Disclaimer: this is not PAC vocabulary, this is strictly an article that promotes comfort and engagement
and not the language that PAC promotes when describing expressions of
PLWD
"Sundowning" is a term used to describe the agitation, pacing, irritability and disorientation that many
people with Alzheimers experience during the late afternoon, evening or night. (disclaimer:this is not PAC vocabulary, this is strictly a definition and not the language that PAC promotes when describing expressions of PLWD)
For those who work or
live with older adults who have dementia, "Sundown Syndrome"
or "sundowning" is one of the most challenging situations they encounter
on a daily basis. Several years ago, staff at the nursing home on the Beatitudes
Campus in Phoenix, Arizona determined they had a serious problem with
sun downing and set about finding some solutions.
As Tena Alonzo, Director of Research and Dementia Programs at Beatitudes, describes it, "In the dementia unit,
everyday at the evening shift change, the chorus would start: a few people would call out and then everyone in the
vicinity would join in. You could hear help me, help me and oh, shut up continuously.
Perhaps it wouldn't have been so bad if that's where the challenging behavior stopped, but
this was just the beginning of the evening! People who were easy to get along with the rest
of day would suddenly want to fight with anyone who crossed their path. Others would
pace the floor looking for an exit to escape. Dinner was disastrous as no one could hear
themselves think. Visiting families and friends were distressed and upset. After several hours
dealing with agitated residents and family visitors who were sometimes inconsolable, the
exhausted staff would finally get everyone in bed so the whole process could begin again
the next day."
As the staff looked at the frequency and severity of residents experiencing "sundowning",
they thought there must be something that can be done about this situation. Is "sundowning"
just a part of the disease? Why do some older adults with dementia act so differently in the afternoon? Isn't there
something we can do to help everyone be more comfortable? The answers to these questions didn't come all at
once, but over time some valuable lessons were learned about older adults with dementia.
In considering possible solutions to "sundowning", the Beatitudes staff had something in their favor. They had recently
begun implementing a philosophy where achieving comfort was the overall staff goal. This comfort philosophy
was not about an end-of-life hospice focus, but rather about meeting the needs of people with dementia the way
they would do for themselves if they were able. This was a big change as it meant stepping away from the schedules
and routines that had been established to embrace the routine of the person with dementia.
To begin, the team decided to observe everyone residing on the
dementia unit between the hours of 2:30 PM and
9:00 PM. This observation, which occurred over several days, shed light
on some interesting scenarios. The staff saw
that many residents looked tired and frazzled and wondered if they would
be more comfortable if they were to lie
down and rest. Much of the time these rest periods were not necessarily
convenient for the staff, and it was a little
challenging at first to envision the perspective of the resident for
some staff members. The team decided if someone
looked tired, no matter when that occurred, they would assist him or her
to rest either in a comfortable chair or on
the bed (some prefer a chair or the couch, some may only lay on top of
their bed, with a throw, while others prefer to change and get back into
bed--the
decision is based on the resident's comfort).
After some discussion, the staff also
agreed that it didn't matter if the rest period
was during a meal or an activity. After
a few months, everyone accepted the rest when tired philosophy. As residents
started to sleep when they were tired and
wake when they were rested, the change
was obvious. They were happier and
didn't seem to need so much psychotropic medication. The nurses didn't
give
PRN medication for agitation any longer and felt comfortable asking the
physicians
to begin tapering the medications. They started with the anti-anxiety
medications because almost every resident was receiving one, and then
worked
on tapering the anti-psychotics. While not every resident was
comfortable without
psychotropic medication, most were.
This first phase of addressing the issues with "sundowning" had been very successful,
but staff felt there was more work to do. Next, they observed the overall unit
environment (or milieu as they prefer to call it). What was seen and heard was
appalling. At the evening shift change, the commotion increased significantly.
Staff were used to speaking all at once and rushing around trying to complete
tasks before end of shift or gearing up to begin their work. This cacophony and
disruption were compounded by a television in the common area and general
noise on the unit. Watching the residents respond to the din was enlightening.
Sometimes people covered their ears or tried to get away from it. Some just
looked scared and bewildered. It became clear to the staff that they needed to
stop talking so loudly and slow down. The television that had been so prominently
displayed in the common area, but never really used by residents, was
moved. The milieu became quiet, and everyone responded positively to the
change in the environment.
It can be easy to forget that being confused and unable to make sense out of the
environment can be extremely tiring for the person with Alzheimers, and over stimulation
only makes this worse.
The staff was amazed that making comfort the goal of everything had such a
positive impact on the residents and on themselves. Once the changes were in
place, no one called out, became angry or upset or tried to leave the unit. Staff
members became sane again, and many reported they enjoyed their jobs more
since the changes were implemented. Families and friends increased their visits in
the afternoon and evening. Dining became a wonderful event which resembled
a restaurant setting rather than a nursing home dining room.
As Ms. Alonzo relates, It's been almost 14 years since we've experienced the pain
of "sundowning" here. We still do the same things, still make comfort the goal of
everything, and both the residents and the staff are better for it.
If anyone has any related article that they would like to share, PLEASE share the link in the comment section.
Wednesday, February 17, 2016
Monday, February 15, 2016
Opportunities
Hi PAC Approved/ Certified Trainer!
Having successfully completed
Trainer Certification, you have the skills and tools to train others in
Teepa’s Positive Approach™. Now imagine
the impact of adding to your organization’s team with additional role specific certifications. Now is the time to build your team!
Your colleague will receive 20% off their registration for
a March or April Coach or Consulant Certification. Tell them to use the disocunt code CERT2
during the on-line registration process.
Do you have a Memory Care Program Director, Resident Care Director, or Executive Director that would benefit from pursuing a
The Coach program is designed for anyone who supervises
caregivers or other team members providing direct care or support to individuals living with dementia. Coach
Certification
equips care team members to help coworkers change their behavior
towards individuals with dementia, leading to improved relationships
and quality of care.
Testimonial
“When I say the Positive Approach™ coaching model has changed my life, it really has changed my life—not
just my personal life, but how I supervise people, how
I appreciate different things from my staff.
Everybody’s personality is as valuable as the next person. So, I think
that as a provider, the light goes off with this training. You’re
meeting
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whole time.”
Events
Do
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Testimonial
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potential residents
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which was to get them to move in if they met our level of care, but also
gave my "canned" speech about the facility. Now I listen and not just
to the words they are saying. I listen to see
if they are a detail person or big picture, facts or emotions. I connect
with the person, then reflect. The result? More move ins! I am loving
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Events
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Wednesday, February 10, 2016
Last Ride
Last Ride
I arrived at the address and honked the horn. After waiting a few minutes I honked again. Since this was going to be my last ride of my shift, I thought about just driving away, but instead I put the car in park and walked up to the door and knocked.
Just a minute', answered a frail, elderly voice.
I could hear something being dragged across the floor.
After a long pause, the door opened. A small woman in her 90's stood before me. She was wearing a print dress and a pillbox hat with a veil pinned on it, like somebody out of a 1940's movie.
By her side was a small nylon suitcase. The apartment looked as if no one had lived in it for years. All the furniture was covered with sheets.
There were no clocks on the walls, no knickknacks or utensils on the counters. In the corner was a cardboard box filled with photos and glassware.
Would you carry my bag out to the car?' she asked.
I took the suitcase to the cab, then returned to assist the woman. She took my arm and we walked slowly toward the curb.
She kept thanking me for my kindness. 'It's nothing', I told her.. 'I just try to treat my passengers the way I would want my mother to be treated.'
'Oh, you're such a good boy, she said. When we got in the cab, she gave me an address and then asked, 'Could you drive through downtown?'
'It's not the shortest way,' I answered quickly.
'Oh, I don't mind,' she said. 'I'm in no hurry. I'm on my way to a hospice.
I looked in the rear-view mirror. Her eyes were glistening.
'I don't have any family left,' she continued in a soft voice. 'The doctor says I don't have very long.' I quietly reached over and shut off the meter.
What route would you like me to take?' I asked.
For the next two hours, we drove through the city. She showed me the building where she had once worked as an elevator operator.
We drove through the neighborhood where she and her husband had lived when they were newlyweds. She had me pull up in front of a furniture warehouse that had once been a ballroom where she had gone dancing as a girl.
Sometimes she'd ask me to slow in front of a particular building or corner and she would sit, staring into the darkness, saying nothing.
As the first hint of sun was creasing the horizon, she suddenly said, 'I'm tired. Let's go now'.
We drove in silence to the address she had given me. It was a low building, like a small convalescent home, with a driveway that passed under a portico.
Two orderlies came out to the cab as soon as we pulled up. They were solicitous and intent, watching her every move. They must have been expecting her. I opened the trunk and took the small suitcase to the door. The woman was already seated in a wheelchair.
'How much do I owe you?' She asked, reaching into her purse.
'Nothing,' I said.
'You have to make a living,' she answered.
There are other passengers,' I responded.
Almost without thinking, I bent and gave her a hug. She held onto me tightly.
'You gave an old woman a little moment of joy,' she said. 'Thank you.'
I squeezed her hand, and then walked into the dim morning light.. Behind me, a door shut. It was the sound of the closing of a life.
I didn't pick up any more passengers that shift. I drove aimlessly, lost in thought. For the rest of that day, I could hardly talk.
What if that woman had gotten an angry driver, or one who was impatient to end his shift? What if I had refused to take the run, or had honked once, then driven away?
On a quick review, I don't think that I have done anything more important in my life.
We are conditioned to think that our lives revolve around great moments.
But great moments often catch us unaware-beautifully wrapped in what others may consider a small one.
PEOPLE MAY NOT REMEMBER EXACTLY WHAT YOU DID, OR WHAT YOU SAID ~BUT~THEY WILL ALWAYS REMEMBER HOW YOU MADE THEM FEEL.
Thank you, my friend...
Life may not be the party we hoped for, but while we are here we might as well dance. J.L.
I arrived at the address and honked the horn. After waiting a few minutes I honked again. Since this was going to be my last ride of my shift, I thought about just driving away, but instead I put the car in park and walked up to the door and knocked.
Just a minute', answered a frail, elderly voice.
I could hear something being dragged across the floor.
After a long pause, the door opened. A small woman in her 90's stood before me. She was wearing a print dress and a pillbox hat with a veil pinned on it, like somebody out of a 1940's movie.
By her side was a small nylon suitcase. The apartment looked as if no one had lived in it for years. All the furniture was covered with sheets.
There were no clocks on the walls, no knickknacks or utensils on the counters. In the corner was a cardboard box filled with photos and glassware.
Would you carry my bag out to the car?' she asked.
I took the suitcase to the cab, then returned to assist the woman. She took my arm and we walked slowly toward the curb.
She kept thanking me for my kindness. 'It's nothing', I told her.. 'I just try to treat my passengers the way I would want my mother to be treated.'
'Oh, you're such a good boy, she said. When we got in the cab, she gave me an address and then asked, 'Could you drive through downtown?'
'It's not the shortest way,' I answered quickly.
'Oh, I don't mind,' she said. 'I'm in no hurry. I'm on my way to a hospice.
I looked in the rear-view mirror. Her eyes were glistening.
'I don't have any family left,' she continued in a soft voice. 'The doctor says I don't have very long.' I quietly reached over and shut off the meter.
What route would you like me to take?' I asked.
For the next two hours, we drove through the city. She showed me the building where she had once worked as an elevator operator.
We drove through the neighborhood where she and her husband had lived when they were newlyweds. She had me pull up in front of a furniture warehouse that had once been a ballroom where she had gone dancing as a girl.
Sometimes she'd ask me to slow in front of a particular building or corner and she would sit, staring into the darkness, saying nothing.
As the first hint of sun was creasing the horizon, she suddenly said, 'I'm tired. Let's go now'.
We drove in silence to the address she had given me. It was a low building, like a small convalescent home, with a driveway that passed under a portico.
Two orderlies came out to the cab as soon as we pulled up. They were solicitous and intent, watching her every move. They must have been expecting her. I opened the trunk and took the small suitcase to the door. The woman was already seated in a wheelchair.
'How much do I owe you?' She asked, reaching into her purse.
'Nothing,' I said.
'You have to make a living,' she answered.
There are other passengers,' I responded.
Almost without thinking, I bent and gave her a hug. She held onto me tightly.
'You gave an old woman a little moment of joy,' she said. 'Thank you.'
I squeezed her hand, and then walked into the dim morning light.. Behind me, a door shut. It was the sound of the closing of a life.
I didn't pick up any more passengers that shift. I drove aimlessly, lost in thought. For the rest of that day, I could hardly talk.
What if that woman had gotten an angry driver, or one who was impatient to end his shift? What if I had refused to take the run, or had honked once, then driven away?
On a quick review, I don't think that I have done anything more important in my life.
We are conditioned to think that our lives revolve around great moments.
But great moments often catch us unaware-beautifully wrapped in what others may consider a small one.
PEOPLE MAY NOT REMEMBER EXACTLY WHAT YOU DID, OR WHAT YOU SAID ~BUT~THEY WILL ALWAYS REMEMBER HOW YOU MADE THEM FEEL.
Thank you, my friend...
Life may not be the party we hoped for, but while we are here we might as well dance. J.L.
Teepa Snow, MS, OTR/L, FAOTA
Dementia Care & Training Specialist
Dementia Care & Training Specialist
“Last Ride” originally published under "And where there is sadness, joy” in book: Make Me
an Instrument of Your Peace (1999).
Teepa's quote at the end of the story: "Life may not be the party we hoped
for, but while we are here we might as well dance." is by Jeanne C. Stein from “Blood Drive”
Wednesday, February 3, 2016
"The Experience of Dementia as a Journey"
I am going on a long journey by train. As I begin, the city skyscrapers and country landscape look familiar. As I continue my journey, the view reminds me of times gone by and I feel relaxed and comfortable. The other passengers on the train appear to be feeling the same way and I engage in pleasant conversation with them.
As the journey progresses, things begin to look different. The buildings have odd shapes and the trees don't look quite the way I remember them. I know that they are buildings and trees, but something about them is not quite right. Maybe I'm in a different country with different architecture and plant life. It feels a bit strange, even unnerving.
I decide to ask the other passengers about the strangeness I feel, but I notice that they seem unperturbed. They are barely taking notice of the passing scenery. Maybe they have been here before. I ask some questions but nothing seems different to them. I wonder if my mind is playing tricks on me. I decide to act as if everything looks all right, but because it does not, I have to be on my guard. This places some tension on me, but I believe I can tolerate it for the remainder of the trip. I do, however, find myself becoming so preoccupied with appearing all right that my attention is diverted from the passing scenery.
After some time I look out the window again, and this time I know that something is wrong. Everything looks strange and unfamiliar! There is no similarity to anything I can recall from my past. I must do something. I talk to the other passengers about the strangeness I feel. They look dumbfounded and when they answer, they talk in new language. Why won't they talk in English I wonder? They look at me knowingly and with sympathy. I've got to get to the bottom of this, so I keep after them to tell me where the train is and where it is going. The only answers I get are in this strange language, and even when I talk, my words sound strange to me. Now I am truly frightened.
At this point I figure that I have to get off this train and find my way home. I had not bargained for this when I started. I get up to leave and bid a pleasure good-bye. I don't get very far, though, as the other passengers stop me and take me back to my seat. It seems they want me to stay on the train whether I want to or not. I try to explain, but they just talk in that strange language.
Outside the window the scenery is getting even more frightening. Strange, inhuman-looking being peer into the window at me. I decide to make a run for it. The other passengers are not paying much attention to me, so I slip out of my seat and quietly walk toward the back of the car. There's the door! It is difficult to push, but I must. It begins to open and I push harder. Maybe now I will get away. Even though it looks pretty strange out there, I know I will never find my way home if I do not get off the train. I am just ready to jump when hands suddenly appear from nowhere and grab me from behind. I try to get away. I try to fight them off, but I can feel them pulling me back to my seat. I realize now that I will never get off this train; I will never get home.
How sad I feel. I did not say good-bye to my friends and children. As far as I know they do not know where I am. The passengers look sympathetic, but they do not know how sad I feel. Maybe if they knew they would let me off the train. I stop smiling, stop eating, stop trying to talk and avoid looking out the window. The passengers look worried They force me to eat. It is difficult because I am too sad to be hungry.
I have no choice now. I have to go along with the passengers because they seem to know where the journey will end. Maybe they will get me there safely. I fervently wish that I had never started out on this journey, but I know I cannot go back.
Author unknown
Please share in the comment section,
How did this journey make you feel?
Why do you think you feel/think this way?
What have you learned from your training that can change the outcome or ending to this journey?
How can you and your trainees MAKE A DIFFERENCE?
Did you consider each GEM level as you read through the journey?
After reading this "journey" I have never forgotten it,... please share your thoughts.
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