Creating a Caregiver Plan

Welcome back, everybody, to a new truth, lies,

and Alzheimer's episode. I'm Lisa Skinner, your host, and

I've done something a little different for you today. I have

created a sample caregiver planner that covers all the

different stages of dementia: the early, the middle, and the

late. So I've actually given you sample weeks of what you can do

on a day-to-day basis for each stage, and these are not set in

stone. You can mix and match and change things around, but at

least it gives you a sample of a planner that you can utilize as

you feel appropriate to your situation. So let's start with

the early stage or mild impairment stage, and this is a

sampling of how you can implement the morning routine.

So starts with waking up, some hydration, a light activity,

reminders for appointments, and then midday provide a manageable

task, a social interaction, and a short break. For the evening,

you want to do a wind down routine. Don't get up and have

them start dancing. That's just gonna set the stage for a

restless night. So wind down routine. Like one of the things

that we used to do in our buildings was do a gentle hand

massage, either with lotion, unscented or scented for a

calming effect, or without, so it's very very effective. You

want to minimize any overstimulation for that exact

reason. I mean, people already who are living with dementia

really have kind of lost their circadian rhythm and can't tell

night from day, and that's when we see nighttime wandering

happen more often and sleep disturbances. You know, they may

be start sleeping more during the day and I mean less during

the day and split it up between daytime and nighttime. So

overstimulating them late in the day can just really, you know,

exacerbate that whole situation. So some of the common triggers

that we see in this stage is developing anxiety about changes

in their increased awareness of their own memory gaps, and

that's frustrating. Subtle confusion or starting to

misplace things and not remembering where they put them.

We see social withdrawal or reluctance to participate in

things that they may have at one time enjoyed, like maybe a

musical concert or some kind of a social activity. So here are

some recommended caregiver responses at this stage, do what

you can do to continuously preserve a person's autonomy,

independence, feeling that they still have control over things,

and you can do this by offering choices. Do you prefer the red

one or the green one? Do you want an English? Would you

rather have an English muffin or rye toast? If at this stage they

should still be able to make a choice, but limited to two

because more than that can cause overwhelm. Use respectful

language. You can use memory aids, gentle reorientation and

reassuring. You can still offer explanations about things.

Encourage meaningful activities that are always aligned with

their interests, which could vary pretty substantially, and

here are some prompts and scripts, sample language. So, a

morning greeting may be "Good morning, Alice. Always say their

name. We're going to start with a glass of water and a short

stretch. Would you like to do first? Now remember, this is the

early stage mild cognitive impairment, so they should

understand what you're asking and be able to respond to it.

But sometimes you're going to have to adjust these this

sampling. Here's a memory cue example. Now you told me, Alice,

that you have always enjoyed planting tomatoes. Would you

like to look at the photos that I have from your garden? This

one is actually from last year. Here is an example of a simple

instruction. Would you please help me and carry this mug to

the kitchen? Now, if you preface that by saying, "Would you

please help me? I would. I could really use your help. I would

really appreciate your help. We're wired to want to help

people, and it makes us feel good when we can. So, Alice,

would you help me out here? Would you please carry this mug

to the kitchen, and I will follow with the next step in a

moment. Is that okay? Okay, task pacing and prompt examples. Here

are some step-by-step examples to offer choices. Okay, first

we're going to pick out a shirt. Then we're going to choose a

pair of socks.

So, would you like the blue socks or the green socks today?

You can hold them up and let them point, or they can verbally

tell you. In terms of safety and environment, now make sure their

environment is clear and uncluttered and has great

lighting. Use doorway labels if helpful, and here are some

caregiver self-care tips for you: take short breaks

throughout the day, rotate the tasks, join a support group,

document the triggers when you see a change in their behavior

and what the effective response or responses were to kind of

turn that whole situation around. You're going to want to

keep a a journal of these because what works during one

situation may not work if the exact situation arises. You

might have to have a couple of different options in your tool

belt. Okay, here's the middle stage planner suggestions. This

would be for moderate impairment. So in your daily

structure, you want to make sure that you're structuring routines

with built-in safety checks, and you can do this by increasing

the use of visual aids and reminders. You could offer more

planned activities with supervision because some of the

triggers during this stage, are becoming more disoriented and

confused with tasks, becoming frustrated from communication

barriers. They're not completely understanding what you're

asking, what you're expecting. They may be trying to process

more words. You're speaking faster. You might need to slow

your speech rate down, so they because they now they're going

to have a more difficult time processing the words that you're

telling them. You might see more sleep irregularities during this

stage and wandering tendencies if they're not being supervised.

So here are some recommended caregiver responses during this

use and offer simplified tasks. That's going to vary from

person to person, and group activities into separate

segments. It's called chunking, making them more manageable and

less overwhelming. You can provide hands-on assistance if

you see they're struggling a little bit. And then, in terms

of implementing safety measures, that can include exit alarms,

door signage, and then one of the things that you can try to

normalize agitation is always still. This is going to apply to

every stage. Calm tone. They're going to pick up your

nervousness, your anxiety. Your if you're in a rush feeling. A

rush. They pick up on that and they emulate those emotions that

they pick up from us. Use redirection and validation,

validation, validation. I can see this is upsetting you, so

let's try something else. Here are some prompts and script

samples that you can use in this stage. Reassurance during

confusion. So here's an example. You're in your kitchen here, and

I am with you. We're going to go step by step together. Very

reassuring for somebody with dementia. Okay, here's some

language to use for redirection. Okay, let's take a short break

right now and listen to your favorite song. After that, can

we finish the simple task that we were working on? Okay, is

that all right with you? Again, you're giving them back the

control to agree. That's very important. If they ask you a

question, a good response is, "Hey, that's a great question,

and here's a straightforward answer to respond: Give them a

brief explanation in response to their question. For task

management, break the tasks that you are providing or offering or

engaging them in into two to three clear steps. Provide a

demonstration. Use checklists that contain simple icons or

pictures so they can visually see what you're asking them to

do. You can you can verbally tell them, but you can also

offer a visual option to just reinforce that they understand

what you're asking them to do or instructing them to do. Provide

motion-activated night lights, and again, this is really

important. Make sure that there's adequate lighting in

their environment, and that wherever they are walking to and

from, that the pathways remain clear. In other words, there's

no clutter or trip hazards. The elderly population, especially

dementia, are very high risk for falls, and can set them in a

downward spiral if they fall and become injured. Use accessible

communication devices, and you can label rooms and cabinets and

things like that. And here are some caregiver self-care tips

schedule respite on a routine basis if you can.

Maintain routines around the care partner's energy levels.

If if a care partner is really starting to show signs of

burnout and exhaustion. You need to replace that person with

somebody that maybe has just started their day and has more

of a positive attitude and higher energy levels, and then

the other person takes a break, and then of course, seek

professional guidance if you need it. There's no shame in

that. Okay, and then late stage planner example. So this will be

now severe cognitive impairment. So the daily structure really

focuses now on comfort, warmth, and minimizes necessary

activities. But we want to be consistent. Always try to be

consistent with people living with dementia, and that includes

a consistent caregiver team or single caregiver for

familiarity. familiarity, this is really important, especially

at this stage. Frequent short interactions rather than longer

sessions, because some of the things that are common triggers

at this stage are the feeling of losing independence. not only

losing independence, but becoming more dependent on a

family member or a caregiver. That's typical at this stage.

They also have a lot more difficulty expressing their

discomfort, their pain, whether they're hungry could be. Kind of

experiencing sensory overload or overstimulation just from their

surroundings. So here are some recommended caregiver responses

for this stage. Have a tool for pain assessment, and you can do

this via cues that they are displaying. You implement

regular comfort measures like gentle touch. Maintain

predictable and familiar routines. That really helps

people with dementia feel safe and secure. Prioritize their

basic needs, which comes down to feeling safe and providing

soothing interventions to help them feel safe and secure. Okay,

prompts and scripts, sample language for this stage. Comfort

cue example. I'm here with you. I'm not going anywhere. Do not

worry. Let's take slow breaths together, and then you can start

demonstrating those. Hopefully, they'll do it too. Here's

another one. I'll adjust your pillow and blanket so you'll be

more comfortable. Here's a pain cue acknowledgement. I know I

can't ask you to tell me exactly where you're hurting, but I can

clearly see that you are uncomfortable. That's

acknowledgement. It's validation. Let me check with

the nurse about your pain relief. I guess that's if you

know you're in a facility. Here's a feeding cue example,

but you can adjust that if they're at home. Would you like

a few bites of soft yogurt now, with some water nearby or some

tea to follow, care task and comfort care, regular

positioning, skin checks, mouth care-extremely important. You

always need to make sure you are providing good and consistent

oral hygiene. Gentle touch is very comforting for a lot of

people, but not for everybody. Some people just simply don't

like to be touched. So know your person, and a familiar caregiver

presence is extremely helpful because familiarity is very

important to people living with dementia. Otherwise, they might

think that they're somewhere that they don't know, they don't

recognize, and now they're not comfortable. They're scared

because they don't know where they are. Provide quiet,

low-stimulating environment. soft music is a great idea for a

lot of different reasons. It's relaxing and it also provides

reminiscence for them and triggers memories, fond

memories. And then for safety and environment, you might need

to consider using padded rails if needed. Implement secure fall

precautions. Again, remove any hazards that are obvious, and

use clear signage for essential areas. And keep familiar objects

that you can give them or use to tell stories or start up a

conversation. So keep them, you know, within reach, so you can

grab them at a moment's, a second's notice. And here are

some caregiver self care tips for this stage. Please don't shy

away from accepting help. It takes a village, and there's no

question about that when you're caring for people living with

cognitive decline, especially as they're progressing through the

stages. Rely on consistent routines. It's helpful to join

caregiver support networks so you don't feel like you're

living alone on an island with nobody to understand what you're

going through. Plan for regular medical reviews of pain control,

comfort measures, and palliative considerations, comfort care.

Here are some cross-cutting tools for all stages. There are

trigger and response logs available free online that

include the date and the time that. A behavior was triggered.

What the situation was, the response you used, and whether

or not it worked, or you had to try something else, or you can

make up your own, just using that as a guidance.

Communication prompts include, and you can keep a list of these

using short, simple sentences, one idea at a time. They're

slower in processing information, and again, use

validation phrases like, "I understand that you feel nervous

right now, or that you are upset right now, and then reassuring

phrases again like "I'm here with you" and we're gonna figure

this out together. Okay, non-pharmacological strategies,

redirection, distraction with meaningful activities, music,

reminiscence, light exercise, sensory stimulation that are

tailored to their preferences, and then in terms of addressing

medical and safety checkpoints, conduct medical regular

medication reviews monitor them for side effects, especially if

there are multiple physicians that are prescribing

medications. A lot of people have primary care physicians and

specialists that are involved in the care. Some fall prevention

measures, you know, in the earlier stages, if they haven't

stopped driving yet, you need to really consider safe driving

safety considerations and an emergency plan when the time

comes that they need to stop driving. So we're going to wrap

this up by me giving you a sample week at a glance, that is

stage oriented. Okay, I mean stage integrated is what I meant

to say. So Monday morning, hydration, light stretch,

favorite breakfast, midday, a short walk or chair based

exercise, two simple puzzles together in the afternoon. Do a

reminiscence activity with photos, and then kind of taper

off to quiet time. Evening, calm environment always a familiar

routine and early bedtime. Tuesday morning medication

check-in with care partner log, midday social visit with a

familiar family member or friend, afternoon a sing-along

or music therapy if available, and then in the evening gentle

massage or hand holding, some kind of comfort routine Sunday

mirror making adjustments for preferences, energy, and safety.

But don't forget, consistent routines are where you're really

gonna benefit from. So you can you know kind of mix and match

these and mix them up based on what you feel is appropriate or

what seems to be appropriate for where they're at at that day and

time. So hopefully this has been really helpful, and that you

will implement some of these suggestions that I've offered

here today. And again, as always, I will be back next week

with another brand new episode of the Truth, Lies, and

Alzheimer's show. I really appreciate you taking the time

to be here with me today and every week. If you are a regular

attendee of my shows, and I'll be back next week. In the

meantime, as I always say, have a great rest of your week. Stay

happy. Stay healthy. People need you, and I'll see you next week.

Bye for now.