The Gems Of Caregiving: Teepa Snow, Dementia Expert

Caregiving Gems

Teepa Snow, MS, OTR/L, FAOTA

1© 2010 Teepa Snow. All rights reserved. Use only with permission. Presentation at Home Instead Senior Care of Sonoma County sponsored Dementia and Alzheimer’s event, March 22, 2010, at the Scottish Rite Masonic Center in Santa Rosa, CA.

Beliefs

• People with Dementia are Doing the BEST they can

• We must learn to DANCE with our partner

• We are a KEY to make life WORTH living• What we choose to do MATTERS• We can change the WORLD with help• We must be willing to CHANGE

ourselves• We must be willing to STOP & BACK OFF

2© 2010 Teepa Snow. All rights reserved. Use only with permission. Handout at Home Instead Senior Care of Sonoma County sponsored Dementia and Alzheimer’s event, March 22, 2010, at the Scottish Rite Masonic Center in Santa Rosa, CA.

How Can We Become Better Care Partners?

Let go of the past to be in the MOMENTGo with their FLOW

Be willing to try something newBe willing to learn something differentBe willing to see it through another’s

eyesBe willing to fail & try again 3

Caring for Someone with Dementia…

What Works BEST?

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The Basics for Success…

• Be a Detective NOT a Judge• Look, Listen, Offer, Think… • Use Your Approach as a Screening

Tool• Always use this sequence for CUES– Visual - Show– Verbal - Tell– Physical – Touch

• Match your help to remaining abilities 5

Positron Emission Tomography (PET) Alzheimer’s Disease vs. Normal Brains

G. Small, UCLA School of Medicine.

Normal Early Alzheimer’sAlzheimer’s

Late Alzheimer’s Child

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Normal Brain Alzheimers Brain7

Learning & Memory Center

HippocampusBIG CHANGE

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Understanding Language – BIG CHANGE 9

Hearing Sound – Not Changed 10

Sensory StripMotor Strip

White Matter Connections

BIG CHANGES

Formal Speech & Language

CenterHUGE CHANGES

Automatic SpeechRhythm – Music

ExpletivesPRESERVED

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Executive Control Center

Emotions Behavior JudgmentReasoning

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Vision Center – BIG CHANGES13

Some Basic Skills

• Positive Physical Approach• Supportive Communication• Consistent & Skill Sensitive Cues– Visual, verbal, physical

• Hand Under Hand – for connection– for assistance

• Open and Willing Heart, Head & Hands

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First Connect – Then Do

• 1st – Visually• 2nd – Verbally• 3rd – Physically

• 4th – Emotionally• 5th – Spiritually - Individually

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To Connect

Start with the Positive Physical Approach

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Your Approach

• Use a consistent positive physical approach– pause at edge of public space– gesture & greet by name– offer your hand & make eye contact– approach slowly within visual range– shake hands & maintain hand-under-

hand–move to the side– get to eye level & respect personal

space– wait for acknowledgement

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A Positive Approach(To the Tune of Amazing Grace)

Come from the frontGo slow

Get to the side,Get low

Offer your handCall out the name then WAIT…If you will try, then you will see

How different life can be.For those you’re caring for!

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Supportive Communication

• Make a connection– Offer your name – ”I’m (NAME) ”… “and

you are…”– Offer a shared background – “I’m from

(place) …and you’re from…”– Offer a positive personal comment –

“You look great in that ….” or “I love that color on you…”

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Support to ‘Get it GOING!’

• Give SIMPLE & Short Info• Offer concrete CHOICES• Ask for HELP• Ask the person to TRY• Break the TASK DOWN to single steps

at a time

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Give SIMPLE INFO

• USE VISUAL combined VERBAL (gesture/point)– “It’s about time for… “– “Let’s go this way…”– “Here are your socks…”

• DON’T ask questions you DON’T want to hear the answer to…

• Acknowledge the response/reaction to your info…

• LIMIT your words – Keep it SIMPLE• WAIT!!!!

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Now for the GEMS…

DiamondsEmeraldsAmbersRubiesPearls

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Diamonds

Still ClearSharp - Can Cut

Hard - Rigid - InflexibleMany Facets

Can Really Shine

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Diamonds• Know Who’s in Charge – Respect

Authority• Can do OLD habits & routines • Become more territorial OR less aware

of boundaries• Like the familiar – FIGHT CHANGE• Can pull it together to make you look

bad• Know how to push your buttons• Want to keep roles the same• Tell the same stories ask the same ?s

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Emeralds

Changing colorNot as Clear or Sharp - Vague

Good to Go – Need to ‘DO’Flaws are Hidden

Time Traveling

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Emeralds• Think they are FINE• Get emotional quickly• Make mistakes – don’t realize it• Do over and over OR Skip completely• Ask – “What? Where? When?”• Like choices• Get lost in past life, past places, past

roles• Need help, DON’T know it or like it!

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Ambers

Amber AlertCaution!

Caught in a momentAll about Sensation

Explorers

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Ambers

• Get into stuff• Fiddle, mess, touch, taste, dig, tear,

fold…..• Move toward action and noise OR

away• Sensory tolerance• Sensory need• Mouth, fingers, feet, genitalia• Can’t figure it out… react physically

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Rubies

Hidden DepthsRed Light on Fine Motor

Comprehension & Speech Halt

Coordination FaltersWake-Sleep Patterns are

Gone

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Rubies

• Fine motor stops• Hard to stop and hard to get going• Limited visual awareness• One direction – forward only• Can’t figure out details – but do copy

us• SLOW to change• On the go or full stop• Use music and rhythm 30

Pearls

Hidden in a ShellStill & QuietEasily Lost

Beautiful - LayeredUnable to Move – Hard to ConnectPrimitive Reflexes on the Outside

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Pearls

• Can’t move• Not aware of the world around – most

of the time• Problems swallowing• Hard to get connected• How we touch and help matters• SLOW!!!!• Varies a LOT

32© 2010 Teepa Snow. All rights reserved. Use only with permission. Presentation at Home Instead Senior Care of Sonoma County sponsored Dementia and Alzheimer’s event, March 22, 2010, at the Scottish Rite Masonic Center in Santa Rosa, CA.