The Importance of a Cognitive Care Community for Dementia Care

We All Age But…

There is no way to avoid the aging process. Our bodies age, we get new wrinkles in relative the same pace. The one difference is, our Brains age differently. The majority of us will encounter some level of age related decline, but some of us will experience a more pronounced level of cognitive decline and/or dementia. Although our chances of getting dementia increase with age, dementia is not a part of the natural aging process. Dementia is caused when the brain is damaged by diseases, such as Alzheimer’s disease or a series of strokes.

Many Studies have been done Comparing the Aging Population with those with a Cognitive Impairment or Dementia…

There have been numerous studies done involving those with Mild Cognitive Impairment (MCI) or Mild Dementia that looked at how that impairment changed a person’s views about themselves. These studies showed that Cognitive Impairment showed  could profoundly affect a person’s understanding of their place in the world.

Two Groups of Seniors…..

Studies looked at two groups of seniors. One group of seniors without a cognitive impairment or dementia and one group with one or both of those impairments. Both groups described experiencing common memory mistakes such as forgetting names of friends and neighbors, misplacing common items, and repeating themselves in conversation. These incidents resulted in a variety of negative emotional experiences and self-evaluations that were expressed differently by the two groups. Participants with age-normal memory changes described feeling as if they are getting forgetful but attributing that forgetfulness to normal aging that happens to everyone and laughing it off as a goof. On the other hand the group with the  MCI or dementia felt “bothered,” “upset,” and “embarrassed” by their memory mistakes. They expressed some degree of self-doubt about their abilities and a tendency to put themselves down.  Some even said that their memory mistakes made them “feel stupid.”

More Differences Between the Two Groups of Seniors…

Memory changes showed to have important consequences for everyday social interactions and relationships with others. The changes described were generally positive for older adults with age-normal memory changes and generally negative for those with a MCI or Dementia. The group with normal memory change described a sense of camaraderie with their same-age peers who experience similar types of memory changes.  In contrast to the normal memory group, individuals with Cognitive Impairment spoke about how their memory problems have led to social withdrawal and isolation . They also stated that they “don’t get out as frequently,” that they are “withdrawing more from social occasions,” and even that they have become more “introverted.” There are a variety of reasons as to why memory problems have led to social withdrawal in the group with the Cognitive Impairment. Remembering friends’ names and shared experiences is an important part of social relationships, and failure to do this can be embarrassing or frustrating. For some individuals, withdrawing from social interactions is a way to avoid embarrassment. Seniors with a Cognitive Impairment, said they have more difficulty engaging in activities because their more significant memory problems leave them feeling lost, confused, or embarrassed. They describe feeling left out or disregarded in social interactions, thus causing them to withdraw from these activities to an even greater degree. In many cases the result is a loss of confidence which leads to withdrawal from social and leisure activities, and the consequent decline in participation in these activities results in increasing difficulty in these areas, followed by further loss of confidence and feelings of inadequacy.

What Happens when the Two Groups Consistently Interact….

In most cases Cognitive Impairment or Dementia will not get better. It is a progressive disease that only gets worse. Currently there is no cure. It is almost impossible to teach all those Without a cognitive impairment how to interact with those With a cognitive impairment correctly. In many cases they wont even understand or know what they are doing wrong. When seniors with no cognitive impairment consistently interact with seniors with cognitive impairment, the deficits of the impaired group become more and more obvious each day. These results lead to decreased confidence and ultimately isolation for the group that is cognitively impaired.

screensavers-widescreen-field-tulips-screensaverWhat is the Answer?

Although there is no perfect answer or a solution, the best answer is a Cognitive Care Community.  A community where all the residents have a degree of cognitive impairment and are grouped by the level of their impairment. In a Cognitive Care Community, residents interact with those that are on their level cognitively. They may be enjoying a lunch where all the table mates take turns telling the same story they already told. Because all of them are doing it, no one is made to feel worse than the other. There is no one at that table that will cut off a table mate mid story and say “you already told us that story”, “stop being repetitive”. All four leave the lunch feeling good about themselves without their deficit being in the forefront.  The goal is to make those good feelings last for as long as possible…


The Key to a Smooth Transition into a Dementia Care Setting

Does anyone actually like to move?

Moving to a different location can be traumatic for anybody especially any older adult. It
becomes even more difficult if the person moving has some type of cognitive impairment or dementia.Usually a
person with dementia is unable to problem solve and accurately judge when
it is time to move. Deciding to move, planning the move, giving the
person with dementia choice and control, and what to do after the move,
frequently concern staff and family.

When is the time to make the move?

In order to make a transition as smooth as possible, the best time to move is while a person is in good health. Every attempt should be made to move the person with dementia while they are healthy. Because Dementia is a progressive disease, it will only get worse as more time lapses. People with dementia who are forced to move out will likely not to do as well following the move as will people with dementia who move voluntarily. Although the decision may not be voluntary, a person with dementia with do better after a move, if the move was planned, and they had some input.

Common mistakes families make?

Many families wait too long to move a loved one with Dementia. During the mild stage of dementia a person is able to establish routines and learn to navigate their environment. Because we know that a person with dementia functions best in a familiar environment, it is key to move them while they still have the capacity to learn that environment. Once an environment becomes familiar, a community is able to provide the necessary cognitive care to compensate for a person’s decreased abilities therefore allowing them to sustain a level of independence and allow for a good quality of life for years to come.

The consequence….

When a family waits too long to move a person with dementia, their cognitive abilities have declined to the point that they are not able to learn a new environment. At this point the new environment will never become familiar. This results in a longer, and more difficult transition as well as a diminished level of independence for the duration of a person’s stay.

The right time…..7730d221ef4d4b91dffa4c2100dde11e--flowers-wallpaper-hd-wallpaper

Although this is different for every person, for many people with dementia, late mild dementia stage-early moderate dementia stage is the best time to move to a community that offers cognitive care for all levels of dementia starting with the Mild level all the way to Severe Dementia. During this level of dementia, most people are still able to establish a routine and familiarize themselves with an environment and thrive for years to come.

Mom Needs Memory Support not Memory Care

Does mom need Memory Support or Memory Care? Good Question

I would first like to start with saying that appropriate Memory Support prolongs the need for Memory Care. In a traditional community setting, those with moderate dementia are either not thriving in Assisted Living or have to move to Memory Care too soon. In my opinion providing the right amount of memory support is the toughest area of senior care because it is not strictly defined.

Can Memory Support ever be Strictly Defined?

The answer is No. imagesqqProviding Memory Support to someone with Alzheimer’s & Dementia is like providing a step stool for someone who needs a boost to see over a ledge. The difference is there are different ledges so different step stools are needed. Providing the right amount of support will enable a person to function as independently as possible. Providing too much support will further disable a person and result in a cognitive decline, and providing too little will hinder a person’s abilities to function and thrive. Cognitive Care is another way to describe Memory Support. Memory Care is a specialized care unit/section/or building where maximum cognitive assistance is provided and independence is limited. Memory Care is also usually a small, secure section, where activities and daily interactions are done in a group setting.

Types of Memory Support

  • have duplicates for commonly lost items, and also knowing the hiding places (for this group of folks, the less space they have the better)
  • know their schedule and guide the person through the day, personally guide to appointments and events
  • anticipate needs and provide assistance without being asked
  • explain tasks by breaking them into parts, with easy to understand sentences
  • know and understand the daily routine and provide assistance in a way that does not make a person feel that they need assistance
  • do not assume a person ate if you did not see them eat.
  • while providing additional assistance, make it seem like you are providing a regular service.
  • keep an eye on someone from 10-20 feet away so they don’t feel like you are hovering over them, but you are watching for safety.

Specific Examples

Jan is 78 and has Alzheimer’s Disease. She missed her last doctor’s appointment, hair appointment, and her favorite church concert. While living at home alone, Jan did not eat for 2-4 days, passed out and found herself in the hospital suffering from malnutrition and hydration. What could have been done to avoid these scenarios?

  • Keep track of Jan’s appointments, by helping her make them at a time when transportation is available, if transportation is necessary. Remind Jan earlier that day, make sure she is ready, and personally take her to the appointment.
  • Bring Jan to breakfast, make sure she gets it in front of her.  After breakfast, tell Jan the next meal is lunch and you will get her for that meal. This will put her at ease.
  • Everyday at 2 pm come to Jan with a pretty glass of water, encourage her, and then watch her drink it. Make sure Jan has a beverage in front of her for her meals and that she is drinking. Replace the beverage with an alternative option if needed.

The Take Away……

Many people are not getting the right amount of Memory Support in their current environment. I have found that there is a large percentage of those impaired with Dementia and Alzheimer’s that need more than Assisted Living, but less than Memory Care. These folks need another option. What they need is Memory Support/Cognitive Care in Assisted Living.

Specialized Memory Care for those with Alzheimer’s & Dementia

What is Memory Care?

When you ask this question you get a range of answers. You hear Memory Care is a specialized unit for Alzheimer’s & Dementia. You also hear it is a lock down unit that is separate from the rest of the community. You hear it is a unit for wanderers. You hear Memory Care is somewhere where specialized care is provided.

What is the Answer?

Depends who is answering. Technically a Memory Care Community or a Memory Care Section is where care is provided to those who exhibit symptoms and/or behaviors related to Alzheimer’s or one of the many Dementia Types. The thing is these symptoms and behaviors are vast and vary to different degrees, effect people in different combinations.

The One Size Does Not Fit All phrase I hear everywhere?000 one size

Every community claims that their memory care offers care based on each person’s ability. How is it possible to offer this type of individualized care in a unit where you have residents that are very active physically, residents who are wheelchair bound and have lost their ability to speak, residents that are prone to outbursts or inappropriate behavior?

The Answer?

You can’t. Unless you have a private caretaker or an activity coordinator for each group of individuals you are not able to provide individualized care and engagement because the abilities of the residents with Alzheimer’s or Dementia vary to such a large degree.

The Real Answer?

A Community has to be able to offer 3-4 levels (sections) of secure care for memory support. One of the sections should include the high functioning resident that is prone to wondering, and has an extroverted type of personality. One section should include high functioning residents that need memory support that are not prone to wondering and also have introverted personalities. Another section should be for those residents in the severe stage of Dementia, who have lost most of their language abilities, as well as independent movement. These residents will also likely need specialized diets, and nutrition therapy. The abilities of these residents are the most diminished of the 3 groups and their care and activities are set up accordingly.

The Take Away….

Although there may be a desire to provide individual care and engagement, that desire is not enough if the environment is not conducive to make that happen. Because the symptoms and behaviors of Alzheimer’s Disease and Dementia vary so greatly, it is imperative to separate residents within the community into smaller groups based on their cognitive and physical abilities. Once this is accomplished, a community is able to create the environment, the care structure, and an engagement plan to meet the need of the residents in each section or group.

Delicious Puree Recipes for Assisted Living & Memory Care

One of my favorite puree recipes are Mango Moose Cups. They are easy to make, and  most importantly very delicious.

    Ingredients you will need
  • 1 tsp gelatin powder
  • 2 tbsp water
  • 5 oz mango puree
  • 2 tbsp granulated white sugar (or more to taste)
  • 5 oz heavy whipping cream

Dissolve gelatin into 1 tbsp of water. Heat remaining 1 tbsp water until it is hot/almost boiling and add to gelatin, stirring until gelatin is fully dissolved. Add gelatin and puree into blender and mix on high speed until fully blended. In a stand mixer, add 2 tbsp sugar and heavy cream and whip on high speed until stiff peaks form. Slowly add puree into the whipped cream, folding it into the cream until completely mixed and uniform in color. Pour into individual portion cups and refrigerate to set.

It is very important to use pretty glassware that is the right size for the right person. One person may require a 4 oz glass and one a 12 oz glass. It is important to note that personal preferences are very important in all food preparation.  Here is an example of a pretty glass.

68d62aeb13c9fe7b24924c8bef61ca5a--dusty-rose-pretty-in-pinkIf we follow this wonderful, easy to make recipes you will get:

mango-mousse-cups-22                                                                                                                    Mango Mouse Cups

(please note that the garnishment on top of the mouse is for decoration designed to make the cup look appetizing. Decoration should be removed prior to consumption for those that are on a pure diet)

Conversations with Dementia Consultant-Navigating the Transition

Alzheimer’s and related dementia’s have a profound impact on family members and the experiences of loved ones living with dementia. As neurodegenerative medical conditions progress they often demand increased attention to needs and environmental transitions can be imminent, but helpful.  The stress and duress of change requires decision making, a lot of detail, and typically a period of adjustment for everyone involved.

Orchard Senior Living recognizes change for some families can be emotionally and physically overwhelming or challenging.  We want to help by offering you the provision of a Transitional Counselor who will support your transition beginning to end.

When living with dementia, we face transitions that are accompanied by a desire and longing to find our way to “well-being.”  We want to feel in control, confident, comfortable with ourselves, and valued by those who are important to us. Talking to someone who understands, creates courage and elicits new ideas when managing change or challenges.

I’m Robin Andrews, a solution focused communications consultant specializing in transition for families living with dementia.  I have a master’s degree in marriage and family therapy and have worked in behavioral healthcare and aging services for 15 years. My collaborative counseling model is based on personal competency and solution-building rather than problem solving. Minimizing emphasis on past failings and problems, I instead focus on a persons’ strengths, abilities and successes.  I would be honored to assist you in a journey toward hope, healing, and self-discovery.skydd

Navigating Your Transition- 3 Step Transition Strategy for Dementia & Alzheimer’s

Orchard Senior Living Introduces Navigating Your Transition; Orchard’s custom program designed to help families during a difficult transition. Evaluate – Plan – Live is our recommended 3 step Transitions Strategy for families.  The three 60-minute telephone or in-person appointments will provide conversation needed to discuss any lingering fears or concerns and then help you plan […]

The 7 Stages of Alzheimer’s Disease

Every person with Alzheimer’s disease experiences the disease differently, but patients tend to experience a similar trajectory from the beginning of the illness to its merciful end. The precise number of stages is somewhat arbitrary. Some experts use a simple three-phase model (early, moderate and end), while others have found a granular breakdown to be a more useful aid to understanding the progression of the illness.

The 7 Stages of Alzheimer's Disease

The most common system, developed by Dr. Barry Reisberg of New York University, breaks the progression of Alzheimer’s disease into seven stages. This framework for understanding the progression of Alzheimer’s disease has been adopted and used by a number of healthcare providers as well as the Alzheimer’s Association.

Here is summary of the seven stages of Alzheimer’s disease based on the ideas of Dr. Resiberg:

Stage 1: No Impairment

During this stage, Alzheimer’s disease is not detectable and no memory problems or other symptoms of dementia are evident.

Stage 2: Very Mild Decline

The senior may notice minor memory problems or lose things around the house, although not to the point where the memory loss can easily be distinguished from normal age related memory loss. The person will still do well on memory tests and the disease is unlikely to be detected by physicians or loved ones.

Stage 3: Mild Decline

At this stage, the friends and family members of the senior may begin to notice memory and cognitive problems. Performance on memory and cognitive tests are affected and physicians will be able to detect impaired cognitive function.

Patients in stage 3 will have difficulty in many areas including:

  • finding the right word during conversations
  • remembering names of new acquaintances
  • planning and organizing

People with stage three Alzheimer’s may also frequently lose personal possessions, including valuables.

Stage 4: Moderate Decline

In stage four of Alzheimer’s disease clear cut symptoms of Alzheimer’s disease are apparent. Patients with stage four Alzheimer’s disease:

  • Have difficulty with simple arithmetic
  • May forget details about their life histories
  • Have poor short term memory (may not recall what they ate for breakfast, for example)
  • Inability to manage finance and pay bills

Stage 5: Moderately Severe Decline

During the fifth stage of Alzheimer’s, patients begin to need help with many day to day activities. People in stage five of the disease may experience:

  • Significant confusion
  • Inability to recall simple details about themselves such as their own phone number
  • Difficulty dressing appropriately

On the other hand, patients in stage five maintain a modicum of functionality. They typically can still bathe and toilet independently. They also usually still know their family members and some detail about their personal histories, especially their childhood and youth.

Stage 6: Severe Decline

Patients with the sixth stage of Alzheimer’s disease need constant supervision and frequently require professional care. Symptoms include:

  • Confusion or unawareness of environment and surroundings
  • Major personality changes and potential behavior problems
  • The need for assistance with activities of daily living such as toileting and bathing
  • Inability to recognize faces except closest friends and relatives
  • Inability to remember most details of personal history
  • Loss of bowel and bladder control
  • Wandering

Stages 7: Very Severe Decline

Stage seven is the final stage of Alzheimer’s disease. Because Alzheimer’s disease is a terminal illness, patients in stage seven are nearing death. In stage seven of the disease, patients lose ability to respond to their environment or communicate. While they may still be able to utter words and phrases, they have no insight into their condition and need assistance with all activities of daily living. In the final stages of the illness, patients may lose their ability to swallow.

Aromatherapy at the Orchard

aromatherapy at the orchard

Aromatherapy uses pure essential oils to improve physical, mental, and emotional health. The sense of smell connects directly with emotions, memories, and instincts. Because of the neuro-associative conditioning process, aromas have the power to evoke states of well being.

Peppermint is an essential oil used as an energizer. It’s best used in the morning, to help stimulate the mind and at the same time calm the nerves. Peppermint is used as a morning pick-me-up and a natural boost for our residents to start their day. Lavender is an essential oil used to calm feelings of anxiety, depression, and general mood swings. Lavender has also been shown to help treat insomnia resulting in a better night’s sleep.

Aromatherapy draws upon the healthing powers of the leaves, flowers, stems, bark, seeds, roots, or peels of plants. When you inhale a scent, that aroma travels directly to the hypothalamus, which regulates a variety of functions such as sleep and emotion. Each morning between 7 am – 8 am, we diffuse Peppermint throughout The Orchard at Tucker. We hope to stimulate appetite and diffuse a postivie aroma into our reidents’ daily morning routine.

Each evening between 7 pm – 8 pm we diffuse Lavender throughout both of our Season’s Neighborhoods. Lavender helps with our residents’ mental fatique, anxiety, as well as aches and pains. Levender’s calming powers aid our residents to a blissful nights sleep.

To schedule a tour of the Orchard at Tucker, click here or call (770) 938-5600.

Residents Experience Our Multi-Sensory Room

orchard assisted senior living in tucker, georgia

Here at the Orchard, we have an incredible Multi-Sensory Room that provides our residents with a gentle stimulation of sight, sound, taste, smell, and movement in a controlled way. We use it to enhance feelings of well-being, reduce stress, relieve pain, and to maximize their potential to focus, all of which help improve communication and memory.

Our room includes soft textiles, familiar objects, and an interesting visual environment. Numerous studies show that multi-sensory rooms have an immediate positive effect on residents with dementia. The room is designed to create a feeling of soothing comfort and safety in a therapeutic surrounding for all residents regardless of their cognitive or physical deficits.

A Sensory Room can brings a person back to a place of safety, relaxation, and control. Read more about it here or contact us today and schedule a tour of our Orchard Community located in Tucker, Georgia here.