. When you set the table for slow movement and quiet activities dinner, ask for help. Have your husband have a calming effect.

Late Stage Activities With Name-That-Tune, Singo, music trivia, advanced dementia, the person will reminisce about music, or plan short lose the ability to participate in many musical programs. A trained music activities, but he can still feel and we're therapist brings a special expertise to not sure how much he is able to take in. music activities. It's important to continue to talk to the Games Many familiar games can person, use lots of touch and provide be adapted or simplified. Try Bingo with sensory stimulation. Take the person numbers, colors or holiday pictures; out to sit in the sun. Read to him. Give dominoes; card games such as him a hand massage or back rub. Listen Blackjack or Pokeno; dice games like to music. dice poker, Bunco, Bowl and Score; and Successful Activities Following are block games such as Blockhead or activity ideas that work well for adults Jenga. Try a puzzle map of the United with memory loss. States, large-piece puzzles (not Helping with daily routines and juvenile), or matching games. chores With supervision and step-by- Word Games Using A-Z, fill in with step instruction, a person can help with specific categories, for example, most household tasks—indoor plant countries of the world. Or use a care, arranging flowers, gardening, particular letter such as "s" and name folding towels, dusting furniture, drying all girls' names beginning with that dishes, setting and clearing the table. letter. Try hangman (Wheel of Fortune) Cooking and baking This is a or simple Pictionary. Complete proverbs favorite activity because there is a or familiar poems ("The Night Before product at the end to be eaten and Christmas" or "Casey at the Bat"). Do enjoyed, and the smells of things simple crossword puzzles or adapt cooking are nurturing and familiar. Cut Scrabble. Use Elder Trivia questions. up vegetables for soup or fresh fruit for Pets If the person is comfortable, a salad, make applesauce, bake simple holding and petting friendly animals can drop or bar cookies, or roll out dough be a good activity. Pets can provide and use cookie cutters. Try zucchini, companionship and unconditional cranberry or banana breads and easy positive regard. A fish tank or bird cakes and pies. feeder can provide interesting Music This is one of the most observation. It can also stimulate successful activities for persons with reminiscence. memory loss. Memory for music seems Exercise and Active Games Plan a to last longer than other memory. It also daily routine of seated and/or standing tends to stimulate positive, meaningful exercise. Take walks and window shop. feelings and thoughts. The music most Toss and/or catch beanbags in a waste people remember seems to be that can. Throw bean bags onto a hopscotch which was popular in their late teens to grid with numbers for scoring points, late twenties. Do sing-alongs, slide them down a long table at thread movement or dancing to music. Play cones, or play Toss Across—a bean bag

tic-tac-toe game. Play balloon volleyball, is saying. Help him express himself and indoor basketball, bowling or practice acknowledge his feelings. putting. Play indoor or outdoor plastic Manicures and grooming horseshoes or ring toss. Bat nerf balls Combing hair and putting on makeup back and forth with wooden paddles, contribute to self-esteem. Nail care and tennis or badminton rackets. For larger hand massage provide pleasant groups, try parachute activities. feelings. Shoulder massage or a back Reminiscence Since long-term rub can be relaxing. Remember to think memory lasts well into the illness, of all areas of personal care—dressing, activities that rely on it have a good bathing, etc.—as an activity. chance for success. During Art/Art therapy Do unstructured conversations, bring up topics from the painting with washable tempera paints past that are familiar. "Reminiscence or watercolors. Do mosaics using boxes" are collections of items in ceramic tiles or paper squares or try various categories (tools, sewing, modern art designs using various paper household articles, men's "things," shapes. Make figures or ornaments women's "things," etc.) Bring them out from baker's clay. Make "quilts" with to handle and discuss and old squares of wallpaper samples or memories will be stimulated. There are collages from magazines or dried leaves a variety of nostalgia books that can be and flowers. Make place cards, get well used. Photos of old movie stars and and birthday cards. Art activities of all famous people and places are popular. kinds work well if well-planned, that is, Individual photo albums or “memory not too complicated and presented one books” that include a life history can step at a time if there are multiple make a person feel special. materials and steps involved. A trained Discussions Look over the art therapist adds a special dimension newspaper and discuss current events to art activities. avoiding items that may be disturbing. Celebrating Holidays/Seasons/ Discuss sports. Read your horoscopes Special Occasions This can provide and advice or opinion columns, and ask gentle orientation to the season and for their advice or opinions. Enhance time of year. More important, it is also a discussions using the encyclopedia or normal, fun part of life for us all. Make the Internet for more information. Use holiday decorations, a holiday or slide shows and travel or nature tapes. seasonal collage, cook and eat special Have discussions around a particular holiday foods and reminisce about past topic, such as first dates, first cars, holidays. Adapt your holiday summertime, the Depression, celebrations so the person with memory weddings, WWII—the possibilities are loss can manage and enjoy them—that endless. Talk about yourselves, family is, keep them simple and avoid and friends, being sure to include the overstimulation. Birthdays and other person in conversation. Really listen to special occasions are also important, the person and show interest in what he but celebrations may need to be

adapted so the person with memory Humor This is obvious—it’s fun! loss can be involved. Arrive early before It’s therapeutic. Watch comedies or old- it gets too crowded or leave early before time TV shows that rely on long-term your family member gets tired. memory. Tell jokes. There’s even a Language Arts Have the person practice called “Laughter Yoga.” with memory read to you or you read to Plan Intergenerational Activities him. Write a poem or a story together. With special planning, both the children TimeSlips (www.timeslips.org) is a and the adults will enjoy their time creative storytelling method that works together and benefit from the well in groups or can be adapted for a experience. one-to-one activity. Resources for Activity Supplies Service Projects In group or The following companies have games, residential settings, there can be group books, and a variety of other supplies projects—assisting with preparing for activity directors. Some may also be mailings, collecting for a food pantry, good for home use. These are just a few sending letters to soldiers, etc.—that suggestions—the Internet offers an provide a sense of meaning and unlimited supply of activity resources satisfaction. You might also do and ideas! something at home with your family  Bifokal.org member.  Eldersong.com Spirituality Staying involved in  Activityconnection.com your place of worship can be important o Online subscription for both you and your family member.  Creativeforecasting.net Praying, bible study, acknowledging o Monthly journal religious holidays and rituals,  Flaghouse.com discussions on the meaning of life or  Geriatric-resources.com the wonder of nature are all activities S&S Worldwide (ssww.com) that can nourish the soul. 

CARING FOR THE CAREGIVER

Studies have shown that caregiving for physically. someone with memory loss is more There are many other feelings you stressful than any other type of may experience. Initially, denial that caregiving. And, we all know that stress there is a problem can be protection compromises our health. But, there's a from facing the illness and all that it lot to be done about the stresses of implies. At some point, denial needs to caregiving. give way to facing what is happening Caregiving can also offer and taking appropriate and necessary opportunities for positive experiences, steps. expressions of love and caring, deeper You may feel anger. Sometimes it intimacy, and stretching of our spiritual seems like the person is acting selves. I remember reading a personal purposefully to annoy you. You know the account of a caregiver who talked about person will not improve. “thriving” and not just “surviving.” You may feel helpless. You just Studies of caregivers who seem to do don't know what to do. Sometimes well indicate that they rely on their nothing works. spirituality for a sense of the deeper You may feel embarrassment meaning of their caregiving role. about the diagnosis itself or the Nevertheless, there are many person's behavior. challenges families confront. You may feel guilt. There's guilt Emotional Challenges Stress has about these feelings. You may think a lot to do with how we feel about our you're not doing a good enough job. You situation. Families dealing with may wish you could somehow escape Alzheimer's disease have many from the situation entirely. reactions. They may wonder, "Why me?" You may feel grief. You are losing Or, “Why my husband?” This wasn’t your loved one day by day. what you expected in your “golden You may feel depression about years.” this loss or as a result of the demands Knowing what the future might of caregiving. bring can be frightening and You may feel isolation as friends overwhelming. Caring for someone with and family drop away or you just don't memory loss requires constant feel like socializing. vigilance. This is demanding and tiring You may feel like you have and takes its toll emotionally and nowhere to turn or you don't want to

burden others with your problems. Learn about the illness and Perhaps you've never had to ask for successful caregiving techniques. It can help. make a real difference. Knowledge is a Physical Challenges You may powerful tool. There are pamphlets, experience fatigue. Caregiving is hard books and educational workshops. work. When there are sleeping Support groups are educational as difficulties, this can add to your fatigue. members share their caregiving tips. You may experience illness. Some Professional advice can also help. studies have indicated that caregivers Do some planning. There’s legal of persons with memory loss have and financial planning to be done. It can weaker immune systems and are more help to plan for the future. There’s an vulnerable to illness. old adage, “Hope for the best and plan Economic Challenges Your family for the worst.” Think about what kind of member may have to quit a job or retire care and help you will want or need. It’s early reducing family income. There are also vitally important to plan for also the costs of care—medical care, emergencies. What will happen if you home care, adult day services and become ill? Who can respond in an possibly residential care. emergency and take charge of the I guess that’s some of the bad situation? news, but there is help and there is Take care of yourself. Practice the hope. You should not travel this journey many stress management techniques alone. One of the positive experiences effective for all varieties of stress of this journey is the truly kind, caring including proper nutrition and rest, and giving people you will meet along exercise, meditation, journal writing, the way if you allow yourself to ask for and others. Workshops on stress and receive help. management are offered throughout Coping Techniques and the community. There are many books Resources There are many ways to cope on the subject. Be sure to get regular with the stresses of caregiving. We all medical care for yourself. Plan time have coping mechanisms that are away from your responsibilities and comfortable for us and seem to work attend to your spiritual needs. well for us. Following are some other Get concrete help with your day- ideas. to-day caregiving. I cannot Recognize and accept your overemphasize this suggestion. There feelings. They are OK. It's also good to are many resources for this—adult day talk to someone and share your programs, home care, and residential experiences and reactions—good and respite programs. Adult day programs bad. Support groups can be helpful for offer you regular, predictable time on this. A good friend, family member, your own while offering therapeutic minister or rabbi can help. Professional activity for your family member. Home counseling is also available. care allows you to get out for an evening with friends or can assist you

when the care and supervision of your for health care and property. Executed loved one at home is just too much to while the person is still competent, they handle alone. Residential respite can stay in force when the person is no allow you to take a vacation from which longer able to make decisions for you will return refreshed and with herself. There are trusts, living wills, do renewed energy. No one should do this not resuscitate orders and other alone. It's not good for anyone involved. planning tools and documents. These Good medical care is imperative. are complex issues to consider, so you It is important to have a good initial should consult appropriate evaluation and ongoing follow-up care professionals about your particular for your family member by a physician situation. What I want to emphasize is who understands dementia. It is also the need to think and plan ahead. important to get good medical care for Financial Planning The power of yourself. attorney for property allows for money Keep your sense of humor. management and financial decision- Alzheimer's disease is no laughing making. This and other tools can help matter, but it is important to be able to you avoid going to court for laugh at ourselves and at our situations. guardianship to manage financial It truly can be the "best medicine." affairs. Even if a person doesn't have Legal and Financial Planning abundant financial resources, Planning ahead and anticipating arrangements need to be made. situations helps avoid crises—another Health Care Planning Health care source of stress. On the one hand, it's planning becomes particularly important to have the attitude of "one important regarding end-of-life day at a time" when caring for someone decisions. Whether or not to with memory loss, however there are resuscitate, whether or not to use a some areas that require planning feeding tube, whether or not to treat ahead. You need to look ahead and do pneumonia or other infections or legal and financial planning. Actually, all illnesses are some of the decisions to adults should have this planning in be faced. The issues are complex and order no matter our age or health, as involve personal beliefs, thoughts and life is unpredictable. However, if it feelings, as well as legal and medical hasn’t been done already, this planning issues and ethics. There is no simple should start early, while the person with answer and there is no one right memory loss can still participate in answer. decisions and is competent to sign legal What is important to remember is documents. that we all have the right and, I would You should consult an attorney add, responsibility, to make these for counsel on these matters, but health care and end-of-life decisions for following are some things to consider. ourselves when we are competent to Two documents that are important to make them. That is why it is so vitally consider are durable powers of attorney important to make these decisions,

discuss them with our relatives and point, you may need to consider physicians, and put them in writing. We residential care. Residential placement should do it for ourselves and for the is one of the most difficult decisions benefit of others who may, at some family members must make. People point, be put in the position of carrying often ask me when a person is "ready" out these wishes. for placement. There is no formula. When someone is in the early Every situation is unique and the stage of Alzheimer's disease or other decision needs to be made with regard dementia, she is probably still capable not only for the person with memory of discussing these issues, expressing loss, but the caregiver as well. There wishes and signing documents. Do this usually comes a time when the with your family member while you have caregiver realizes it is necessary to the opportunity. If you haven't and are make a change. That time is unique to faced with making health care decisions that person and can depend on many for your family member, think about factors including a caregiver’s physical what she would want. You are being health. asked to make the decision you think Taking the time to plan ahead for your relative would make, were it residential placement allows you the possible to do so. opportunity to investigate your options Whatever the circumstances, and to consider financial issues. Many these situations are difficult, long-term care facilities have emotionally painful and accompanied specialized Alzheimer's programs and by feelings of grief and loss, sometimes there are also facilities that specialize doubt and guilt. Even if they are totally exclusively in dementia care. clear about what needs to be done or Even when caregivers have done not done, family members have told me a superhuman job, placement is that making end-of-life decisions is still difficult. There may be feelings of guilt. very difficult. The support and guidance There are certainly feelings of loss. It's of others during this time can help you important to remember that when you cope with your feelings. place your loved one in a residential Autopsy Another end-of-life issue facility, you haven't given up your to be considered is autopsy. A diagnosis caregiving role. Your presence and of Alzheimer's disease can only be caring continue to be very important. confirmed by an autopsy of the brain. Just the fact that you visit regularly Brain tissue is also used for research. If helps insure that your loved one will get this is something you are considering, good care. Many family members help speak with your physician or contact the with meals, laundry or join in on Alzheimer's Association—Greater Illinois activities. Chapter at 800-272-3900 for Hospice Care In some situations, information on how to make keeping the person at home until she arrangements. dies is an option. It may require hiring Residential Placement At some full-time help. Hospice services are also

available under Medicare for can change your attitude. Alzheimer's patients. These hospice Get help early and often. Don't go services can also be offered in long- it alone. It's not wise or healthy for term care facilities. either you or your family member. Ask What's important to keep in mind friends and family members. Give them is that your situation is unique and you specific ways they can help—taking your need to do what is best for you and your mother for a walk, staying with your family. Support groups or professional husband so you can go out to eat with a counseling are often helpful to people friend or take in a movie, giving your during these transitions. wife a manicure, or bringing over a meal See the Positive Look for positive to share. moments. There are many. A memory Pamper yourself from time to stirred, a song sung together, a hug, a time. You deserve it, need it and your smile, an "I love you" at an unexpected spirits will benefit. moment. We must learn to live in the Take it one day at a time. It's wise moment, because this is all the person to think and plan for the future, but with memory loss has. If something is needless worrying is unproductive. enjoyed, even for a moment, it's worth Enjoy the moment and your special it. Take the opportunity to provide a relationship with the person you are quality of life for your loved one and caring for. yourself. It may not be the life you Accept your feelings. They are expected or would have chosen, but it’s yours and they are valid. Find a friend, all you’ve got. confidant or professional to share them Remember that you, as a with. caregiver, have a special role. It's Be gentle on yourself, especially certainly not one anyone would ask for, at those times when you have lost your but it is special nonetheless. patience or feel like you aren't Caregivers, Take Care Caregivers, functioning at your best. No one is family or professional, need to take care perfect. of themselves. Following are tips, Say "no" sometimes. "rights," and reflections that are good Use your creativity. Try new advice. solutions to ongoing, difficult problems. Taking care of yourself is not Take a timeout in a quiet place. being selfish. You will be better able to Laugh, play and "smell the roses." care for your loved one. Be proud of your Accept that you can't change accomplishments as a caregiver. Your everything about your situation, but you role is a valuable one.

RESOURCES

INFORMATION & REFERRAL NorthShore Univeristy Alzheimer’s Association—Greater Illinois HealthSystem Neurological Institute, Chapter, www.alz.org/illinois, Chicago, 847-570-2570 800-272-3900 (help line) and 847-933- Northwestern Alzheimer’s Disease 2413 (business line), provides Center, Chicago, 312-695-9627 information and referral, support Rush Alzheimer's Disease Center, groups, education. Chicago, 312-942-4463 Alzheimer's Association, www.alz.org, Chicago, 312-335-8700 LEGAL SERVICES (business line) and 800-272-3900 (help Chicago Bar Association website line), national office for above. (www.chicagobar.org) Illinois Department on Aging, Lake County Bar Association Springfield, 800-252-8966, provides website (www.lakebar.org) information and referral about National Academy of Elder Law community support services. Attorneys (www.naela.org) North Shore Senior Center, www.nssc.org, 847-784-6000, with ADULT DAY SERVICES offices in Northfield and Evanston, Visit www.iadsa.com for a list of adult offers a wide range of in-home and day programs throughout the state that community-based supportive services. are members of the Illinois Adult Day Services Association. SUPPORT GROUPS North Shore Senior Center’s House of HOME CARE SERVICES Welcome Adult Day Services, Northfield, The Community Care Program provides 847-242-6250, offers an Alzheimer’s state-funded in-home and adult day Family Support Group. services for financially eligible For other support groups, call the administered through local Case Alzheimer's Association at 800-272- Coordination Units. Respite care and 3900 or visit www.alz.org/illinois. other services are also available. For information, call the Illinois Department MEDICAL on Aging at 800-252-8966; or North Consult with your primary healthcare Shore Senior Center, 847-784-6040, for provider for referrals or visit the website Maine, New Trier, and Northfield of your affiliated hospital. Below are townships and 847-864-3721, for several area programs that provide Evanston and Niles townships. memory assessments. Home Care Agencies provide a variety of in-home services.

RESIDENTIAL PROGRAMS Assisted Living Facilities offer a Residential Respite A residential facility variety of supportive services. Some may be used for a short-term stay while specialize in dementia care. you take a break, travel, or if you Retirement Homes may accept a become ill. person with early memory loss and may Special Care Dementia Units help you make arrangements for Many facilities have units with special additional in-home care within their care programming. facilities.

BIBLI0GRAPHY

Alzheimer’s Association, www.alz.org. Feil, Naomi, A.C.S.W. V/F Validation, The Feil Method. Cleveland, Ohio: Alzheimer’s 101: The Basics for Edward Feil Productions, 1989. Caregiving. Washington, DC: South Carolina Commission on Aging, South Fogler, Janet, M.S.W., and Stern, Lynn, Carolina Educational Television M.S.W. Teaching Memory Impairment to Network, and the Administration on Adults. Baltimore, MD: Johns Hopkins Aging, 1989. University Press, 1984.

Alzheimer’s Disease: An Overview. Fox, Jacob, M.D. Update on Alzheimer’s Alzheimer’s Disease and Related Disease. Chicago: Rush Alzheimer's Disorders Association, 1994. Disease Center, June 15, 1989.

Bell, V. and Troxel, D. The Best Friends Gwyther, L.P., A.C.S.W. Care of Approach to Alzheimer’s Care. Alzheimer’s Patients: A Manual for Baltimore, MD: Health Professions Nursing Home Staff. American Health Press, Inc., 1997. Care Association and Alzheimer's Excellent book on being in relationship Disease and Related Disorder with persons with dementia. Association, 1985. Gives concrete, hands-on advice on Broyles, J. Frank. Coach Broyles’ caregiving applicable to home care as Playbook for Alzheimer’s Caregivers. J. well as nursing home care. Frank Broyles and the University of Arkansas Board of Trustees, 2006. Heston, L.L., M.D., and White, J.A. Dementia: A Practical Guide to Brain Calisthenics. Life Magazine, July Alzheimer’s Disease and Related 1994. Disorders. Freeman and Company, 1983. Buckwalter, K.C., Ph.D. Management of Behavior Problems. Chicago: American Getting a Diagnosis. Alzheimer’s Society on Aging Conference, July 14, Association, 2002. 1989. How the Brain Ages. Society for Cohen, D., Ph.D., and Eisdorfer, C., Neuroscience, 1992. Ph.D., M.D. The Loss of Self. New York, N.Y.: W. W. Norton Co., Inc., 1986.

Kessler, Elizabeth, M.D. Memory Some Practical Suggestions for Coping Changes and Alzheimer’s Disease. with Alzheimer’s Disease and Related Highland Park Hospital, Highland Park, Illnesses. Ypsilanti, MI: Eastern IL: October 19, 1994. Michigan University, 1989. Excellent book on behavior with many Kitwood, T. Dementia Reconsidered, helpful techniques. The Person Comes First. Buckingham, England: Open University Press, 1998. Sheridan, C., M.A. Failure Free Activities for the Alzheimer’s Patient. Oakland, Kuhn, D., M.S.W. Alzheimer’s Early California: Cottage Books, 1987. Stages: First Steps for Family, Friends, and Caregivers. Alameda, California: Sincox, R.B., O.T.R., and Cohen, P.S. Hunter House Inc., 2013. Adapting the Adult Day Care Excellent book for families and Environment for Older Adults with professionals on early stage issues. Dementia. North Shore Senior Center, Parkside Human Services Corporation Lustbader, Wendy, and Hooyman, and the Illinois Department on Aging, Nancy R. Taking Care of Aging Family 1986. Members. New York: The Free Press, 1994. Snowdon, Ph, D., Kenneth. Aging With Grace. NY: Bantam Books, 2001. Mace, N., M.A., and Rabins, P., M.D., M.P.H. The 36-Hour Day: A Family Guide Snyder, Lisa, MSW. Speaking our to Caring for Persons with Alzheimer’s Minds—Personal Reflections from Disease, Related Dementing Illnesses, Individuals with Alzheimer’s. NY: W.H. and Memory Loss in Later Life. Warner Freeman and Company, 2000. Books, April 2001. Sommers, T., and Shields, L. Women Mental Decline in Aging Need not be Take Care. Gainesville, FL: Triad Inevitable. New York Times, April 16, Publishing Company, 1987. 1994. Addresses caregiving role of women.

Rabins, Peter, M.D. Beyond the 36-Hour Unlocking the Mind. Chicago, IL: Day. Chicago: Center for Applied Chicago Tribune, September 18-19-20- Gerontology, June 14, 1990. 21, 1994.

Reisberg, B., M.D. A Guide to Veermeesch, P.E., Ph.D., R.N.; Greene, Alzheimer’s Disease—For Families, R., M.S.W.; and Meade, H., A.C.S.W. Spouses and Friends. New York: The Managing the Client with Dementia: A Free Press, 1981. Resource and Training Guide for Nursing Homes and Adult Day Care Robinson, A.; Spencer, B.; and White, L. Centers. New Jersey Department of Understanding Difficult Behaviors: Health, 1988.

Zgola, J.M. Care That Works, A Zgola, J.M. Doing Things. Baltimore, MD: Relationship Approach to Persons with Johns Hopkins University Press, 1987. Dementia. Baltimore, MD: Johns Excellent book on keeping persons with Hopkins University Press, 1999. Alzheimer's disease involved in Excellent book on caregiving. meaningful activity.

house of welcome adult day services specialized programs for persons with memory loss

THE DAY PROGRAM Persons EARLY MEMORY LOSS PROGRAMS with memory loss and their Supported by the Martin and Mary L. Boyer Foundation families can benefit from the North Shore Senior Center’s Mind Matters is a group program House of Welcome Adult Day Services for persons with early memory (HOW), providing specialized programs for loss, focusing on socialization, persons with memory loss from Alzheimer's stimulation and support. disease and other dementias. HOW’s day program offers structured, therapeutic, Mind Matters Family Support small-group activities in a comfortable, Group is offered to family homelike setting. Participants with early, as members of Mind Matters well as more advanced memory loss, enjoy participants. meaningful activities and friendships, while caregivers benefit from time on their own. Special services of bathing, hairdressing, massage therapy and podiatry are COMMUNITY EDUCATION available. Family members are provided HOW publishes an Alzheimer’s supportive case management services. Caregiver Manual. Educational programs on dementia and related topics are offered.

ALZHEIMER’S FAMILY SUPPORT GROUP HOW offers a support group for VOLUNTEER OPPORTUNITIES family members of persons Volunteers are an integral part of with memory loss from our HOW team, bringing a rich Alzheimer’s disease and other dementias. diversity of talents, making a real difference in the lives of our participants!

The mission of the North Shore Senior Center is to foster the independence and well being of older adults, enhance their dignity and self respect, and promote their participation in and contribution toward all aspects of community life.

For information, call House of Welcome at 847.242.6250 1779 winnetka road, northfield, illinois 60093 • fax 847.242.6275 • www.nssc.org

JL/alzheimer’s caregiver manual/ ACM2005 revised 2014-12