Dementia: Being Useful

My experience of listening to someone who has suffered stroke, that has led to dementia, suggests a number of things. First of all the fear never goes away and any symptom takes on a new perspective.  That isn’t surprising when you have had a near death experience. Then there is the possibility that the person concerned will develop a perspective that focuses on a chronic condition, rather than recovery.  It’s easy for me to suggest it but I don’t think any of this is helpful for the individual concerned.  Therefore I focus on: ‘you are recovering from stroke; just as I am from bilateral hip replacement’.  I think this is a preferable state of mind and I preach it daily.  So what has this got to do with this morning?

I think it is important for someone who has dementia to feel useful.  So this morning when my wife declined an invitation to join me on a short shopping trip, I left her the opportunity to feel useful – a messy kitchen.  I returned an hour later and she had spent the whole time tidying my mess.  While I have been out she has been ‘on the go’ the whole time.  It doesn’t matter if things are misplaced or not completely clean: she feels useful.

My wife has now taken to the sofa after hard morning’s work.  She feels good that she has been left alone to get on with household tasks: rather than being supervised by carers.  If we are to have a life with dementia we have to take calculated risks, so that we can continue life in our own sweet way.  It all a question of judgement on the day.  This morning went well: tomorrow brings another day and fresh challenges.

Dementia: Telephone Lines

I suddenly remembered Geoff Lynne this morning lead singer of ELO, in the good old days, and thought of Telephone Lines a rave from the grave.  As M sleeps a lot these days one of the things I do is disconnect the land line.  If she is awoken by the ringing of our telephone it causes distress; particularly if the call is for her.  The last thing she wants to be doing when she has been woken up is to take a call on the telephone when she is trying to come round.  It is now evident that all telephone calls have the potential to cause distress.

Imagine, if you can, that your short term memory is poor and you have no recall over what has gone on in the last few hours.  The telephone rings and it is for you: with butterflies in your stomach you take the receiver.   You have to say something as the questions arise: so you simply provide detail rather than appear like a blithering idiot.  Confabulations flow and you build up a story based on something that you have done in the past.  The person at the other end of the phone may twig and hopefully does not let on.  Then it could get worse than that.

The caller decides they have to initiate conversation and shares some personal detail.  At the end of the call with the emotional memory still intact ‘bad news’ is often retained and dwelt upon as nothing else has been retained.  With this being a typical scenario it is tempting to leave the phone off the hook more frequently.  The alternative is to suggest some guidelines to callers.  I once read on Talking Point a suggestion that may fit the Bill that went something like this:

Keep calls brief

Open with: ‘Hi just phoning to let you know we are all fine

Do not pass on any bad news

Don’t ask any questions

Just say: ‘is there anything you want to tell me?’

All seems very straightforward but not that easy to pass on without causing upset.

Dementia: Fail to Prepare: Prepare to Fail

There is a steep learning curve when you are caring for someone with dementia.  Pretty quickly you develop some ‘Golden Rules’ that you try to keep to.  When you get things wrong you see your mistakes before your eyes and can pay for them dearly.  It is one of those situations where Fail to Prepare: Prepare to Fail, hits you straight between the eyes.  If you are really unlucky you might even get a real slap on the face – as I have done on a couple of occasions.

Yesterday I maybe just got lucky on a couple of occasions.  We coped well without a carer and I managed to track M down fairly quickly when she had gone off for a walk.  At bed time  I averted the hunt for P J’s and tooth brushes by making sure they were on hand.  Such things are easy to do and simply have to become part of my routine.  It is helping others to be supportive where the real dilemmas present themselves.  How do you give visitors ‘the nod’ without causing offence or appearing to be an expert?

I hope she doesn’t mind me doing it but I will use a close family member as my example.  B is hoping to visit along with her son on Saturday.  I don’t think she has seen M since stroke and will not be familiar with her presentation.  She already has something of an advantage over some of our visitors: she is familiar with dementia.  Along with my other sister she is a regular visitor to mum who has vascular dementia.  She has also seen my brother’s Alzheimer’s progress at an alarming rate.  However, I am wondering if there is anything else I can do to make sure her visit is supportive to my wife?

In some ways we are already off to a good start as B has said lets see how M is nearer the day.  I am hoping that she has the time to read my Blog occasionally just to see how things are going.  Also I feel our relationship is such that we might even chat things over before her trip up here.  So a little preparation might just help…….  Now I wonder what to give them for lunch?

Dementia: Risk Taking Can Lead to Good Outcomes

I have taken a couple of risks here this morning and on both occasions the outcome has been positive.  Early on  I received a call from our Care Agency that our normal carer was not in work and they were struggling to find a replacement.  As they were unable  guarantee a familiar face, as C’s replacement, I told them we would cope by ourselves.  There would have been little point in sending someone who didn’t know the ropes here and M’s response may well have been to refuse to get out of bed for a stranger.

This meant that I had to hurriedly change my plans to meet my Admiral Nurse as I couldn’t risk leaving M alone for a couple of hours: I made do with a chat on the phone.  It also created an opportunity for us to regain control of our own house: no longer invaded by carers and me scooting off.  So the happily married couple had their house to themselves this morning and things have gone well.  It raises the question about the need for flexibility within Care Plans but I recognise the difficulties with such arrangements.

Early in the afternoon I took another risk by watching Bargain Hunt on the T V and leaving M to her own devices in the kitchen and garden.  I kept my ears finely tuned to have an idea that she was still on task.  It is likely that I ‘bobbed off’, as they say around here, for a moment or two during the one o clock news.  When I came too all was quiet and M had scarpered.

After asking a couple of neighbours if they had seen her, I jumped in the car to widen my search.  Sure enough I soon came across her on a familiar route a couple of streets away.  With minimal encouragement she joined me  in the car and returned home, saying she didn’t know where I had gone.

Some would concentrate on the dangers of my risky behaviour and perhaps I have had couple of lucky break today.  However, no harm has been done and all is well without the involvement of carers or police.  Just another day in the life of caring when dementia is the elephant in the room.  Once you have had one day with dementia; you have had one day with dementia.

Dementia: Reviewing Bedroom Behaviour

My bedroom behaviour is clearly in need of review.  I am generally the first in bed at night and often up before the crack of dawn.  Generally, I  and watch with increasing bewilderment my wife’s routines before she joins me in bed at night.  Last night was fairly typical as her search for missing things became even more frantic.  Drawers were opened and banged shut as the search for her toothpaste  intensified.  Nothing surfaced and I stayed under the covers for fear of making matters worse.  Various announcements were made including thieves stealing her belongings yet again.

The search went on for over half an hour and the frustration became more evident.  Eventually M announced that she would sleep in another room, away from the thieving B’s that keep nicking her stuff.  At that stage I decided that I could take it no longer and went down stairs to see the closing half hour of Match of the Day.

When I returned upstairs my wife was standing looking out of the window in floods of tears.  I eventually managed to coax her into bed and console her somewhat with a cuddle.  I reassured her that I would sort things out in the morning and we could easily buy some more toothpaste.

Just for a change this morning I managed to stay in bed beyond the crack of dawn.  Therefore, I saw with my own eyes the difference it makes when I am beside M when she wakes up.  Her fears of being left alone are gone and if I play my cards right she knows she is safe with me beside her in bed.  We indulged in matter of a fact chat for a while then I got up and began my morning tidy up of the bedroom.

As I opened the top drawer of M’s dressing table I found two tubes of her toothpaste.  If only I had joined in the search last night I would have saved us both an hour of anguish.  Why on earth I stayed in bed last night rather than help the search I will never know.  It’s not surprising she couldn’t see her toothpaste wit her loss of vision.  The white tubes were on a white background in the half light of a table lamp.

I need to change my behaviour in the bedroom and work towards last in last out.  The former is slightly easier to accomplish than the latter: M continues to sleep for England.

A Different Approach Pays Off

My wife usually wakes up in the morning distressed over one thing or another.  This morning she is worried about whether she is late for school: a return to a childhood nightmare.  I’m pretty sure where it comes from but detail is not important for the sake of this post.  However, just by chance, or intuition, I made a move that seemed to ease her concerns.

I took myself out of the bed and moved to sit on a small bedside table adjacent to her head.  This seemed to have an immediate beneficial impact as I stroked her arm and tried to ease her anxiety.  The reason is quite simple: I am a safe option, no longer in the bed, as she tries to figure out where she is and who I am.  All I am confirming is that I am there to help her; so simple.   As I see the anxieties disappear before my eyes, I almost kick myself for not thinking of this before.

Once I have sorted out what she needs I am off to make her the first cup of tea of the day.  How can the arrival of her ‘Tea Boy’ first thing in the morning be anything other than a good start to the day?

Fine Tuning the Approach to Dementia

We have had a good chat this morning about the consequences of stroke for M.  As an ex car worker I would liken it to the engine occasionally misfiring: when the spark and fuel don’t quite arrive at the same time.  Older readers may remember ‘pinking’ when the timing was out and the engine would run on, after the ignition key had been turned off.  Oh those happy days with the timing light or a cheap tuning kit: under the bonnet on a daily basis trying to get the old banger to run smoothly.

Hardly being a neurologist my understanding is that stroke could be seen as a bolt of lightening striking the brain.  Lasting damage has been done to a certain critical areas . No one can say with any certainty what the long term consequences stroke will be.  It is possible that pathways in the brain might re route and capacity will be regained.  Uncertainty is the order of the day and the general thesis is that when dementia has occurred decline is inevitable.  Yet there are days when I am astounded by my wife’s lucidity and intellectual capacity.

It would be lovely if I could just get out that tuning kit or timing light and make the necessary adjustments.  Unfortunately my time under the bonnet has long gone: technology has taken over from the mechanic in me – it’s far too complicated now.  When things go wrong with our vehicle now I take it to an expert who plugs in  his lap top diagnoses the problem and sorts out any problem.  So no tinkering anymore for this D I Y mechanic.

I still think it is worth tinkering with my approach to dementia: sitting back and witnessing decline is not for me.  It is clear that having our regular carer back has made a significant difference.  There has to be other changes that we can make to our environment that will impact upon mood and capacity.  Watch this space: there is lots of room for me to tinker with my approach to dementia.

Dementia: Buffering Leads to Packing to Go Home

We had a lovely evening yesterday watching an Emmylou Harris concert on YouTube.  She is a recent discovery of ours a belated rave from long ago.  Just In case you are not familiar with her songs here is one of our favourites: Making Believe. Then buffering started and we waited for the Internet to get up to speed:  I will just have to spend some more of our cash and get cable installed.

To go back to Emmlou we had sang along for  the best part of an hour, then the natural break occurred and M took herself off in the interval.  She was gone for a while and I busied myself with something; even dozed off.  When I came round and the buffering continued I switched to  a T V channel, to watch how James Bond was pursuing the latest villain.  I caught up with 007’s latest antics for a while, and then decided I had better check up on my wife.

Bet you have guessed what she was doing by now.  Yes there she was in our utility room packing to go home.  I would suspect that she went into the kitchen; called into the downstairs loo/utility room, forgot why she was there, and decided to get some things together for the homeward journey in the morning.

It all seems to fit together somehow.  If you wanted to get away from somewhere you would plan your escape.  You wouldn’t want to leave the nightmare of dementia without some of your own things.

Seeing C Q C In Action

This morning I saw the benefit of using C Q C with an immediate improvement in our situation.  I am being a bit naughty here I know; the lengths some bloggers will go to get attention.  So I had better come clean I am talking about Consistent Quality Care, rather than the Care Quality Commission.

As I have mentioned before we have struggled along for a few weeks with different faces from the Care Agency.  The ‘Special One’: C has been away on honeymoon and things have been rather difficult in her absence.  During her absence my wife asked after her every day: ‘Is C coming today?’  That old emotional memory still intact see!

Today I have watched something akin to ‘Poetry In Motion’.  The moment M opened the door she was pleased to see her adopted daughter (my words not hers).  As breakfast came and went we chatted, even bantered, the morning away.  As C tidied up the debris in the kitchen she nudged M effortlessly towards a pampering morning.

On return from  a small shopping expedition I immediately saw the results of the ‘pamper party’.  Not hung over in any way M looked so much better with her lovely locks flowing again and her skin glowing in the sunshine.

C’s approach to her work is commendable; it is not a job it is a cause to this young woman.  Newly married she is often up at the crack of dawn and  on the go until darkness falls, with no paid breaks.   Her rewards for her professional approach: a zero hour contract and minimum wage.

We are so fortunate that we have found C Q C in action and hope that we are able to hold onto this gem of a carer.  Can you blame us for adopting her?

Better Practice 2015 conference

I found Kate Swaffer’s post really interesting and have copied it across from her Blog:

Kate Swaffer (she/her) Kaurna Country's avatar

Screen Shot 2015-08-07 at 1.22.28 pmYesterday I was invited to give a presentation at the Better Practice Adelaide 2015 conference held at the Hilton Hotel, and most of the time now when I present, I also always represent Dementia Alliance International in some way. The theme of this event was Quality – Through the looking glass: What’s new in 2015.

One of the points I made in my presentation was that when looking in the mirror of aged and dementia care currently, it does not look like a place I would want or like to go. When I look at the current medical model or pathway of care for people with dementia (or rather, lack of an ethical pathway), that is not very attractive either, and if I was Alice, I’d simply refuse services at all. I reviewed about models of care, rehabilitation for people with dementia, human rights, Prescribed Disengagement, language and stigma…

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