Merry Christmas to my readers

In this economy I feel blessed to have been offered a wonderful position as Assisted Living Administrator.  Please know that although we have closed A Good Daughter Elder Care Management, I will continue to share my experiences with those interested in elder care, family caregiving, Alzheimer's disease, and issues centered around health care administration as it has evolved today.  Please know that I wish you all a wonderfully healthy 2012 and much love to all my colleagues and friends that I have made throughout the years.

Activities for Alzheimer's

Keeping the mind and body active and busy is important for everyone, but especially for the person with Alzheimer’s disease.  Activities should focus on the person’s abilities, not their limitations.  Activities should be safe, with enjoyment, not achievement being the intent.  Recognize that the A.D. person’s interests can change from day to day and hour to hour.  Activities that provide mental stimulation are best done in the morning, while soothing or calming ones are best done in the late day or evening.  Realize that the attention span is likely to be short and the person may not be able to initiate activities but may be able to do them once the caregiver starts. 

Following are some ideas for useful and interesting activities:

  Helping with chores gives the person a feeling that they are still part of the household.  Examples include:  setting the table, folding the laundry, sweeping the floor, and sorting the silverware.

 Exercise releases tension, meets physical needs, and provides a feeling of accomplishment.  A stationary bicycle or easy video can be used effectively.

  Gardening – simple tasks under supervision can provide satisfaction as the person “watches their garden grow’.

  Arts and Crafts – i.e., making pencil holders or vases from tin cans, trivets with glued tile pieces, painting shells and stringing beads for jewelry.

    Games appropriate to the individual’s level of function can be stimulating.

  Puzzles can be fun but first find the most appropriate for their stage.

    Sorting buttons, cards, coins, keys or socks can be a good activity for a lower functioning individual.

  Drives to interesting places can be calming and life enhancing.  A trip to the zoo, the botanical garden, or to a Florida Wetland is fun and provides the basis for positive communication.

    Reading aloud and using visual aids to share stories, poems and pictures about days gone by.  

  Use of a VCR or DVD player – old movies can bring back pleasurable memories.  Nature and travel films move more slowly and are easier to follow.  Never have a person with A.D. watch the news.  Especially during time of impending hurricanes- this can serve to agitate unnecessarily.

    Scrapbooks to put in favorite or treasured small items or pictures. 

  Busy Boxes and Reminiscence Boxes can include everything from kitchen gadgets to sports equipment, sewing supplies, or cosmetics depending on the gadgets to sports equipment, sewing supplies, or cosmetics depending on the person’s interests and the safety of the objects.

    Music which the person enjoys can be soothing or stimulating.  This includes everything from active listening to sing-a-longs.

Meaningful activities can give the A.D. person a feeling that they are making a worthwhile contribution and thus enhance their self-esteem.  Some positive ways to introduce an activity are: “Can you please help me with…”  or  “Could you show me how you do …., “  “It would be nice if you would make this for me.”  It is not a good idea to ask the person to do a simplified version of an activity or craft in which they once excelled, as this could be upsetting.  Above all, the A.D. person needs to feel a sense of accomplishment, satisfaction and involvement from the activities you are presenting.  And as we know, caring for pets provides a sense of accomplishment.  

As a former Activities director in long term care I understand the importance of activities. We have hired an assistant care manager with a degree in psychology and experienced at Activities Planning for seniors.  Please call our office or visit us online at www.agooddaughter.com if you are interested in setting up an activities program for your loved one with Alzheimer's disease.  

Communicating with the Alzheimer’s Patient

This is a favorite discussion of mine because I remember when I cared for mom and the caregivers would tell her “Momma speak English”.  I would constantly remind them that she “Speaks Alzheimer’s” and that they needed to learn her language, not the other way around.  Little did I know that when I took my training to be certified as an Activities Director I learned that caregivers do indeed need to communicate with persons who have A.D. in their own language.  Because I lived with mom every day, I did learn her unique language so here are some additional tips for those family caregivers and/or paid caregivers who need to communicate with the Alzheimer’s patient.


If you really need to be heard, make sure that you have the person’s attention by saying their name and making eye contact.  Remember cognition level may vary from day to day, time of day, location and conversational topic.  Limit the number of people in a conversation when you are communicating.  Use short, simple words and sentences with minimal information.  This really makes life easier all the way around.  Reduce distractions and extraneous noise when trying to communicate.  Use more than words to communicate.  Body language, gestures, and facial expressions also communicate meaning so learn to use appropriate ones.  Encourage the person to express thoughts even if having difficulty.  Be careful not to interrupt them.  Demonstrate tasks in easy to understand steps, one at a time.  Use recognition rather than recall questions when introducing someone.  Try saying, “This is Maria who we met last summer”, instead of saying “Don’t you remember Maria from last summer?”  Expect that the person may ask the same question over and over again.  Repetition is very common in this disease.  Try to have patience, be reassuring, and move on.  While on the subject of patience, ask one question at a time.  If asking a question, then wait for a response.  Sometimes there may not be a response, so gently move on.  Above all, and this is very critical and may take some practice, but you must avoid criticizing, correcting, and arguing.  It is always counterproductive.  Remember, you can no longer teach them something like you can do with a two-year-old, it is up to you to:

1. Treat them with respect and dignity and not as if she/he were not there.  I had a family member who was so happy to see me that she would have conversations about him in the third person in front of her husband with A.D.   Years later I learned that after I left he would always act out in anger.  
2. This one is crucial.  Simplify tasks.  Break down tasks and activities into easy steps.  Limit choices.  Allow time for their slower processing time.  Reassure the person with each step (i.e., “you are doing great”).
3. Maintain a calm soothing environment.  Soft sounds and voices are best.  Music can be very comforting.  Give a reassuring touch when appropriate.  Avoid abrupt movements.  Keep the environment as consistent as possible. 
4. Know what to do if the person becomes agitated.  Try to figure out the source that’s upsetting the person with A.D.  Does he/she need to use the bathroom?  Are they in pain?  Change the subject if it appears to bother them (also known as redirecting which is successfully used in long term care).  Distract and move on to a different activity.
5. .          Use their view of reality.  Reality orientation is not effective with those who suffer with severe memory loss, so validate them because their reality is different from yours.  Whenever possible, go along with the person and ‘be in their world’.  Don’t argue as it will not be productive.  Practice reminiscence (recalling past events).  Focus on pleasant experiences and achievements. 

Above all, patience is essential.  The person with A.D. may have little or no control over their strange verbal, physical, or sexual behavior.  The affected person may not remember enough about their past reasoning or behavior patterns to always respond appropriately.  What can seem like manipulative behavior is just the disease talking.  

If you or your loved-one’s staff needs to learn to speak Alzheimer’s, use these tools.  If you are a long distance caregiver and need someone to partner with you in achieving goals for someone dear to you, call the offices of A Good Daughter Elder Care Management in Boca Raton at 561-392-3574.  We will be happy to discuss how we can be of help.  Our support group for family members meets on the third Wednesday of the month from 5:30 – 7:30 pm and is free of charge.  

The Caregiver's Role

Everyone with Alzheimer’s disease at some point will need help from a caregiver.  Sometimes a family member will meet this need; often a paid caregiver will do so.  Whomever is filling this role, they will need to make many adjustments from the time the diagnosis is given.  Fear of what will happen and how they will be able to manage the manifestations of the disease is very common.  Thus, the best thing that the caregiver can do is to gain understanding of the disease.  Most of all, if you are a family caregiver and are feeling overwhelmed, do not feel guilty if you are unable to fill the caregiver’s role yourself.  Not everyone can fill this very difficult task. 

If hiring a home health assistant, they must: provide adequate supervision with activities of daily living, ensure the patient’s medical well being, provide assistance with daily chores, provide assistance with personal care, and provide companionship and psychological support. If the family member is working as a daily caregiver, here are some valuable tips:

•  Get enough sleep.  It is vital to take care of oneself.  Exhaustion makes it harder to cope with your loved-one’s demands.
• Eat well and pay attention to nutrition.
• Keep medical appointments and follow your doctor’s orders.
• Set aside some personal time just for you.
• Find ways to put enjoyment and relaxation into each day.
• Join a support group!!! Make friends with others in similar situations and share your concerns and helpful tips.
• Cultivate patience.  Becoming angry and frustrated will only make the situation worse.
• Try meditation, deep breathing, and exercise often.
• Let family and friends help.  Ask them for help if they do not offer.  Do not let yourself become isolated, as no one can do this alone.  Make up schedules for other family members so everyone can share some caregiving chore.
•  Learn about community resources and make use of community support.
• Plan ahead for emergencies and the future.  Consider an elder law attorney for help with Medicaid planning, VA benefit programs for caregiving needs, and special needs trusts for asset planning.
•  Consider utilizing private or subsidized in-home respite care, individual counseling and day care programs.
• Be realistic.  Feeling guilty about what you cannot do may keep you from doing what you can. 

Remember, you may always hire a certified geriatric care manager who will oversee a loved one’s needs for caregiving, medical appointments, medications management, caregiver supervision, educating family members about the illness, and teaching them that the patient’s behavior is not intentional even when it is repetitious, difficult, or abrasive .  For more information go to www.AGoodDaughter.com or contact 561-392-3574 to set up a complimentary meeting with our care managers.

Wisdom for Family Caregivers caring for someone with dementia…….

If your loved one has dementia, has become forgetful, repetitive, isolates him/herself, is confused about where he/she has left items around the house and confused about how others perceive him/her, please share these words of wisdom:

1.       Tell them to take their time and not let others rush them.

2.       Tell them to explain to people that they have a memory problem asking them to repeat things if they feel it is necessary.

3.       If your parent loses a thought, tell them not to panic.  It may come back later so they should relax – it happens!  Try telling your parent to ask the person with whom they are speaking to remind them of the last thing they said.

4.       Tell them to focus on what they can do and not on what they cannot do.

5.       Try to keep them on a schedule for meals, medications, exercise and bedtime

6.       Help them write notes and leave them in a visible place (for example “turn off stove).

7.       Tell them to ask for help with sorting and choosing clothing.

8.       Consider buying them a pocket sized voice memo recorder to jog their memory.

9.       Tell them if someone comes to their door whom they don’t recognize not to let them in.  They may ask for a name and phone number and give them to a family member later on.

10.   If a parent lives alone, ask a friend or relative to call them each day to make sure they are alright.  Make sure this friend or relative has a key to the house.

11.   Make sure they take someone of trust  along whenever they go out.

12.   Arrange for someone you trust to pay their bills and balance their checkbook.

13.   Ask them to write important things down in a “memory book” then ask them to keep it with them.

14.   Label things around the house with the contents of important things such as their “sock drawer”

15.   Have them make a list of what they want to do each day.

16.   Keep a calendar of their appointments and commitments in a very visible place.  Have them mark off the days each night before going to bed. 

17.   Help them feel comfortable about asking for help.

These items above and more are within the purview of a Geriatric Care Management Service.  At A Good Daughter, we have a trained assistant care manager with an undergrad degree in psychology, previous experience providing cognitive stimulating activities in long term care, and  who has also taken care of her grandparents – an experience which changes you forever.  So, call A Good Daughter Elder Care Management and let us provide a comprehensive assessment of your loved one’s needs.  We can provide a very detailed document with concrete recommendations for keeping your family member with Alzheimer’s safely living in their own home with appropriate care.  Call 1-800-963-3877 and ask for the senior care manager, Olga Brunner who will be happy to meet with you for a complimentary consultation.  We also conduct a support group for family members on the third Wednesday of the month between 5:30 pm and 7:30pm which is also complimentary but you must RSVP. Visit us on the web at:  www.AGood Daughter.com  

Symptoms of Denial When a Parent has Alzheimer's disease

Many persons with dementia do not recognize or acknowledge their condition or deterioration.  This is part of the disease.  In fact, some may not even recognize their own reflection in the mirror.  If you'd like to recognize some common reactions when a parent with Alzheimer's exhibits symptoms of denial, some of their reactions are:
1.  Anger over issues of control and loss.
2.  Defensive responses when confronted with facts of memory loss or functional problems.
3.  Refusal to make or keep doctor's appointments.
4.  Gradual withdrawal from social situations.
5.  Less participation in activities that a parent once enjoyed.
6.  Unusual or unreasonable fears of people or situations.
7.  Excuses for changes in behavior, (such as "I'm tired, I'm a homebody, I don't like to walk")
8.  Insistence on continuing activities that are unhealthy or even dangerous,such as driving.  In fact we once had a client that would just go and purchase a new car whenever the daughters took away her car keys!!!!

The family caregiver may wish contact a geriatric care manager if they are in town visiting a loved one and find such symptoms of denial, if you are noticing self-neglect especially with hygiene, if driving is becoming problematic for a parent and you notice increasing car dents, or if mom or dad is just not getting out anymore.
We are your source for peace of mind.

A Good Daughter, Inc. is a Geriatric Care Management company, located on Spanish River Blvd. in Boca Raton near Federal Highway. We offer Comprehensive Assessments and will write a Plan of Care detailing our recommendations for your elderly parents in Southeast Florida.  Our website can be viewed at www.AGoodDaughter.com which will provide you with information about our other services and more or call us at 561.392.3574.  

Birth of a New Tradition

Happy Thanksgiving-

As we anticipate being with family and friends for Thanksgiving next week, I wanted to pause and thank all of you for your support and interest in the services we at A Good Daughter provide to our seniors in PB County. 

This year we have identified a community resource that we will support through donations and hope that you will also support with tangible items that may be brought to: CCC of Boynton Beach.  As you shop for and prepare for your own holiday, please keep in mind the needs of our frail elderly that the Community Caring Center of Boynton Beach and the Boynton Faith Based CDC is seeking to support this year. 

Here is a little information about who they are:

“CCC Green Market is a drop site for our food pantry – We are providing 250 Thanksgiving Baskets to needy families November 19^th, and cooking Christmas Day dinner for the community, homeless, and frail and elderly shut- ins.  As the holidays approach Americans will give the gift of genuine concern for other Americans who are in need”.   Please also visit the Secret Garden Café entirely staffed by volunteer staff at the CCC Green Market, 410 East Boynton Beach Blvd., Boynton Beach, Fl.  333435.  561-752-8598”  http://www.localharvest.org/secret-garden-cafe-at-the-green-market-new-gourmet-prepared-foods-M32313

Have a wonderful Thanksgiving and we look forward to seeing our female clients at our High English Tea served by the Secret Garden in December.  Please contact us at 561-392-3574 for more information.

Thank you,

Olga Brunner, M.S., CMC

Senior Care Manager

A Good Daughter Elder Care Management

Why Are Florida Drivers So Cruel???

This morning on my way to work I was peacefully humming my mantras, enjoying an enlightened day when suddenly as I approached my exit I could see a blue Marquis on the right hand lane attempting to get to his left lane.  Problem was that he must have been an elderly gentleman and was driving very slowly indeed.  I stayed behind him as I was nearing my exit and wasn't in too much of a hurry anyway.  Everyone behind me moved over to the left lane where this gentleman was attempting to enter whizzing by and not letting him into the lane.  Why?  Why are we in such a hurry that we cannot let someone enter a left lane when they clearly need to do so?  It was just so painful to watch.  I just knew he was going to have an accident.  Thinking he was probably cognitively impaired when I observed him shying away from the left lane and then make another attempt to reenter (seems to have gone on forever), I just called the police giving them his tag number.  I was sure he was not going to make it on any road today.  First of all, a person who is inexperienced on a highway should not be on the interstate and secondly drivers in Florida were just totally cruel making a difficult situation downright dangerous.  The elderly man finally exited the interstate at my exit and I stayed behind him until he pulled off the road and into a strip mall. 

For someone interested in recommending a driver's assessment when cognitive impairment is suspected, I would highly recommend the FAU campus as they have a wonderful 2-pronged approach: assessing cognition as well as an on-the-road driver's test.  Here is a link to their site.  http://nursing.fau.edu/index.php?main=6&nav=685

Stay safe everyone!