Advice for memory care caregiver

vintagemother, BSN, CNA, LVN, RN · Mar 26, 2016

People afflicted with Alzheimer's and Dementia are very special pts.

For me, it really helped to learn about the physiologic changes that occur to the brain in these illnesses. Their brain literally shrinks. [emoji29][emoji29][emoji29]

Once I saw an autopsied brain of 1 of these pts, I realized that they truly aren't in control of themselves or their behavior.

Once i knew that, I learned its never personal. Not when they call you names, or try to choke you, etc.

That really helped me be a better CNA (back then) because I knew they weren't really trying to do the things they tend to do.

Your "advanced care/total care" pts will be "easier" in some ways, because they aren't likely to be able to hit you, and they are bed-bound, so as long as you keep the bed locked and low, put up side rails as ordered, etc, they won't be high fall risks.

But the hard part about working with those pts is the contractures and inability to eat. Contracted muscles hurt to be moved but these pts still need to be turned q2hrs and cleaned, which causes them pain. [emoji29]

Watching them slooooowly pass due to Alzheimer's is sad.

I worked in a locked down memory care unit as a nurse and best believe, you need to be careful so that you don't get hit. While still providing compassionate care.

Preventing falls and elopement was huge at my facility. Falls were common. Like once per week on my shift with 40-50 residents.

Don't be nervous. Go in with a positive and empathetic attitude. Observe the other staffs interactions with pts so you can learn which techniques work best for which pts.

amoLucia · Mar 26, 2016

Safety safety safety. Regardless of the level of cognitive impairment, safety is always an issue.

Bonnieparker22 · Mar 26, 2016

Thank you for the advice. This disease breaks my heart and I hope to be a compassionate caregiver and to help them end their journey with as much dignity as possible.

CrunchRN, ADN, RN · Mar 26, 2016

Never argue. Go into their world. Know they are prone to being frightened so make them feel safe.

amoLucia · Mar 27, 2016

Never argue. Go into their world. Know they are prone to being frightened so make them feel safe.

Very true. But our first impulse is like pure reflex; the urge to be correct.

To OP - also trying 'reality orientation' is quite painful for these. Your pt, 'Ms Lucy', frantically searches for her husband (long passed away). If you tell her the truth, she'll most likely become more frantic & agitated & hysterical. Why should we continue to inflict 'psychic pain' by hammering her with reality?

Many of us who work with dementia pts tend to stretch the truth with some benign little white 'Therapeutic Fibs'. (There's been threads here on AN about such.) The intention is to be GENTLE, and diversionary, not making fun of the pt.

Caring for these pts can be so frustrating, but also very rewarding.

Good luck to you.

IsabelK · Mar 27, 2016

Therapeutic lies are your friend. "Your husband is at work, he'll be back around supper time."

"Your mother went to visit a friend/grocery shopping and will be back soon."

"The car is in the shop; it needed brakes/whatever."

Redirection is good: "Let's get something to drink."

If the sky is purple, don't argue. The sky is purple.

A great story: I worked as an LPN in a nursing home with a dementia unit. Every morning 3 little old ladies would come out of their triple room and check out of the hotel. They'd go to the cafe (dining room) and have a leisurely breakfast. They'd walk in the square (the unit was set up with a big circle with two wings coming off of the circle) and then go to a little tea shop (dining room) for lunch. They'd sit in the park and people watch in the afternoon (in the big circle--lots of seating). For dinner they'd go to their favorite restaurant/diner/tea room. At the end of the day they'd watch a movie (in front of the big screen television in the area that had been the park and square earlier in the day). They'd have a late night cordial (bedtime snack). Then they'd all go check in for the night to the hotel. The staff kept three plastic keys for them and a notebook to sign the guest register. I had "tea" with them many times.

mtjoanna · Mar 27, 2016

In my area, a lot of the folks have grown up on ranches, so it's not uncommon for older gents (and ladies) to feel the need to get up and check the livestock. It's also very common for people, especially in the evening, to feel the need to "go home" for this or that reason. Enter their world: "I just checked the heifers. I didn't see any new calves; you can do the next check after breakfast." Or "it's awfully dark and cold out there tonight. Why not stay in this bedroom for tonight and you can get a fresh start in the morning." I've had a number of people try to pay me for their "hotel" stay. I assure them that the bill has already been covered and the room is theirs for another night. Don't try to convince them that "this is your home now;" as they will fight you because what you are saying makes no sense to them.

It is not uncommon for there to be some combativeness with pericare. I know some staff get impatient and upset with this but the residents are often not able to remember where they are and sometimes get to where they don't know who they are anymore, but they darn sure know that you aren't supposed to be messing with their pants! Imagine how you'd feel to have someone you don't know try to remove your clothing and mess about with your "private affairs." Also remember that a LOT of sexual abuse was never discussed or dealt with with our older population, so some of their panicked responses could be from memories of old trauma.

Alzheimer's (AD) literally eats away the memories, starting with the most recent memories first and working backwards. This is why so many of those with AD are unable to recognize family--in Mrs. Smith's mind, she's only 24 years old, there's no way that she could have a grown up daughter--so that woman who looks so familiar must be a sister or a cousin.

There's a lot more information out there. Actively educate yourself--this is a great site with lots of info: Healthy Brain Versus Alzheimer's Brain | Alzheimer's Association. It's a worthwhile and important job that you are getting ready to do--it's an honor to be of immediate help to those who are under your care. Remember that, and some of that attitude will show and will help when things are difficult.

Bonnieparker22 · Apr 2, 2016

If anyone is interested-I started my job and I absolutely love it. I am still in training but I've been doing a lot of the basics; showers, toileting, changing clothes, cleaning, and feeding. Some of the residents have been very easy and some have been very hard. I was sold on this job the minute a gentleman who I was helping use the toilet said to me "I am so glad you are here." My heart jumped into my throat and it really made me realize how rewarding this job is.The staff I work with is AMAZING. I partially wanted this job so I could see if I could "hack it" as a nurse and this gives me hope. Thanks for the advice!

CoryGreene · Jul 6, 2018

Professional caregivers can do wonders for Alzheimer patients, as they are well experienced to take good care of them.