Is it Walking or Wandering? Ten Pointers to Put Caregivers in the Right Direction

Is it Walking or Wandering? Ten Pointers to Put Caregivers in the Right Direction

One of the most frequently asked questions of this eldercare consultant is: What is an appropriate residence for my family member? To be effective in this role, it not only entails a thorough assessment of the adult senior but also refresher visits to long standing residences and visiting those residences that have opened since Covid.

A “mix and mingle” recently brought me to Briarcliff, New York to a new residence that is exclusively devoted to residents with dementia. An impressive feature was the enclosed outdoor space where residents can “wander, “as my guide pointed out, or, as I would like to think, where residents can “walk.” So, what’s the difference?

Wandering implies that the person’s actions are aimless or purposeless, putting them in danger to themselves. Stepping outside on a stormy day, making one’s way over to a busy intersection or leaving the house in the dark of night. But in other situations that wandering is walking. It has a purpose; since it is difficult for the person to communicate feelings or needs verbally, it is up to caregivers, sometimes with the assistance of a professional or organizations such as the Alzheimer’s Association to figure out the reason for a loved one’s walking. While the explanations can be plentiful, the Ohio Council for Cognitive Health provides some direction as to why a person with dementia is walking continuously:

Pain: the person may be in pain and not able to express the pain.

Medication: the person may be experiencing medication side-effects that cause agitation.

Noise: the room may be too noisy or overstimulating

Boredom: If the person is bored, he or she may walk as something to do.

Toilet: The person may be searching for the bathroom and is not able to find it.

Lost item: The person may be searching for something that he or she believes is lost. This item may or may not exist.

Hunger: The person may be hungry and not realize that he or she needs to eat.

Confusion: The person may not recognize their own home and may want to go somewhere that they think is home.

Habits: The person may be trying to continue a long-standing habit such as going to work.

Sleep disruption: Restlessness or changing sleep patterns can lead to confusion between night and day. A person may wake early, become disoriented and think it is daytime and leave the house for work or a walk.

And this eldercare consultant’s suggestion, it comes from my favorite tee shirt which shows a pair of Birkenstock sandals. Beneath the sandals is the quote: “All who wander are not lost.” I would like to adjust that quote a bit and say all who walk find tranquility in the moment. The assurance of putting one foot in front of the other in uncertain times.

The Art of Listening: Achieving Successful Communication

The Art of Listening: Achieving Successful Communication

As Aging Life Care specialists, we are called upon to provide an assortment of services. The needs are as varied as the families we are helping. We continuously strive to be experts in our knowledge of homecare, entitlements, senior residences, elder law attorneys, and providing skilled and supportive counseling. But we are only effective if, throughout our dialogue with families, we listen. Effective listening combined with effective communication sets the foundation for successive and successful outcomes.

The art of listening, sometimes referred to as “active listening” requires two essential tasks. First, that we as care managers, listen, making a mindful effort to hear the words that seniors and their families are saying. Second, we must concentrate on what is being said establishing a virtual stop sign that leaves no room for our own assumptions and prejudices. We cannot assume or anticipate conclusions. With these two tasks as starting points, our listening is enhanced by four other components.

We listen mindfully, putting aside any distracting (as opposed to professional beliefs) thoughts. We listen without having an inner dialogue that will have an automatic response to a situation that is verbally evolving.

We listen without interrupting, knowing it may disrupt a client’s train of thought, especially if the person is cognitively compromised. A semi-smile (think Mona Lisa) or an encouraging “uh-huh,” lets the person know we are with them, we are listening.

We ask for clarification at the appropriate time. Siblings may finish telling of their conflicting feelings about what they each think is best for mom, and we reply: “So let me make sure I understand.” It is that clarification that allows for modification and affirmation.

Finally, after all information has been shared, the Aging Life Care specialist summarizes what has been said and listens for what has not been said, the latter perhaps a clue to the issue at hand.

Our listening skills remain strong as we adapt to the challenges brought on by the COVID-19 virus. Historically, families have sought the guidance of an Aging Life Care specialist as they pondered whether a parent would be better served in assisted living or remain at home with help. Now, families are asking our guidance as they question if a parent should return home or remain in their senior residence. Whoever would have thought? Thru this crisis, we will stand strong with our families, listening deeply and fully, a north star during uncertain times.

New Help in Choosing a Nursing Home

New Help in Choosing a Nursing Home

Selecting a nursing home here in Westchester County, or beyond, is filled with a myriad of emotions. Sometimes the decision is made easier by the fact that the complexity of care needed can only be met in a nursing home. Other times, it is the exhaustion experienced by the caregiver that necessitates entering a nursing home. And still, other times it is for rehabilitation and the stay is short term.

Regardless of the scenario, the process of selecting a nursing home can be daunting. Many times, the person is in the hospital and the discharge planner will hand a family member a list of nursing homes and ask them to select three. You may well know three great Italian restaurants in the area, but nursing homes are a different story. Over the years, as an elder care consultant, I have learned the good, bad and ugly about the residences in Westchester County and have guided families accordingly.

In conjunction with my assistance, the Center for Medicare and Medicaid Services (CMS) provides a helpful guide in the form of Nursing Home Compare. This five-star quality-based system, not unlike how hotels are rated, allows a person to compare various factors that, in their totality, lead to a better level of care and consequently a higher star rating.

Enhancing the need for consumers to learn as much as they can before selecting a nursing home, in October of 2019, CMS announced that it would add a new icon which is a red circle with a white stop hand in the center. This icon, seen below, alerts the researcher that the nursing home has been cited for abuse which has caused resident harm within the past year. Their star rating will be capped at two stars and only if the facility goes without an abuse citation for one year will the icon be removed.

While the abuse icon is another step to motivate nursing homes to look at the quality of care they are providing, experience has taught me that the absence of an abuse icon does not necessarily mean the absence of abuse. Visit at off-hours, smell, observe and talk to staff and residents. A difficult decision can be made a little easier.

Nursing Home Abuse Icon