What to do when the person with dementia asks the same questions

by Monica Heltemes on 9/24/2014 to Dementia Activities

new resource, "Ask the OT". Caregivers often have questions or situations that come up in dementia care. Although one answer never fits all situations, having different perspectives on the issue can help - in this case the perspective of an occupational therapist (OT).

Why does the person with dementia say the same things over and over?

The easy answer, but one that can be hard to keep in perspective, is that the person does not remember that he or she already told you that piece of information or story. Yes, in literally seconds, the person can have forgotten what was just discussed. The diseased brain is like a sieve with holes in it. The information just leaks right out instead of staying in the brain as it should.

Sometimes the person may be doing it to get attention. I don't mean to say that the person is purposely doing it to get attention, but rather the person may be bored or even frightened and may be seeking conversation or reassurance.

Another possibility is that the person is having a strong memory of a past event. The fact that the person is experiencing memories is a good thing, but perhaps it is not a happy memory or an unresolved memory, that is worrying the person. In either case, the caregiver understanding that the dementia illness is causing this behavior, is important.

Is there a way I can reduce the dementia behavior of repetitive questioning?

Yes, there are strategies to try. If one does not work, try another. The repeating may not go away completely, but it likely can be reduced.


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HIPAA - Individually Identifiable Information: Know the Rules! ,,,,,, from Harmony Healthcare International, Inc.

 Privacy Rule. One such policy includes incidental use and disclosure of confidential health information (also known as Protected Health Information or “PHI”). Per the requirements in the HIPAA Privacy Rule (See 45 CFR 164.530), protect the confidentiality of individually identifiable patient health and financial information from any unauthorized intentional or unintentional use or disclosure.

For clarity,  Protected Health Information (PHI) is defined as any information in the medical record or designated record set that can be used to identify an individual and that was created, used, or disclosed in the course of providing a health care service such as diagnosis or treatment.

The HIPAA Privacy Rule specifies the following pieces of “Individually Identifiable Information” that, when linked with health or medical information, constitute PHI (45 CFR 164.514):

    Names of the individual, and relatives, employers or household members of the individual
    Geographic identifiers of the individual, including subdivisions smaller than a state, street addresses, city, country and precinct
    Zip code at any level less than the initial three digits; except if the initial 3 digits cover a geographic area of 20,000 or less people, then zip code is considered an identifier
    All elements of dates, except year, or dates directly related to an individual including birth date, admission date, discharge date, date of death and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older
    Telephone numbers
    Fax numbers
    Electronic mail addresses
    Social security numbers
    Medical record numbers
    Health plan beneficiary numbers
    Account numbers
    Certificate/license numbers
    Vehicle identifiers and serial numbers, including license plate numbers
    Device identifiers and serial numbers
    Web Universal Resource Locators (URLs)
    Internet Protocol (IP) address numbers
    Biometric identifiers, including finger and voice prints
    Full-face photographic images and any comparable images
    Any other unique identifying number, characteristic, or code

Failure to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) can result in Civil and Criminal penalties. These civil and criminal penalties can apply to both Covered Entities and Individuals.





If you have questions regarding HIPAA or need help maintaining compliance, please click here to contact Harmony Healthcare International or call them at (800) 530-4413.

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Feds delay enforcement of home care wage rule - Modern Healthcare

Feds delay enforcement of home care wage rule - Modern Healthcare: Feds delay enforcement of home care wage rule
By Lisa Schencker | September 11, 2015
The U.S. Labor Department won't start enforcing its new rule requiring higher pay for many home healthcare workers just yet, despite a recent court decision upholding the rule.

The new rule won't go into effect until 30 days after the District of Columbia Circuit Court of Appeals issues a mandate making its opinion effective. It's unclear when that mandate will come because industry groups have asked the court to wait until after they try to appeal the matter to the U.S. Supreme Court.

The rule was slated to go into effect Oct. 13.

Online Tools | Caregiver Center | Alzheimer's Association

A diagnosis of Alzheimer's raises many questions. The Alzheimer's Association has several free, online tools to help you find answers, local resources and support.
Alzheimer's Navigator®
ALZConnected® (Message Boards)
Caregiver Stress Check
Care Team Calendar
Comfort Zone®
Community Resource Finder
E-Learning Workshops
essentiALZ Individual Certification
TrialMatch®
Virtual Library

Read more: http://www.alz.org/care/alzheimers-dementia-online-tools.asp#ixzz3ST9Bt8Q1

Stephanie Z's link list

Stephanie D Zeman MSN RN
This is an updated list of links about information care givers will need. Most helpful will be "Understanding the dementia experience" which will give you an idea of what your LO is going through; and "Communication skills" Which will help you to communicate in ways which will avoid or decrease her negative behaviors.

It is also important for you to use the 800 number at the National Alz. Assoc. if you run into problems we can't help with. The 24/7 Helpline is: 1.800.272.3900

Here are some very helpful links on dementia care:

Guide to diagnosing and treating dementia

https://www.caregiver.org/diagnosing-dementia

Anosognosia explains why dementia patients are unaware that they are ill:

http://alzonline.phhp.ufl.edu/en/reading/Anosognosia.pdf

Understanding the dementia experience

http://www.smashwords.com/books/view/210580

Communication Skills:

http://www.alzconnected.org/discussion.aspx?g=posts&t=2147511283

Selecting a home health caregiver:

http://www.alz.org/care/alzheimers-dementia-screening-providers.asp

Elder abuse and neglect:

http://www.alzconnected.org/discussion.aspx?g=posts&t=2147495517

Bathing and Showering

http://www.alzconnected.org/discussion.aspx?g=posts&t=2147491802

Help with dental care (PDF fine from Aust. Alz. Ass.)

http://www.alzheimers.org.uk/site/scripts/download_info.php?fileID=1782

How to determine if your LO has pain. Use the Pain Scale:

http://prc.coh.org/PainNOA/Abbey_Tool.pdf

Picking at skin/scabs

http://www.alzcompend.info/?p=233

Sexual Consent Guidelines Weinberg Center and Hebrew Home

http://www.businessweek.com/pdf/hebrew_house_policy/sexualconsentguidelines.pdf

Finding a Memory Care Unit:

When you start to look at nursing homes or ALFs, begin with a call to your local AD chapter and get a list in your area.

You can also go to: Guide to retirement living

http://www.retirement-living.com/ where you will get free information on nursing homes in your area.

Then go to the government site called Nursing Home Compare and get the results of their last surveys so you can get some idea of the quality of their care.

http://www.medicare.gov/nursinghomecompare/search.html

Also, when you select some, Google them along with the word lawsuit to see if there are or were any significant problems that crop up.

Do select at least 3 to look at. DO NOT expect them to look like an ALF. The decor will be less attractive, but in a good nursing home with a dementia unit, the care will be much better.

Once you have picked one, you will want to visit at least 3 times. Once during meals to see what the residents are eating (see if you can eat there as well), once on the evening shift, and once during activities to see how many people attend or have other things of interest available to do.

OTHER HELPFUL SITES

Twenty Common Nursing Home Problems and How to Solve Them.

http://www.nsclc.org/wp-content/uploads/2011/02/20-Common-Problems-Nov-2010-Final.pdf

Urinary infections in people with dementia

http://www.disabled-world.com/health/aging/uti.php

Eating problems

http://www.alzconnected.org/discussion.aspx?g=posts&t=2147489263

Caregiver kitchen

http://caregiver.com/kitchen/index.htm

Australian Site: Nutrition Matters – Finger Foods:

http://dietitiancentre.com.au/wp-content/uploads/2011/11/Nutrition-Matters-Aged-Care-September-2010-Final.pdf

Hope this helps Stephanie Z

Delirium or Dementia - Do you know the difference?

From   http://www.alz.org/norcal/in_my_community_17590.asp from Northern California and Northern Nevada Chapter Home > Delirium or Dementia - Do you know the difference?

What do we mean by delirium?

Also called the acute confusional state, delirium is a medical condition that results in confusion and other disruptions in thinking and behavior,
including changes in perception, attention, mood and activity level.

Individuals living with dementia are highly susceptible to delirium. Unfortunately, it can easily go unrecognized even by healthcare professionals
because many symptoms are shared by delirium and dementia. Sudden changes in behavior, such as increased agitation or confusion in the late evening, may be labeled as “sundowning” and dismissed as the unfortunate natural
progression of one’s dementia.

When is a change in behavior delirium and not part of dementia?

In dementia, changes in memory and intellect are slowly evident over months or years. Delirium is a more abrupt confusion, emerging over days or weeks,
and represents a sudden change from the person’s previous course of dementia.

** Unlike the subtle decline of Alzheimer’s disease, the confusion of delirium fluctuates over the day, at times dramatically. Thinking becomes more
disorganized, and maintaining a coherent conversation may not be possible. Alertness may vary from a “hyperalert” or easily startled state to drowsiness and lethargy. The hallmark separating delirium from underlying dementia
is inattention. The individual simply cannot focus on one idea or task.

What if you suspect delirium?

..... Secondly, create a safe and soothing environment to help improve the course of delirium: keep the room softly lit at night, turn off the television
and remove other sources of excess noise and stimulation. The reassuring presence of a family member, friend, or a professional often prevents the need to medicate.

And lastly, tread lightly with medications. Sedatives, sleeping medications and other minor tranquilizers play a very limited role in delirium management
unless a patient is experiencing drug withdrawals.

Prevention of Delirium

  Avoid illness through smoking cessation, a balanced diet, regular exercise, adequate hydration and vaccinations to prevent influenza and pneumonia.

  Avoid alcohol in any amount.

  Exercise caution with medication, especially sleep aids, and periodically ask the physician for a “medication review.”

  Eliminate or reduce the use of the following medications:

  Antihistamines (e.g., diphenhydramine)

  Bladder relaxants

  Intestinal antispasmodic

  Centrally-acting blood pressure medicines (e.g., clonidine, methyldopa)

  Muscle relaxants

  Anticholinergics (drugs with atropine-like effects)

  Opioids (e.g., codeine, hydrocodone, morphine)

  Anti-nausea medication

  Benzodiazepine type sedatives

The following interventions appear to reduce the risk of delirium during hospitalization:

  Early mobilization after surgery

  (e.g., walking, getting up in a chair)

  Assisting the individual with eating

  Round-the-clock acetaminophen for surgical pain (may lessen the need for stronger drugs)

  Minimizing bladder catheter use

  Avoiding physical restraints

  Avoiding multiple new medications

  Hydration – encourage and assist with fluids

  Normalizing the environment (e.g., pictures from home, familiar objects, cognitively stimulating activities and reminders, visits from family
members)

  Providing sensory devices if needed

  (glasses, hearing and visual aides from home)

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Overview of Delirium and Dementia

by Juebin Huang, MD, PhD

Delirium (sometimes called acute confusional state) and dementia are the most common causes of cognitive impairment, although affective disorders (eg,
depression) can also disrupt cognition.

Delirium and dementia are separate disorders but are sometimes difficult to distinguish. In both, cognition is disordered; however,

dementia affects mainly memory, and

delirium affects mainly attention

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 Matching the environment to patients with delirium: lessons learned from the delirium room, a restraint-free environment for older hospitalized adults with delirium.
Flaherty JH1, Little MO.

Abstract

Delirium is associated with several negative outcomes and is not always preventable. Current practices for the management of older hospitalized adults with delirium, such as one-on-one sitters, antipsychotic medications, and physical restraints, have limited effectiveness or potential health risks. 

{snipped} The authors have found that a restraint-free environment can be achieved; "tolerate, anticipate, and don't agitate" (the T-A-DA method) are the core principles of the nonpharmacological approach that go beyond the traditional strategies of management (such as reorientation); based on observational data,

Alzheimer's and Dementia Care Must read books

 Kisses for Elizabeth: A Common Sense Approach To Alzheimer's and Dementia Care (Volume 1) by Stephanie -Large Print Paperback
also available as  Kindle Purchase

 Creating Moments of Joy: A Journal for Caregivers, Fourth Edition (NEW COVER) by Jolene Brackey (Sep 1, 2008) Paperback
also available as Kindle Edition

The 36-Hour Day, fourth edition: The 36-Hour Day: A Family Guide to Caring for People with Alzheimer Disease, Other Dementias, and Memory Loss in Later Life, 4th Edition