Transcript I Want to Stay Home.....”

“I Want to Stay Home.....”
Aging in Place with Dementia
Presented By:
Cindy Campbell, OT Reg (Mb)
Objectives
 To understand what Occupational Therapy is
and the role of an occupational therapist
 To be aware of ways to create a home
environment that promotes safety AND
independence
To provide you with a strategy to approach
problems you may face when providing care
Objectives
 To provide you with tips to optimize
independence with daily activities
 To provide you with practical safety tips
for the home
Statistics
• Less than 10% of older adults reside in a personal care
home
• Currently, almost 20,000 Manitobans have Alzheimer’s
disease or another dementia
• In Canada ¼ of all family caregivers are seniors
themselves, 1/3 of them are older than 75
• In Manitoba today caregivers spend over 9 million hours
of informal unpaid care
(Alzheimer Society of Canada,2014) .
What is Occupational Therapy
“Occupational therapy builds the skills for the
job of living and solves problems that
interfere with people’s ability to do activities
or occupations that are important to them.
These problems may be a result of injury,
disease, social disadvantage, or the
environment” (caot.ca, 2003-2014)
‘Aging in Place’
"the ability to live in one's own home and
community safely, independently, and
comfortably, regardless of age, income, or
ability level.”(CDC, 2013)
‘Aging in Place’
“Aging in Place is a matter of preserving the
ability for Manitobans from every culture to
remain safely in their own community, to
enjoy the familiar social, cultural and
spiritual interactions that enrich their lives
even though their health may be
compromised.”(Government of Manitoba, n.d.)
Types of ‘Homes’
Where do seniors live?
• Single family home
• Apartment
• Seniors Housing or 55+
• Assisted Living
• Supportive Housing
The Benefits of Home
Home is……
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Familiar
Comforting
Safe
Private
A place of memories
A Healthy Home….
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Is familiar and orientating
Enables independence and is engaging
Encourages confidence and self-esteem
Reinforces a sense of identity
Provides a comfortable environment
Promotes safety for the person with
dementia and the caregiver
(NSW, 2011)
The Challenge......
To provide a safe environment for an
individual with Alzheimer’s disease or a
related dementia while at the same time
enabling the person to maintain their
independence and quality of life.
The Goal......
To find a balance between protecting the
individual from risk while enabling
independence and maintaining as normal
a life as possible.
Finding a Balance……..
Identify safety concerns
Consider how we can modify the
environment
Minimize Risk and Optimize
Independence
Identifying Safety Concerns
Identify both current and potential safety
concerns
Develop a plan for now and for the future
Implement as appropriate
Modify the Environment....
By changing the environment you are able
to minimize both safety concerns and
stressors that lead to responsive
behaviors that place the individual and
others at risk
Tips for Modifying the Environment
• Involve the person with dementia
• Modifications that meet the preferences
and need of the person
• Modifications that respond to the specific
problem at hand
Tips for Modifying the Environment
• Change as little of the environment as
possible
• Build on the individual’s strengths
• Try simple solutions first
• Recycle ideas and use trial and error
(NSW, 2011)
(
Minimize Risk & Maximize
Independence
A safe environment can be a less restrictive
environment where the person with
dementia can experience both increased
security and independence
Steps to Problem Solving
Step 1: Identify the Problem
What is the problem or need?
When does it occur?
Who is it a problem for?
(NSW, 2011)
Step 2: Potential Causes
What are the potential causes
• Symptom of dementia, progression
• A change such as hearing loss, vision,
change in schedule or medication
• A physical need – hungry, cold, hot, tired, pain
• A change in ability to complete a task
• A change in the environment
(NSW, 2011)
Step 3: Finding a Solution
Take your time
Start with the simplest solution
Ask for help
Keep in mind the goal of independence
(NSW, 2011)
Living Alone with Dementia
Consider……..
• Quality of life
• The amount of support available
• Level of stimulation and isolation
• Response to an emergency i.e. 911
• Acceptable level of risk to the person AND
to others
(Alzheimer Society of Canada, 2014)
Living Alone with Dementia
Available Supports…….
• Family, friends and neighbors
• Alzheimer’s Society
• Home Care – Public or Private
• Emergency Response Systems i.e. Lifeline
• Day Programs
• Meal Delivery
• ERIK Kit
Tips to Safely Optimize
Independence
Memory Aids
• Reminder notes
• A calendar identifying important dates and
appointments
• A notebook or diary
• Written daily schedule outlining the
activities for the day
• A designated basket for important items
Memory Aids
• Use photographs to reinforce the
individuals sense of identify and to
remember family members
• Use photographs to label items if the
person is unable to read
• A visitor log book
Communication
• Post important phone numbers by the
phone
• A press button phone with large numbers
• Program important phone numbers into
the phone so the person just has to press
a single button
• Note pads and a pen by each phone to
record messages
Dressing
• Sort out closets and dresser drawers to
make it easy to choose what to wear.
• Arrange complete outfits on a hanger
• Put away items not appropriate for the
season
• Label drawers and items in the bedroom
and bathroom to make items easier to find.
Dressing
• Break the task of dressing into smaller
tasks and remind the person of each step
or use a written or visual diagram
• Modify or choose alternative types of
clothing such as replacing zippers with
velcro or pants with elastic waist band.
Personal Care
• Ensure that the necessary equipment is in
place for safe bathing i.e. bath seat, grab
bars, non slip mat, hand held shower
• Label taps as hot/cold
• Use electric devices such as an electric
shavers
• Use bright colored items to attract attention
and make items easier to find such as a
brightly colored toothbrush
• Provide written or visual ‘how to’ charts
Toileting
• Put a sign on the door with words, symbols or
a picture indicating where the toilet is
• Leave a night light on in the washroom and in
the hallway leading to the bathroom
• Put up a sign reminding the person to use
toilet paper, flush the toilet and wash their
hands
• Install equipment such as grab bars and a
raised toilet seat
Toileting
• Use a colored toilet seat for contrast making
the toilet easier to find
• Provide easy to remove clothing for easier
access
• Commode for use in the bedroom at night
time
• Establish a toilet routine to reduce accidents
• Put tape across the bathroom door latch, to
prevent the person from locking him/herself in
• Use of incontinent products i.e. Tena pads
Meal Preparation
• Label cupboards with words or pictures
that describe what is inside, for example,
dishes, knives and forks.
• Write out your favorite recipes – step by
step
• Write out directions for even basic items
i.e. these are the steps to – use the
toaster, make coffee, boil an egg
Meal Preparation
• Use electrical appliances that shut off on
their own
• Install a smoke detector and check the
batteries regularly
• Leave written reminders like "turn off the
stove" or "unplug the iron." Place them
where they are visible
Meal Preparation
• Consider meal delivery options
• Place regularly used items on the counter if
using the cupboards is challenging
• Paint red and green lines on stove knob to
indicate on and off
Meal Times
• Provide visual cues for eating
• Eat with the person or arrange for
someone else to attend at meal times
• Specialized cutlery, non-spill cups, a dish
with a lip on the edge
• Provide finger food
• High nutrition drinks i.e. ensure or boost
Medications
• Arrange medications in a weekly dosette
or pill container
• Have only a small amount of medications
in the home at one time
• Bubble or blister pack medications
• Automated medication dispenser
Management of Finances
• Talk to your bank manager about in home
banking
• Arrange direct deposit and automatic
withdrawal for bill payments
• In preparation for the future assign a POA
Community Mobility
• Leave a set of house keys with a trusted
neighbor
• Write telephone numbers in large print and
post by the phone. Include people to
contact in an emergency
• Keep a list of emergency contact and
number information somewhere at all
times
• Inform neighbors so that they can watch
for unusual happenings
Community Mobility
• Leave a note by the front door reminding
to take important items such as keys and
wallet and to lock the door
• Write your address down and post by the
phone
• Keep a map with you that shows where
your home is
Home Safety
Home Safety
By Home Environment
 By Behavior
- Rummaging and Hiding items
- Impairment of the Senses
- Illusions, Delusions and Hallucinations
- Losing One’s Way
Home Safety - Kitchen
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Remove knob covers from the stove
Automatic shut off features i.e. Stove Guard
Disconnect the stove
Place a sign on the microwave reminding the
person to not put metal items etc. in the
microwave
• Remove the microwave if it is not safe
• Install a smoke alarm
Home Safety - Kitchen
• Keep limited amounts of food readily
available
• Empty garbage cans regularly and place a
latch on the cupboard with the garbage in
it
• Remove sink stoppers to prevent a flood
should the water be left on
Home Safety - Laundry
• Put a velcro latch across the washing
machine and dryer openings to discourage
placement of items
• Turn off the machine at the wall when not
using
• Make sure laundry detergent and bleach
are in a safe location
Home Safety - Bedroom
• Appropriate lighting, especially for at night
• Remove scatter rugs
• Make sure the bed is at the appropriate
height to make getting in and out easier
• Equipment such as a bedrail or hospital bed
• Place a soft mat on the floor if concerned
about falls out of bed
• A clear pathway to and from the bed
Home Safety – Living Area
• Cover sharp edges with padding or protectors
to prevent injury in the event of a fall
• Ensure a clear walking path
• Keep the arrangement of the furniture
consistent
• Remove scatter rugs and other obstacles
• Provide furniture that is firm and a good seat
height or use an electric recliner chair
• An electric stair lift is access to the 2nd level is
necessary
Home Safety - Outdoors
• Install ramps and railings as needed
• Emphasize door frames by painting them
a bright contrasting color
• Lock away unsafe tools and appliances
• Create a safe environment for familiar
activities such as gardening or ‘tinkering’ in
a work shop
• Place a hidden lock mechanism on gates
Rummaging and Hiding Items
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Lock up all toxic and dangerous materials
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Simplify the environment, remove clutter
and valuable items
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Close access to unused rooms
Rummaging and Hiding Items
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Keep trash cans hidden and out of sight
Place safety catches on cabinets and
drawers.
Notch the bottom edges of the drawer so a
lifting and pulling action are required to open
the drawer
Provide a safe box, junk drawer or a treasure
chest for the person to keep items
Sensory Changes
● Vision
● Smell/Taste
● Hearing
● Touch
Safety Tips for Changes to Vision

Mark the edges of steps and doorways
with brightly colored strips
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Place brightly colored signs or simple
pictures on important rooms
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Create color contrast between floors and
walls to help a person see depth
Safety Tips for Changes to Smell
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Install good quality smoke detectors and
check them frequently to ensure batteries
are working
Keep only small quantities of food in the
fridge and check the fridge regularly for
spoiled foods
Safety Tips for Loss of Sensation or
Touch
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Adjust water heaters to 120 degrees
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Place signs on appliances that produce
heat: “STOP VERY HOT”
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Use a thermometer to check water
temperature, for example water for bathing
Safety Tips for Impairment of
the Senses (Taste)……
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Keep spices and condiments such as salt
and sugar away from easy access
Remove or lock up medications
Consider childproof latches on the
refrigerator and cupboards
Keep dangerous substances locked away
Safety Tips for Hearing
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Avoid excessive noise in the home such
as having the radio and TV on at the same
time
Avoid large gatherings of people in the
home
Check hearing aid batteries
Safety Tips for Hallucinations, Illusions
and Delusions……
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Provide adequate lighting to eliminate
shadows
Reduce glare by using soft light
Remove or cover up mirrors
Avoid television shows that are violent
Vary the home environment as little as
possible
Do not confront the person who becomes
reactive
Pacing in the Home
• Provide the individual there own work area
with activities that they enjoy doing
• Use signs as cues to discourage the
person from entering the room
- a stop sign
- bright colored fabric cues placed across
door way
- yellow safety tape
Safety Tips for Losing One’s Way
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Support the emotional need behind the
desire
Provide stimulation and exercise
throughout the day
Provide a safe area for pacing
Put away outdoor clothing that may cue a
desire to go outside
Register with the ‘Safely Home’ program
Safety Tips for Losing One’s Way
●
Secure the doors in a way that does not lead to a sense of
being locked in or create frustration
- Place door locks out of the line of vision
i.e. slide bars or deadbolts at the top or bottom
(For safety reasons if using locks the caregiver must be present in
the home to provide supervision and be able to access and manage
these locks easily)
- Camouflage the whole doorway with fabric, painting or a
mural
- Use child proof doorknob covers
- Simple alarm system such as bells on the door, a welcome mat
that sings a tune
Safety Tips for Losing One’s Way
• Install an alarm on doors and windows
• Keep a current picture of the person for
identification
Resources Available to Assist in Home
Safety
Victoria Lifeline
Alzheimer Society of Manitoba
Your Regional Health Authority
Home Care
Adult Day Program
Community Therapy Services
Equipment for Home Safety
Questions
References
Alzheimer Society Canada (2014) Living with dementia. Retrieved from
http://www.alzheimer.ca/en/Living-with-dementia/Stayingconnected/Living-alone
Canadian Association of Occupational Therapists (2003-2014). What is
occupational therapy? Retrieved from
http://www.caot.ca/default.asp?pageid=3024
Canadian Association of Occupational Therapists & Alzheimer Society
of Canada. (1998). Living at home with Alzheimer's disease and related
dementias: A manual of resources, references and information. Ottawa,
ON: CAOT Publications ACE. Retrieved from
http://www.caot.ca/default.asp?pageid=3700
References
Centers for Disease Control and Prevention (2014). Healthy Places
Terminology. Retrieved from
http://www.cdc.gov/healthyplaces/terminology.htm.
Government of Manitoba (n.d.). Aging in place. Retrieved from
http://www.gov.mb.ca/health/aginginplace/
New South Wales Government (2011). At home with dementia: A
manual for people with dementia and their carers. Retrieved from
http://www.adhc.nsw.gov.au/individuals/caring_for_someone/caring_for_a_
person_with_dementia
Case Study 1
Robert is the primary caregiver for his 75
year old mother Grace. Grace lives alone in
a single family home and over the last year
Robert has noted a steady decline in her
ability to manage. Robert is now assisting
with grocery shopping, transportation to
appointments and home maintenance. Over
the last few months to his mother’s home he
has noted a number of significant
changes…….
Case Study 1
• She does not appear to be eating the food
from the fridge that he provides but rather is
eating dry goods such as chips and baked
goods.
• She is no longer doing her laundry and often
remains in the same clothing for days and
require reminding to change
• She does not appear to be taking her
medications consistently
• She often forgets her purse when leaving the
house and is locked out upon her return
Case Study 2
• Edna is the caregiver for her husband
Norman. Norman has a diagnosis of
dementia and is having difficulty mobilizing
in the home. He is afraid to walk through
doorways, especially where there is a
flooring change, is tripping when walking
up the stairs and becomes upset when he
sees his reflection in the mirror……