CAREGIVER GUIDE

Caregiver tips for bathing

Bathing: Equipment, Techniques and Tips

Problems with bathing may be caused by:

• Temperature of the water is too hot or too cold
• Temperature of the bathroom is too hot or too cold
• Forgetting that he/she needs to take a shower/bath
• Not enough privacy or embarrassed to have the caregiver help
• Not enough contrast between tub and floor can be confusing
• Fear of falling
• Being rushed or taking too long to take a bath/shower
• Inability to stay focused long enough to complete shower

Products that make the bathroom a safer and more accessible environment:

• Grab bars provide safety during entering and exiting the tub/shower and provide stability during bathing/showering. They should be anchored into the center of a wall stud to withstand the stress that will be placed on them. They must be long and wide enough to grasp easily.
• Bath/shower stools or seats and transfer benches prevent fatigue and falls. They must have rigid seat and backs. Legs should be rubber-tipped to prevent movement while seated.
• Hand-held showers can be used to direct water while remaining seated on a stool or in a tub.
• Non-slip and anti-slip bath mats prevents falls.
• Childproof latches on cabinets containing medicine to prevent accidental poisoning.

Physical aspects of bathing

• Put a towel over the person's shoulders for warmth and/or if modesty is involved
• Do not use bath oils since they make the tub/shower slippery
• Use tear free/tangle free shampoo/bath gel
• Encourage person to wash self, assisting only when necessary
• Let person put on terry robe if drying with towel is a problem

Environmental aspects of bathing/grooming

• Have handrails installed
• Have a shower chair or bench installed
• Use a hand-held shower head
• Use a non-slip bath mat inside shower stall/bathtub
• Use a anti-slip bath mat outside shower stall/bathtub
• Avoid noise, which will echo in the bathroom
• Remove everything from the bathroom that could be a distraction
• Remove electrical appliances
• Make sure the temperature in bathroom is comfortable for bather
• Make sure there is adequate lighting
• Remove locks from bathroom door (if necessary)
• Make sure the hot and cold faucet handles are identified with red and blue colors
• Make sure the hot water is set for 120° F or lower.

Tips to increase or maintain cooperation with bathing/showering

• Know the person's preference (bath or shower - morning or evening)
• A shower usually is easier and safer than a bath
• Do the bathing in the morning when the person is not tired
• Give bather washcloth so he/she can help while caregiver washes important parts
• Limit bath/shower to ones or twice a week and do sponge baths in between
• Use same routine every time
• Have everything ready before bathe/shower time
• Do not force a person to take a bath/shower
• When assisting, tell the person what part you are going to wash
• Give simple instructions as necessary
• Never rush a person
• Bathe person quickly to prevent chilling and agitation

Caregiver tips for dressing

Dressing: Tips, Equipment and Techniques Problems with dressing may be caused by:

• Forgetting that it is time to change clothes
• Loss of understanding how to get dressed
• Inability to recognize parts of the body
• Room temperature that is too hot or too cold for dressing
• Distractions from people, clutter or noise
• Lack of privacy
• Poor lighting

Physical aspects of dressing:

• Encourage person to do as much of the dressing as possible
• Place matching outfits together
• Place accessories with the clothes they go with
• Let the person sit while dressing
• Give verbal cues
• Give visual cues

Environmental aspects of dressing:

• Have room at a comfortable temperature for dressing
• Make sure there is privacy
• Make sure the environment is calm without distractions
• Make sure everything is ready to be used

Tips to increase or maintain cooperation with dressing:

• Have the same dressing routine every day
• Allow enough time
• Talk with a calm voice
• Label closets and drawers
• Lay out the clothes in the order they should be put on

Use short and simple instructions:

• Give verbal or visual cues with dressing
• Use a pantomime technique with dressing
• Don't force a person to change clothes
• Try distracting the person if there is resistance
• If given a choice of clothes to wear, keep it simple
• Use simple garments
• Use pants with elastic waistbands
• Make sure the clothes are comfortable
• Use slip-on shoes with non-skid soles
• Remove dirty clothes to avoid confusion

Caregiver tips for grooming

Grooming: Tips, Equipment and Techniques

Problems with grooming may be caused by:

• Forgetting that it is time to comb hair, brush teeth etc.
• Loss of understanding how to comb hair, brush teeth etc.
• Inability to recognize parts of the body
• Distractions from people, clutter or noise
• Lack of privacy
• Poor lighting

Physical aspects of grooming:

• Encourage person to do as much of the grooming activities as possible
• Keep hair in an easy to care for style
• Know the person's preference for shaving with electric razor or hand razor
• Encourage female person to use some make-up if this was important to her
• Encourage the person to clip or cut their nails twice a months
• Encourage the person to brush their teeth at least twice a day
• For denture wearers, encourage soaking teeth at night

Environmental aspects of grooming:

• Have room at a comfortable temperature for grooming
• Make sure there is privacy
• Make sure the environment is calm without distractions
• Make sure everything is ready to use (comb, toothbrush etc)

Tips to increase or maintain cooperation with grooming:

• Have the same grooming routine every day
• Allow enough time for grooming activities
• Talk with a calm voice
• Lay out grooming supplies
• Lay combs, brushes etc. in clear view
• Use short and simple instructions
• Give verbal or visual cues with grooming
• Use a pantomime technique with grooming
• Don't force a person to comb hair, brush teeth etc.
• Try distracting the person if there is resistance

 
Caregiver tips for Incontinence problems

Incontinence: Tips, Equipment and Techniques

Problems with incontinence may be caused by:

• Moving too slow to make it to the toilet in time
• Clothing may be too complicated to pull down quickly
• Loss of sensation of needing to use the toilet
• Inability to tell a someone that he/she needs to use the toilet

Medical reasons for incontinence:

• Urinary tract infection or prostate enlargement or infection
• Side effects of medications
• Impaired nervous system
• Pelvic muscle weakness
• Pelvic, prostate, or rectal surgery
• Stress or fear

Physical aspects of incontinence:

• Keep the skin dry, clean and well lubricated
• Recognize changes in skin condition to prevent skin problems
  • When the skin is too dry, moisten it with ointment or lotion
  • When the skin is too moist, dry it with powder or cornstarch
• Change wet pads and clothes often
• Use soft pads and clothing and keep them wrinkle free

Tips to prevent or decrease incontinence:

• Establish a regular schedule for toileting
• Start the schedule first thing in the morning, continue with two-hour intervals, and adjust as necessary
• Use the same routine every time
• Learn to tell the signs or facial expression of the person needing to use the toilet
• Place a commode or urinal at the bedside at night
• Use toilet before leaving the house and/or when arriving at destination
• Limit the intake of liquids after dinner and in the evening to help control incontinence at night time
• Provide reminders to use the bathroom
• Don't wait for the person to tell you he/she has to use the bathroom

Take the pressure of incontinence by:

• Using washable chair cushion covers
• Waterproof cushions by sliding them in a garbage bag
• Waterproof bed by putting a plastic mattress cover over mattress
• Putting washable or disposable pad in bed to protect the linens
• Using incontinence pads, diapers, or absorptive underwear
• Changing clothing immediately after an accident
• Taking extra pads and clothing when going outside house

Caregiver tips for nutrition

Nutrition and Eating

A Healthy Diet

A good diet and 6 to 8 glasses of liquid (unless there are restrictions from the physician) are important to health. Foods rich in the B vitamins are critical to keep brain cells and nerves healthy; these foods include dark, green vegetables, beans and other legumes, meat, fish, and dairy products. Routine gum, tooth, and denture care are also important. When using a toothbrush becomes difficult, frequent visits to the dentist's office may be necessary.

If weight loss is a problem, nutritious snacks every one or two hours may help. Boost the calories of foods with extra butter, oleo margarine, cheese sauces, or diet supplements. People over 65 years old and who are more than 10 to 15 pounds overweight may benefit from foods with fewer calories, such as fresh fruits and vegetables. Also helpful is more frequent exercise, such as walks, folding clothes or towels, kneading bread dough, sanding wood, or scrubbing furniture outdoors.

Eating Made Easier

As the ability to coordinate hand and finger movements change, cutting up food and feeding oneself may become a struggle. It may help to set up one dish or bowl with a small amount of food and one spoon. Foods that are colorful and easy to put on a spoon will help, for example, soft casseroles or stew. Foods such as peas, rice, pieces of meat, or spaghetti may slip off a spoon unless they are in small pieces with sauces to hold the pieces together. Mashed potatoes, vegetables in cheese sauce, thick soups, puddings, yogurt, and applesauce are easy to manage.

When a spoon is hard to use, finger foods such as small pieces of fruit, vegetables, meats, bread, or cheese will help keep eating an independent activity. If swallowing becomes a problem, moist, soft foods help. People who struggle to swallow may find it easier to drink thicker liquids, such as tomato juice and milk, and may struggle with thinner liquids, such as water or apple juice. Sometimes liquid leaks into the lungs when people swallow poorly. After a few swallows, the person should cough to make sure the lungs are clear, then continue eating.

Eating with Dignity

Wearing a colorful shirt or blouse when eating in a public place helps disguise spilled foods or liquids. Also, the person with the memory disorder should sit in the quiet part of the restaurant and away from the people traffic. The person with the memory disorder should sit in a chair facing a wall and not a window or the dining room, watching activities of everyone else. In this way, the person is more able to focus on eating and not be distracted by other people in the restaurant.

Eating: Tips, Equipment and Techniques

Problems with eating may be caused by:

• Difficulties with swallowing
• Poorly fitted dentures or some type of mouth discomfort
• Side effects of medication
• Inability to recognize hunger
• Inability to recognize difference between food and non-food items
• Depression
• Some medical condition
• Losing interest in food, or hoarding food
• Forgetting to eat

Physical aspects of eating

• Encourage person to sit up straight with head slightly forward
• Present the food no more than 24 away from the person
• Encourage self-feeding at beginning of meal and then help feeding as the meal progresses
• Or help feeding at beginning of the meal and then encourage self-feeding as meal progresses
• Give only one utensil to use
• Give bowl instead of a plate
• Use spill-proof plate, plate guard, or scoop plate
• Use wet washcloth or Dycem placemat under dishes to avoid spilling
• Allow enough time between bites

Environmental aspects of eating:

• Avoid distractions and noise such as conversation, television or radio
• Keep the table setting simple, remove everything from the table that has nothing to do with eating (e.g. centerpiece, flowers, papers)
• Use unbreakable plates, bowls, and cups
• Avoid tablecloths, placements, plates and cups with a pattern on it
• Use plain colored dishes with a contrasting colored tablecloth or placemat
• Make sure there is enough light to see the food
• Try relaxing music to encourage eating/feeding

Tips to increase or maintain good eating habits:

• Offer meals at regular times and in the same place
• Have several small meals instead of three large meals
• Have the main meal in the morning or early afternoon
• Offer liquids frequently, and at room temperature
• Offer a variety of food, since a person's food preferences may change over time
• Offer finger food or food in bite size pieces
• Offer food that does not require much chewing
• Offer food at the right temperature

Caregiver tips for driving with Dementia

Driving with Dementia

One of the most devastating losses for persons with dementia is losing their independence. Driving is a major form of independence and restriciting someone from driving can be very stressful for the caregiver and care recipient. The following are some suggestions to help caregivers to better understand and deal with this subject more effectively.

A person with wandering problems should not have access to an automobile. People with severe memory problems have a greater chance of getting into an accident. Sometimes the person with the memory disorder will use their own judgment and give up driving a car. Occasionally a family will request that the person play it safe and stop driving. The doctor, based on a medical and neuro-logical evaluation, may advise the patient to stop driving. Carrying out the doctor's orders is the family's responsibility. The person may become angry with the family about the restriction on driving. The family should remind the person, "The doctor wants you to stop driving until you are better." The recommendation to stop driving extends to all motor vehicles, such as trucks, motor boats, or lawnmowers.

To help stop the driving, the caregiver should:

• Put away or hide the car keys.
• If the person insists on keeping the car keys, file down the ignition key.
• Donate the car to a favorite charity or to a hard-working grandchild.
• Buy a new, different car. A difference in style, color, and model, especially on the inside and at the control panel, should result in the person being unable to learn how to drive the new car.
• In some cases it may be necessary to fix the car so that it cannot start. One way to disable a car is to remove the spark plug wires.
• Sometimes it is helpful to ask the doctor to inform the care recipient they no longer will be able to drive so the caregiver doesn't take the blame and look like the bad guy.

Caregiver tips for sleep problems

Tips to Improve Sleep

Try to avoid caffeine. Remember that tea and many soft drinks, such as cola as well as coffee, have caffeine. Sugar and chocolate also can keep a person from sleeping.

Avoid heavy meals with meats, such as beef or pork, thick sauces, or rich desserts just before bedtime. Some kinds of medicines also can cause trouble sleeping; discuss this with your doctor.

Some people, for example those with back problems or arthritis, may wake up because of pain. If people have medicine for pain, taking this medicine at bedtime will help them sleep.

A person may wake up at night because they have to use the bathroom. If they drink less after dinner, they may not have to go to the bathroom in the middle of the night. However, it is important to make certain they do not get dehydrated. It may be easier for them to have a commode or urinal close to the bed. Those who cannot control going to the bathroom sometimes wake up because of wetness. Incontinence underwear may help prevent the feeling of wetness.

If people have too much rest during the day, it may be hard for them to fall asleep at night. They should have some exercise, preferably in the late afternoon or early evening. People who have severe progressive dementia need exercise just as healthy people need exercise.

People often have trouble sleeping at night if they take naps during the day. Even though it is easier for the caregiver to do chores when the person naps during the day, it may cause problems sleeping at night. Sometimes keeping someone in street clothes with the room well lit will keep them from taking a nap.

Do not forget the nightlight. A person who wakes up and is afraid or does not know where he or she is, probably will not be able to get back to sleep. Also, if there is some light in the house, there is less risk for a fall. Sometimes keeping the room a little quieter or a little cooler will help. The only activity that should take place in the patient's bedroom is sleeping.

Make sure the house is safe. Before bedtime turn the stove off at the circuit breaker. If all else fails, request from the physician a sleep medicine that does not interfere with memory function.

Night Wandering

Night Wandering - Some patients wander at night. Unfortunately this may keep the caregiver in light sleep, on the alert, or awake all night. The caregiver must have a good night's sleep to handle the challenges of each day. Remember, if the person sleeps well, the caregiver is also rested.

Remember these sleep helps:

• Keep the bedroom at a comfort-able temperature.
• Keep the bedroom quiet.
• Use the bedroom only for sleeping and not for other activities.
• No sleeping during the day. No naps after 3 pm.
• No late morning sleeping. Have the person with dementia rise early the same time each morning.
• No caffeine or other stimulants in the diet, especially before bedtime. No coffee, tea, cocoa, chocolate, soda with caffeine, or desserts with refined white sugar.
• Keep the hours before bedtime restful to help the person wind down and relax.
• As a last resort, medicine may be necessary to help sleep.
  
  

  Affinity Care of NJ
   732-324-1515
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