Preventing Wandering with Memory Loss Patients

What Makes a Great Memory Care Facility?

At Tanglewood Assisted Living, we practice the five foot rule with memory loss patients. If you wish to be understood by a memory loss patient, you should be within five feet of that person when you speak to them. Most memory loss patients simply cannot process words that are shouted at them from across the room. In order to communicate effectively you should get close, make eye contact and begin by using the person’s first name. If the patient is sitting down, you should not stand over them and talk down to them. When you stand up, you assume a dominate posture which makes people feel uncomfortable. Instead, kneel down so you are at the same eye level as the patient and you will immediately put them at ease. Touch is important to memory loss patients. While you’re speaking, hold their hand or put your hand on their arm or shoulder. Be generous with hugs and handshakes. At Tanglewood, the staff is trained repeatedly to maintain a calm and pleasant tone of voice. Memory loss patients have not lost their ability to appreciate tone of voice and if you become upset you will only make a bad situation worse. Some patients will be depressed or mad at the world. With these you should commiserate. Offer compassion, sympathy and condolences. Other patients may be mad at you. They may accuse you of all sorts of atrocities. With these folks you should simply apologize and say you’ll try to do better. You should never get mad. Always remain calm and pleasant. If you do feel yourself becoming upset, walk away. Make sure the patient is safe and walk away. Come back in ten minutes and the patient’s attitude will have changed completely. Ask only simple questions of a memory loss patient - questions which require a yes or no answer. Don’t ask “would you like lemonade or ice tea?” Even such mildly complex questions generate confusion. Ask only yes or no questions. The best chance of having a coherent conversation with a middle or late stage memory loss patient is to talk about events that happened long ago. Such very old memories usually remain intact and the memory loss patient will feel comfortable talking about them. If possible, bring photographs from the patient’s younger days and talk about the people and places in the pictures. Finally, musical memories also remain intact. A patient will remember and enjoy the lyrics and melodies of music they’ve heard throughout their lives and especially music they heard as a child. They will usually enjoy and sing along with hymns and pop music songs they heard in their youth.

Unfortunately, almost all memory loss patients will become incontinent. At first they will have an occasional accident but eventually they will forget when and how to use the bathroom and will need to wear an undergarment all the time. While nothing can prevent this from happening, there are some techniques which can delay incontinence and cut down on the number of accidents. Prompting: Accidents often occur because the memory loss patient simply waited too long before heading for the bathroom. If a caregiver will prompt the patient every two to three hours, by asking if they need to use the bathroom, the number of accidents can be reduced significantly. If the memory loss patient continually says they don’t need to use the bathroom, the caregiver should respond with “let’s give it a try” and help the patient to the bathroom. By the time you get to the bathroom, the memory loss patient may suddenly realize they have to go. An old trick which may help is to sit the patient on the toilet and run water. Bedside Commodes: Many accident happen at night. Often a sleepy resident will have trouble getting to the bathroom in time. Putting a portable commode next to the bed and keeping a night light in the room will help this situation. Washable Protective Pads: An incontinent patient can damage or destroy furniture, mattresses and carpeting. A caregiver may have to remove and wash bed linen every morning. Even the best undergarments are subject to leaks. If you have a loved one in the house who suffers with incontinence, you should cover your furniture with washable protective pads, often called “chuck” pads. Chuck pads should be used to cover furniture and mattresses. Even mattresses with waterproof mattress pads should also have an extra large chuck pad underneath. These pads are now available in a variety of colors to match the furniture. Undergarments: Some undergarments pull up and down like underwear and are useful in the early stages of incontinence when the patient still uses the bathroom by themselves and the undergarment is mainly to protect against accidents. To change this type of undergarment however, the caregiver must remove the patients shoes and pants to put on a new undergarment. This inconvenience can be avoided by using briefs which are secured on the sides with elastic bands and buttons. These can be changed without removing the patient’s pants.

Memory loss in the elderly, whether brought on by Alzheimer’s disease or some other cause, is a progressive condition, becoming worse over time. At some point in the progression of this condition an elderly patient will lose the ability to make rational decisions and someone else, usually an adult child, will have to take over responsibility for making medical and financial decisions on behalf of the memory loss patient. For this change to take place legally, quickly and inexpensively, two important documents must be signed by the elderly patient while they are still competent to make legal decisions. Medical Durable Power of Attorney A Medical Durable Power of Attorney (MDPA) is a legal document appointing someone else to speak for a patient regarding medical decisions, in the event the patient cannot speak for themselves. The document specifically names an individual, plus one or two alternates, to take charge of medical care. The document also allows a patient to specify certain types of treatment they do or do not want in the event the patient cannot speak for themselves and will not recover from their illness. Ideally, this document should be signed long before someone develops memory loss. If an elderly patient is diagnosed with memory loss and does not have a MDPA in place, the patient may still have time to sign a MDPA. Most elderly patients in the very early stages of memory loss, are still quite independent and rational and would still be considered legally competent to sign legal documents. This fact affords the memory loss patient an opportunity to execute and sign a MDPA even after being diagnosed. Once a memory loss diagnosis is made, the elderly patient and their family need to move quickly to have a MDPA executed, before the elderly patient’s competency to sign legal docments become questionable. Memory loss can progress quite rapidly in some patients and dramatic changes in abilities can occur almost overnight. The family of a patient with memory loss will be called upon to make difficult choices regarding medical care. One such choice occurs frequently with late-stage memory loss patients and provides a good example of the importance of an MDPA. Near the end of life, many memory loss patients stop eating. A patient may be hand-fed for a time but eventually the patient stops swallowing and any further attempts at hand-feeding will cause aspiration or choking. At this point the family must decide whether to connect their parent to a feeding tube or allow their loved one to pass away. With an MDPA in place, the family will not have to guess how their parent felt about such a difficult decision. The MDPA will state specifically whether the patient does or does not want such life-prolonging medical care. The MDPA accomplishes many objectives. It makes the transition of responsibility for medical decisions smooth and inexpensive, avoiding the possibility of costly and time-consuming court hearings. It allows the elderly parent to set forth in detail the type of medical treatment they do or do not wish to receive in the event they are terminally ill and cannot speak for themselves. It relieves the adult children of the burden and uncertainty of trying to guess how the parent felt about life-prolonging medical treatment. It allows the patient advocate to execute a Do-Not-Resuscitate Order to make certain the facility caring for their parent follows their parent’s wishes regarding life-prolonging medical treatment. General Durable Power of Attorney Similar to a Medical Durable Power of Attorney, a General Durable Power of Attorney (GDPA) appoints someone to act on behalf of the memory loss patient for financial and property decisions. (If the memory loss patient has a trust, the language of the trust may have the same effect as the GDPA, giving authority to a successor trustee to handle financial affairs when the memory loss patient can no longer handle such matters.) Without a GDPA (or the equivalent language in a trust,) a court hearing will be required to appoint and empower a conservator who will handle financial and property affairs for the memory loss patient. Such court hearings can be expensive. Both the Medical Durable Power of Attorney and the General Durable Power of Attorney are critical legal documents. They give effect to the wishes of the people involved and they avoid the expense and uncertainty of probate court oversight.