Sometimes, with Alzheimers, one has to take a more creative approach

Telling Mom that a certain behavior, like calling 9-1-1 when it's not an emergency, is not going to work. When someone is in the later stages of Alzheimers, one might need to be more creative.

Posted 10:00 a.m. Jun 6, 2019 — Updated 10:00 a.m. Jun 6, 2019

Liisa Ogburn

While I recognize that a minority of people have the means to send their parent or spouse with advanced memory needs to residential care, I wanted to share some creative and effective practices I’ve seen in a family care home recently that may inspire ideas for people caring for loved ones at home.

Having toured over 80 communities across the care spectrum in the Triangle area, and then being in and out of over 30 on a regular basis, I’ve come to a much more nuanced understanding of what is effective when dealing with advanced memory care needs.

The best memory care often depends on a mixture of external conditions (such as providing adequate time to care for a patient’s needs in a clean, safe setting), as well as the cultivation of internal practices among staff, such as patience, compassion, knowledge about dementia, a sense of humor, flexibility and creativity.

There are certainly some larger facilities, especially those set up as “households” with six to eight resident rooms situated around a common living area, that do a wonderful job. However, in the typical residential memory care communities, with the one caregiver to eight residents (as mandated by North Carolina), if everyone needs help (after a fall, getting to the bathroom, getting dressed, bathing, getting their pain medication, etc.) at the same moment, it can feel like a crisis. Well-run Family Care Homes, with a one caregiver to three resident ratio, provide more space to meet each resident’s unique needs.

Recently I visited The Retreat at Cary in MacGregor Downs Country Club. (I’ve written about other care homes in previous articles) and felt the owner Tara Lowman, RN, and house manager, Erin Haugan, had developed some note-worthy responses to challenging behaviors that were worth sharing:

Sundowning, or night time agitation that prevents a resident from sleeping, is common with Alzheimers. When one resident started getting up repeatedly at night, worried that he had missed his son’s call, Erin had the son make a short video in which the son says to his dad, “Hi Dad, go back to sleep and I will call you first thing in the morning.” Seeing this resettles Dad much more easily.
Anxiety is also extremely common in the later stages of Alzheimers. When another resident started waking up scared in the morning because she didn’t know where she was or who she was, staff learned to put on a particular song from her childhood and would stand beside her and sing this tune until she re-settled.
While short-term memory goes by the wayside as dementia progresses, parts of longterm memory can remain somewhat intact. When a third resident started insisting that he needed to leave for work every morning, staff had him fill out a short survey in his own handwriting. One of the questions was “When did you retire from work?” Afterwards, whenever he started to get stressed about being late for work, staff would show him this note, written in his own handwriting, that he had retired.
We all need space and quiet at times. Tara said when someone becomes overwrought because of noise or the number of people in the room, they take them to a quiet room, where they can calm down and regather themselves.
Animals can help reduce anxiety and irritability, and because of their friendliness and non-threatening way, patients with dementia can become more interactive than they might with other humans, which is why Tara often brings her small poodle into work for the day.
When appropriate, staff also use humor to lighten a moment. For example, many feel awkward that they need so much help. A smile or joke can help diffuse the situation.
Knowing details about each resident’s past can also help with the present. For example, in the case of a previous resident who had been a successful business woman, when she did not want someone straightening her room, the aide instead presented herself as the resident's new secretary for her important business transactions.

Please send me your creative approaches and lessons for a future article. To see images of The Retreat at Cary, visit https://www.retreatatcary.com/ Mrs. Lowman is opening a second house, The Retreat at Cary Corner in August, which will also have cottages where more independent spouses can live.

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