Memory Care with Teresa Youngstrom
Dementia Care: It Takes a Village
(upbeat music) - Hey, care partners. Teresa Youngstrom with MemoryCare with Teresa Youngstrom. So glad you're here. Hey, we have a lineup like none other today. I have invited some incredible guests from incredible different lines of work and you are going to be so excited. We're gonna do a case study with these women and they're gonna give us some information from each of their perspectives on how they could help this individual. Okay, let me start by just reading you the bios of this amazing group that we've put together today. We're gonna start with Jane Jarman. She's an experienced dementia specialist working with persons living with brain change, consulting care partners, families, and serving as a dementia staff trainer for long-term care communities. Jane creates awareness opportunities for her clients in introducing dementia skill techniques and effective communication strategies while also deepening their understanding of the many, many, many facets of dementia. Jane's a certified independent, positive approach to care, tip a snow trainer, also an advanced consultant, as well as a certified dementia practitioner. As a PAC trainer and coach, Jane teaches healthcare and professional organizations increased awareness, dementia knowledge and skill building so they may better understand changes occurring with a person living with dementia. As a PAC consultant, Jane works with families to determine what challenges and changes are occurring. By identifying the unmet emotional, physical, social needs of their loved ones, the goal is to work towards a supportive and caring environment for both the person living with dementia and their care partner. Jane is a current board member of the Central Oregon Parkinson's Council. Community educator for the Alzheimer's Association in Central Oregon and a community resource for the Council on Aging in Central Oregon. We're gonna welcome Jane in just a second. We also have Dr. Cindy Kane. She is a practice physical therapy. She has practiced physical therapy for over 35 years in both North Carolina and Florida, with most of her years spent working in assisted living and skilled nursing facilities. Cindy is passionate to increase the awareness and understanding of brain changes with dementia, as well as share skills for improving interactions for all those dealing with people living with dementia. Cindy is a founder of Engaging Dementia Effectively, which provides teaching, training and consulting services around Western North Carolina. Mostly to facilities and families. Cindy is a licensed physical therapist with her doctorate in physical therapy. A certified dementia practitioner, certified Montessori Dementia Care Professional, she's also trained under TIPA SNOW's organization, positive approach to care, and certified as an independent trainer, consultant and advanced consultant. She's also a community educator with her Alzheimer's Association in local mountain region. Cindy lives in Canton, North Carolina, with her two cats and is active in her faith community. She enjoys travel and has a heart for the Czech Republic. Last but not least, we have Missy Hardin. Missy is an experienced occupational therapist and a certified dementia care practitioner. She strongly believes that those living with a dementia diagnosis and those who have the privilege to partner with them can experience joy and dignity in care through increased dementia awareness and care skills training. Missy is also a certified independent positive approach, certified independent positive approach to care, advanced consultant and a trainer with TIPA SNOW's organization. She is able to offer support and encouragement through consultative surfaces, care partner training and community workshops. Missy facilitates a virtual family care partner support series in volunteers as a community educator with the Alzheimer's Association. Co-facilitates a virtual support group with the Association for Front to Temporal Degeneration and teaches to community-based neuro fitness classes. These ladies are so qualified to be here with us today and I am so excited to welcome them here with us. Welcome, everybody. - Welcome. - Hi. - Hey, what a lineup. I mean, so exciting. I'm a nurse and you guys got this and that and this and this and that and you're serving all over America. It's so cool. Welcome. - Thank you for having us. - Yeah, yeah, super great. So I knew this would be a great day if we could get you all together, bring in all these skills and all this knowledge and all this passion for caring for other people, struggling with brain failures and bring it all together so we can educate the community and yet another perspective. So without further ado, let's move right on to our case study for today. So I prepared a woman, a client, a resident, a patient and sent this out to the ladies so they could prepare some information for us. So here's who we're gonna be discussing today. Mary is a 78-year-old woman who lives in the mother-in-law suite at her son's home. She was an elementary school teacher for 40 plus years and has always enjoyed the outdoors. Mary was diagnosed with Parkinson's disease 10 years ago and her family reports increased forgetfulness for the last three years. Her neurologist recently confirmed her dementia. She is mostly independent until recently and has demonstrated bigger mistakes. She can shower if she remembers but frequently puts on clothes she took off. She can feed herself and walks with a walker when she leaves her home. Mary has pretty good safety awareness during the day hours but can be more difficult in the evening. The family is frustrated because she keeps setting off the smoke alarms by leaving items on the stove in her suite. She also tried to stand on a chair last week to reach an upper shelf and she fell, broke her right wrist. Thankfully, she is left-handed. She will be in a cast for five more weeks. They've hired a caregiver to visit in the evening but really have no idea how to train her on engaging activities, hygiene with a cast or reconciliation when things go wrong. What are a few ideas you have to guide this family and their caregivers to help keep Mary safe and happy with her current dementia situation? So I'm gonna start today with Missy. Missy is an occupational therapist. How important is it for us to explore Mary's environment? - The environment, we often refer to that as the silent partner. There's so much that can be contributing to not only her ability to function but also the challenges with her inability to function. The beauty of her being at home with her family support is that as an occupational therapist, we cannot only work with Mary but we can work with her family to help them that are understand the challenges she has and also how to help foster her continued independence. - I love that. I love that answer. That's so good. Yeah, I think it's a blessing too that she still has family around. Although not there 24/7, you know how that progresses. We either have to bring help in or we have to help them move somewhere where they can get more care. Do you see anything significant when you see Parkinson's disease and a dementia diagnosis? Like we're seeing here together in Mary's history. - I do very often, well, maybe 50% of the time somebody that has Parkinson's disease will develop dementia with lewy bodies. And that's gonna affect not just memory but oftentimes it affects concentration, the ability to problem solve, more of this thinking brain issues and it often doesn't show up first which makes it dementia with lewy body versus Parkinson's disease. It's really important because those changes if they don't show up first can be fairly confounding to family members who don't understand the why now. - Absolutely, absolutely. And it seems like more and more research is coming out on lewy body and we're seeing so much more of it now that we're learning how to pick up the symptoms even earlier. So I'm so glad you brought that up. Let's move on to Cindy. Cindy, as a physical therapist, I'm guessing that you see some safety issues with the Parkinson's and the new arm fracture too. Can you elaborate on how disabling one arm fracture in a sling or in a cast? How challenging can that be even for her gait? - Yes, and it's amazing to me. Normal elderly people who fall and fracture their shoulder or something. And once that arm is immobilized, it totally throws off their ability to balance, especially if it's sore and they're keeping it all locked in on their body that typically we use our arms to kind of help our balance as we go. Then you overlay Parkinson's on that which has a problem with mobility anyway where people will stiffen up, they go more slow, they have freezing gait on top of not being able to use that arm. It can be really cause a great decline in their mobility and causes unsafe mobility and actually an inability to move more so, which sounds funny 'cause doctors will say it's just the arm. It's not their legs, their legs are fine. But in truth, the arm greatly impacts the legs and especially somebody with a neurological issue like Parkinson's disease even more so. - Got it, yeah, good, very good point. Do you see, can you think of anything that could improve her safety, the safety awareness in the evenings? Do you have any ideas from that perspective? - Well, definitely, I just chuckle when you hear about the climbing up on the chair to read something and that was not thinking clearly or maybe being very determined. I don't know which, but definitely in the evenings as people with dementia tend to get tired and just like all of us, we get tired and brains get tired. So I would think doing something maybe even resting earlier in the day or encouraging her to take a rest in the day. Other things to mention that she liked the outdoors, if possible, right now where I live, we're having tremendous snow. But as possible to get her outside and get some sunshine, which also impacts the later afternoons for the mental and their cognitive abilities. So that's something else and that's a great way too. If she could get outside and walk with someone, that's a great way to improve balance and mobility is getting out on some even, uneven terrain. It mentions she used a walker outside typically, which is great for safety, but it doesn't build anything. It actually takes away from people's mobility in the long run. - Got it, great points. I know with my mom, as the evenings got more difficult, putting a nap in there from say two to four was, it was a game changer really. So I love that you brought that up. Let's hear from Jane. Jane, as a dementia trainer, coach, how important is it to adapt communication techniques based on the time of day? - It's really important, Teresa. I'm glad you brought that question up. It's really important that we as family members and care partners understand the awareness of communications that they're actually starting to decline, both comprehending what we're saying and the ability to express. They might not be able to find that word, that word finding. So oftentimes people living with dementia experience that difficulty towards the end of the day. We call it in the industry, sundowning, but I like to call it like your battery, your battery bandwidth. We usually start with a 100% battery bandwidth of charge. Say if you're well hydrated, you slept well, that whole thing. But a lot of times for folks living with this brain change, they start with like maybe half, maybe 50%. And they're going through the day, trying to keep up with everybody and everything, conversations, doing things, trying to get through the day. And then towards the end of the day, the emotions are kind of on the surface. Their anxiety is spiraled up. They're confused. So they may be labeled, what do I do with this person? They don't know what to do with themselves. So it's hard, it's really important for family to know when to communicate. And a question would be, when is Mary best to communicate important things? Is it morning after that first get the coffee? Or in the afternoon, maybe right before lunch? Hey, Mary, we've got an important appointment tomorrow. We've got our eye doctor appointment. So we need to get that on that whiteboard so we can visually see it. And make sure she's understanding that. I think it's really important to know when she's at her best. And a lot of times for a lot of people, mornings and maybe mid-afternoons are our best. Late-afternoons, it's that bandwidth. It's that battery, you know, battery kind of declining, so. - Yeah, I mean, I'm more tired in the evening. I wouldn't be at my best to do this with you if it were, you know, in the evening. So makes good sense. You know, we all are connected through TIPA Snows organization. That's how we first came together. And we met each other. - You know, TIPA says we all approach from the front, but would you say tone in body language? Are they important when communicating with Mary? - Oh, absolutely. I think they really, that's part of the brain that still is intact. They can pick up on inflection and tone. And when you've got your arms sitting here across like this going, "Mom, oh my gosh, you've asked me that question 55 times. I really can't, I just, I'm so, I can't answer it." They pick up on that. They pick up on body language. They pick up on the finger wagging. They pick up on, you know, if you've got your back turned away from them and they can't really see if you're talking to them, they don't, they feel sometimes they can be frustrated by that, that you're not addressing them, you know, face to face. So what we like to do is what we call getting in there, getting to that positive physical approach. TIPA Snows says, getting in, starting at public, it's public stance and getting into that more personal space. And then coming to the side so they can see you, but they also have that visual field of looking beyond you, just in case, you know, they don't want to just see you head on in that what we call confrontational stance. So intonation, body language, it really makes a difference. And we use a lot of a combination of nonverbal and verbal and keeping it short and sweet with them. - Yeah, great, great point. You know, I want to swing back to Missy. Missy, I think we all can agree that caring for the care partner is very important too. And, you know, sometimes we're not thinking about, you know, them getting the care and support that they need. How would you prepare and maybe support the family here? - That is really important. I love the fact that you said care partner because it helps us recognize that 50% of the interaction comes from the person living with dementia, 50% comes from the family care partners. They have to connect. And it's really important for us to assess what is the awareness of the family care partners, awareness of their person's diseased brain? What is the awareness of their level of stress or distress? You mentioned that Mary's family was getting frustrated because of some of the changes they were experiencing. So how can we better equip the family care partners or any care partners coming alongside a person so that they have more awareness and more skill to better support the person that they are supporting? - That is so, so good. You know, in my experience over the years, caring for people living with dementia and the care partners, frequently you find that they may just plant them in front of the television and they may just sit there all day, not really engaged, not really using what they still have left. And I know they still have a lot left. TEEP is impressed out upon us that just 'cause one part of the brain is dying doesn't mean the whole brain is dying. And so we don't write this person off. We just figure out how to join them on their journey, right? All their journeys are a little different. We all know that. But I would say, can you give us an example, Missy, of, what would you see some great things we could do to make a meaningful day for Mary? - I would start with the area of mistake and frustration. So meal preparation. She's cooking in her mother-in-law suite. Well, what a great time to have her great skill as a teacher, planner, organizer, help plan meals and start building in that support in a natural relational way to bring that skill, have her continue to participate so that she doesn't feel less, but she feels competent even with the added support. - Gosh, that's good. Yeah, because they still need purpose, don't they? All these individuals, they still need purpose. And how can we do that? Cindy, how might you train a caregiver, care partner, to protect Mary and themselves against future falls? - And it's really interesting that you ask that because the natural inclination Mary has had a fall. So she needs to sit down and be stationary, which is only gonna contribute to more falls because she's going to not only her Parkinson's disease is gonna create more stiffness in her system, but she's gonna lose quality of life, as well as ability. So I think it's really important with a caregiver to learn that and train them on how to support her. Teepa shows a way in which we call the hand-under-hand, which is absolutely fantastic for assisting people to walk. And what she really needs to do is be mobile and be walk around the house. And my guess is, since she used to walk her outside and not inside, she probably did what we like to call furniture ambulation where she would, she knows just where the dresser is, just where the chair is, and she would put her hands out to get through where right now she can't do that because the one hand's in a can. And that again is gonna throw her off. So it might be good to just do some walking throughout the suite, seeing how she mobilizes and maybe even moving some of that furniture. So she does have a place where she has a hand grab, where she might not have had last time or before for that, as well as the basic best exercise for helping people with balance and leg strength is the good old sit to stand. And that's something that I would train people to work with them, don't help them up. And sometimes if they're able, don't even let them push if they're in a safe environment where you're there, but let them use their leg strength. And if they can get up and down and just have them do it a few times before you walk into the other room, it's a great way to prevent falls and to build leg strength. - I love that. Having cared for people with Parkinson's in the past, it seems like it's use it or lose it, use it or lose it, you know, and how even if you're creating a new pathway in the brain to understand this new exercise, we gotta keep exercising. And that's so, so very important. And it seems like, too, in my experience, if you do initiate a walker for one of these individuals, if they have a true dementia with short-term issues, they don't remember, they use a walker, do they? And they park it and say, "I don't use my mom would have said I don't use that thing." And she would have parked it, so interesting. Cindy, do you have some exercises or activity from your point of view? Anything else you can think of from your point of view that might help this woman and her family? - Well, I definitely think assisting her gait as needed. I would get rid of the walker because that makes people slow down and like someone on the journey of dementia is not gonna use it properly. But things like sit-to-stands, maybe even having a time of dancing, where you might get with a care partner and put on some music and dance it out, where they get some movement and it's kind of fun, but you're really working on balance and stability. So that can be something that can be done too. Not so much, let's do 30 reps of this or that, but in motion, in motion and mobility, supporting them and making better strength and better stability. - I love that, yes. Squats and leg lifts don't sound near as much fun as dancing with me. - Yeah, I love that to keep the fun in there. That's vital to keep the relationship great too. Hey, Jane, I know you find great importance and how Mary should spend her day too. And you give us some examples of some additional activities to engage her from your perspective. - Sure, I think this is a really good time for family to put on that detective hat and kind of look back on Mary's life. What did she do for her career and what gave her value with that and productivity? You kind of have to look at different aspects of her life. What brings her joy? What are her hobbies, her personality traits? Is she an introvert? Is she an extrovert? Is she likes to talk, to do, to watch? And what does she like to do with wellness and self-care and what does she like to do to recharge her battery? These are all questions that we can be asking family members to kind of reflect and ask her and outside caregiver, because that's a good way for her to get to know the caregiver and caregiver vice versa. And then based on that, let's formulate kind of a plan of how to incorporate some of these activities that she can do safely and that she can do on her own. Because the more, I think it's really important that the more that she can do on her own, like say button or shirt or make coffee if you have everything laid out on the counter for her, she's able to do that. We're preserving the skills that she still has, which is so important because once we start doing everything for them, it kind of goes away. And we don't want that to happen. So we wanna really give her that fulfillment of I'm doing things during the day. I'm going out to the bird feeder. If I've got a nice clear path, Cindy, Dr. Cindy has made sure that path is nice and clear. She can go and refill the bird feeder. I mean, things that she can do safely on her own or maybe under the watchful eye of caregiver or family member. I think it's just super important to kind of formulate a plan for her. So I just like those techniques. And it gives her kind of that self-esteem, keeps that sadness, depression kind of at bay and a sense of, you know, I can still do things. I'm still a vital member of my family. - Perfect. You kind of covered my last question too 'cause I wanted to ask you how important it is to uncover what Mary can still do with or without support. And you kind of covered some of those things. Anything else you can think of? - Well, to be honest with you, I think it's just important for family to really understand where Mary is in her disease, in her brain change, I like to say and be really open to being proactive with it. And not just, well, mom can't do this, mom can't do that. Let's keep thinking. Let's try to keep being creative with other things. If she doesn't like something, maybe put it away for a minute. I mean, she doesn't want to look at a photo album. Let's give it a rest for a minute and let's find something else to do. Let's maybe, you know, I'll read to her or get up and dance or sing a song. You know, look out the window and kind of try to formulate, you know, what are we looking at? What can we talk about the birds that are by the bird feeder? I mean, just anything that can kind of, it just kind of initiate conversation, conversation starters. So I just like all of, you know, all of those different ideas that we can just be thinking, just kind of on the fly, really and truly. - Yeah. So we're engaging her, but we're not demanding anything from her. - Absolutely. - And we're not asking a million questions. Do you remember my name? Do you remember my name? - Yes. - Ah, doesn't that list the hair stand up on the back of your neck? Like, ah, we don't use that. Do not, I mean, remember, don't you remember? - Yeah. - I know, oh my goodness, you guys, so much wealth of information here, so much compassion for these individuals, for their families. You know, if I ever get dementia, I want this team, the whole team on my gay. So I'll let my husband know how to get all of you guys. So, but before we end, you know, I know there's so much more. So if you could, for me, I'll go around, if you could tell me, you know, the name of your business and what your special gifts are that you offer and then how can someone from this audience get ahold of you? 'Cause you know with technology now, we can serve people across the States and around the world and it's beautiful that, you know, you all have different skills and talents. And so Dr. Cindy, let's start with you. Tell us in your business and how, what do you do, what's your specialty and then how can someone get ahold of you if they need your services? - Okay, thank you, Theresa. The name of my business is Engaging Dementia Effectively and my greatest heart and niche is really reaching out to rehab professionals and folks like this case study with the lady with Parkinson's, where it's not solely just the brain changes, but we've got body figuring into it and how we as healthcare professionals can do a better job at working with both areas and improving strength, mobility, quality of life for folks. And I have a website engagingdementiaeffectively.com and you can reach me through that. I do consulting, a free 30-minute consult. If people have questions about maybe doing things differently or want me to speak with one of their therapists who's coming in and they're just doing leg lifts after the hip fracture and leg lifts are important, but it doesn't really translate to someone with a lot of brain change. So thank you for letting me do a plug and I'm really out there to try and change the rehab world. - Yeah, I love that. Jane, tell us about you out there in Oregon, name your company and what are your specialties and how can someone get ahold of you? - Okay, thanks, Theresa. Hi, I'm Jane and Jarman and my company is called Dementia Connections, LLC and I'm out on the West Coast in Oregon. And kind of my specialty is I love to educate. I love to teach. So I go into long-term care communities and I teach mainly assisted living and memory carers and I teach, I start anywhere from executive directors all the way down to maintenance and housekeeping because everybody has a piece of the pie in terms of connecting with the residents there. So they all I think should be on the same page with knowledge and with skill and with knowing that dementia isn't just about memory loss, it's about a lot of other things. Language issues. Comprehension, you know, reception of language, vision, things like that, sensory awareness. So I love to kind of give that light bulb moment for everybody going, wow, there's a lot of different, there's a lot of different things that go along with this disease, but we can still support them and they can still have beautiful vital lives. I do that and I also family consult as well and I actually work with persons living with dementia have a few clients that I work with and kind of as a case manager and consult with family members and just and work alongside of them and just kind of create, you know, wonderful moments for their, you know, along their journey. So yeah, and then you can get ahold of me just through my dementiaconnections@gmail.com and dementiaconnectionsllc.com is my website. So thank you. - Perfect, yes. - Ms. Martin, tell us about you, tell us about your business, your gifts and then how can folks get ahold of you? - So my business is called No-I-Care, Dementia Care Consulting. I feel strongly that the more you know, the better you can care. The best way to get in touch with me is through Douta Senior Consultants. I am their Dementia Care Specialist and that's d-o-w-d-a seniorconsultants.com and my specialties are just helping anyone on the Dementia Care journey be able to live better, more fully understand their strengths, understand where support is needed, start developing a plan because we know with this progressive disease needs are gonna be ever changing and increasing. So focusing on family care partners to better support their loved ones living with dementia, helping those living with the disease, better advocate and have awareness and plan for their best future and then as professional care partners come on, helping them be educated and develop skills to best support this person to live their best life. - Fantastic. Well, thank you all for being here and thanks to the great audience. So you know how to get ahold of these amazing women. There's so much more to what their businesses do and what they can offer you. So please like, share and subscribe so we can get this information further and further out to the many millions of people that are struggling right now, not having an idea how to work with their individual, their Mary and there's lots of Mary's out there that need us, okay? Thanks again everybody for being here. I'm Teresa Youngstrom and just keep in mind, you got this. (upbeat music) (upbeat music) (gentle music) (upbeat music)