Has your elderly loved one been diagnosed with a form of dementia? Are you now evaluating your care options? If so, it’s important to start creating a dementia care plan.
The sooner your loved one’s symptoms and level of functionality can be evaluated and addressed, the better for them, and for you. Creating a dementia care plan will help you and your family understand the diagnosis and prepare a course of action.
Think of a dementia plan of care as a snapshot of your loved one’s current situation, focused on their needs and the best ways to keep them safe, healthy, and happy. Of course, as time goes by, their needs and desires will change. Your loved one’s dementia care plan goals and interventions will have to be periodically reviewed and updated.
A care plan for your loved one with dementia evaluates their long-term care needs and preferences, as well as the needs and wishes of family caregivers. Taken altogether, this information helps all involved parties stay focused on the important tasks that require attention. It will be a crucial document that is updated through all seven stages of dementia.
Dementia Care Needs Assessment
To create an effective dementia care plan, you must first identify the type of memory loss or dementia. You will also need to assess the impact it is having on everyday life. A dementia care needs assessment should consist of five key components, including:
- Medical needs
- Functional needs
- Emotional and psychological needs
- Social impact
- Family impact
If your loved one is exhibiting signs of dementia, your first step should be a visit with their primary care physician. The doctor needs to rule out any biological or environmental factors that may be causing dementia or memory loss. For example, repeated head trauma, drug abuse, excessive alcohol use, severe vitamin deficiencies, or thyroid imbalances may all be contributing factors. A simple blood test can help determine what is causing memory loss, and in some cases, the symptoms may be able to be reversed with the proper interventions.
The primary care physician may refer your loved one to a specialist, such as a geriatrician, neurologist, or psychiatrist. These doctors have specific experience with the aging process and/or the brain and can help determine the most accurate diagnosis for what your loved one is experiencing. The medical findings of these specialists will allow the dementia care plan to be tailored to a specific diagnosis such as Alzheimer’s, Parkinson’s, Lewy Body, frontal lobe, or vascular dementia.
The next step is to hire a geriatric care manager who will take over the dementia care needs assessment phase and write a care plan. A geriatric care manager is a nurse, social worker, gerontologist, or mental health expert who has experience assessing care needs, advocating for quality of life, and working with involved family members. During your loved one’s initial visit with the geriatric care manager, it may be helpful to have one or two involved family members present.
After the medical evaluation, a geriatric care manager will visit your loved one’s home to explore how dementia is affecting their ability to complete functional tasks. Since dementia affects brain function, your loved one’s motor skills and information processing may be impacted. Often, that means they may not be able to manage as independently as they used to.
Emotional and Psychological Needs
Changes in your loved one’s cognitive abilities may cause a variety of different emotional responses, including frustration, anger, grief, and depression. A geriatric care manager helps to evaluate your loved one’s emotional and psychological needs so that a comprehensive dementia plan of care can be developed.
Evaluating the emotional and psychological needs that accompany a change in cognition can be very complex. For instance, your loved one’s dementia may cause depression and anxiety—two mental health conditions that are known to affect concentration, social engagement, and information processing. If the depression and anxiety are effectively diagnosed and treated, your loved one may be able to function better.
To gauge social impact, a geriatric care manager will ask how your loved one’s dementia is affecting their social interactions, such as:
- Do they spend most of their time at home?
- Do their friends and neighbors visit as often as they used to?
- Is your loved one still an active participant in family events?
Many people with dementia are at risk for social isolation, and social isolation, in turn, can exacerbate dementia symptoms. Caring for someone with dementia at home often involves adapting social activities and outings to make them more accessible. Adaptation can help your loved one reconnect to the people and activities that bring them joy.
Caring for dementia can be tremendously challenging for family members. That’s why a geriatric care manager evaluates the wishes of the family system, as well. Involved family members need care, too. Family caregivers should be especially vigilant about self-care, such as eating properly, taking medications as prescribed, and maintaining social outlets. If you are feeling overwhelmed or stressed, it’s important to seek occasional respite care. Respite care provides a break, or period of relief, for the principal caregiver.
Symptoms that Impact the Dementia Care Plan
After the baseline evaluation phase is complete, a comprehensive dementia care plan is written by the geriatric care manager. The goal of a care plan for dementia is to lay out a roadmap that will help your loved one stay as healthy and remain as independent as possible. As their behaviors, needs, or placements change, the dementia care plan must be updated accordingly and it may be time to consider in-home senior care.
A dementia care plan must include a list of risks and concerns for which must be properly cared. The most common issues facing a person suffering from dementia include:
- Ability to function independently
- Language aphasia
- Incessant repetition
- Inconsistent abilities
- Sleep disturbance
- People recognition
- Anxiety and depression
- Poor nutrition
- Aggressive behavior
- Home safety
Let’s take a look at each risk or concern.
Ability to Function Independently
Something that may seem a simple task to you could be a huge hurdle for your loved one with dementia. For instance, take putting on a cardigan. There are many steps that have to happen in sequence. Going to the closet, identifying a sweater, taking it off the hanger, putting the first arm through the armhole, swinging the sweater around to allow access for the second arm, buttoning up…you get the point.
It’s no surprise that many dementia patients need assistance with activities of daily living (ADLs). ADLs are the six fundamental self-care activities required to lead a normal, independent life. The list includes eating, bathing and hygiene, dressing, grooming, transferring and mobility, and toileting and continence.
The instrumental activities of daily living (IADLs) are more complex than ADLs. Although they’re not essential for survival, IADLs are vital for older adults who want to live independently at home. The six IADLs consist of communicating, managing medications, transportation, shopping and preparing meals, keeping up with housework, and managing personal finances.
ADLs and IADLs are the cornerstones of any personal care plan for elderly adults. A geriatric care manager will use ADL and IADL checklists and tools to measure how much assistance your loved one needs to live independently at home.
If your loved one has been diagnosed with “aphasia,” it means they have an impairment of language that affects the production or comprehension of speech and the ability to read or write. You may have noticed that your loved one has difficulty with word retrieval, slurs words, uses made-up or jumbled words, repeats one word over and over again, or remains totally silent.
Sometimes family caregivers assume that if their loved one is struggling with communication going “out” (expressive aphasia), then they also must be struggling with communication going “in” (receptive aphasia). This is not necessarily the case. Understanding dementia involves realizing that just because someone cannot communicate outwardly does not mean they cannot understand what is being said to them.
As your loved one’s dementia progresses, there may be changes in how they process language. For example, at first, they may be able to understand verbal comments, but over time, you may need to try communicating using written cues, gestures, and even hand-on-hand demonstrations.
Many people with dementia are prone to wandering. For some, wandering may represent an opportunity to be physically active, and an open door or gate may seem like an invitation to go for a walk beyond their residence. For others, it may be a form of escape from an environment that feels unsafe or unfamiliar. The danger, of course, is that once a person with dementia has wandered away, they may not be able to find their way back home.
Fortunately, there are a variety of dementia care plan interventions, ranging from installing bells on doors to embedding GPS systems in shoes, that can help mitigate the risks of wandering.
Safe driving involves many of the same skills that are impaired by dementia. For example, dementia affects the occipital lobe, which is responsible for depth perception and processing of visual cues. Dementia can also affect motor skills, response times, judgment, orientation, and other factors that are critical to driving well. A care plan for a dementia patient almost always suggests prohibiting driving.
Memory is a three-part process:
- Receiving information/data
- Storing that information correctly
- Retrieving the information at a future time
If your loved one asks the same question over and over again, they are probably having a difficult time receiving your answer, and because of that, the information never gets stored properly. Literally seconds later, they may have no recollection that you answered their question. And so, they ask again… and again. This is one of the reasons for caring for someone with dementia at home requires tremendous patience and compassion.
People with dementia may have different abilities (or disabilities) from one day to the next. For example, on Monday, your loved one may have a conversation with you about what’s happening in the news and be able to tie their shoes with ease. On Tuesday, they may be unable to do either one.
As frustrating as these inconsistencies may be, it’s important to understand that your loved one can’t control them; they’re a symptom of dementia. Some dementia care specialists explain inconsistent abilities using the analogy of faulty wiring. When wiring is damaged, sometimes the connections work, and other times, they don’t.
Many people with dementia experience disorientation with time. In other words, their internal clocks get mixed up, and they no longer follow traditional patterns of sleep and wakefulness. If this is happening with your loved one, it may not be a big problem for them, but it could be quite problematic for you. Caring for people with dementia is demanding, and when you don’t get adequate sleep, the challenges become even more difficult.
Sleep issues require thoughtful dementia care plan interventions that may include the use of medications and or behavioral approaches to help your loved one get back on a more traditional sleep and wake pattern.
It’s not unusual for a person suffering from dementia to not recognize people, even family members. This can be very difficult for family caregivers, particularly when the caregiver is a spouse or child.
When you care for someone who is cognitively intact, even though the physical strains may be difficult, that person is an active care partner, someone with whom you can talk, commiserate, get direction, and at times, receive acknowledgment and recognition that they appreciate what you do, and who you are. Caring for someone with dementia can be considerably more challenging. If your loved one’s dementia has progressed to the point where they no longer recognize you as an important person in their lives, you may be experiencing intense feelings of loss, grief, and even resentment.
Incontinence of the bladder or bowel can occur in the later stages of dementia. Not surprisingly, incontinence often impacts someone’s desire and ability to leave their house which can lead to social isolation. Incontinence is frequently the reason that family caregivers seek out dementia home care or placement in a community that can provide this level of support for their loved one.
Anxiety and Depression
Anxiety disorders affect 10-20% of older Americans and about the same percentage (18%) are affected by depression. Among those experiencing memory loss and other changes related to dementia, the prevalence of anxiety and depression may be even higher. A proper assessment can help determine the anxiety or depression and should be taken into account when writing a care plan.
Dementia often affects the frontal lobe of the brain, which is the region responsible for impulse control and judgment. As a result, your loved one may have difficulty curbing their desire to eat foods that give them a sense of comfort, or conversely, their appetite could be suppressed to the point that they experience weight loss. Caring for someone with dementia at home involves making sure they have regular, nutritious meals.
Dementia that affects the frontal lobe, such as Lewy Body Dementia and Fronto-Temporal Dementia, cause feelings of frustration that can manifest as agitation, aggression, or even combative behavior. If these behaviors happen frequently, a care plan for a patient with dementia should suggest the appropriate interventions.
There are certain areas of the home that may put your loved one at significant dementia risk for injury. Common interventions typically include:
- Putting timers on stoves and ovens so they can’t be left on
- Adding grab bars in bathrooms for help with toileting and showering
- Installing wander guard devices to address elopement risk
- Adding bells on doors so the caregiver knows when a door opens
- Decluttering and removing throw rugs to mitigate the risk of falls
- Removal of poisonous household cleaners that could be ingested
- Removal and disarming of firearms
Interventions that Impact the Dementia Care Plan
Unfortunately, you loved one suffering from dementia is bound to go through the different stages. Working with a geriatric care manager, you can quickly identify the setbacks and adjust the plan accordingly. The most common interventions to look for, that could impact the dementia care plan, include:
- Sudden memory loss
- Challenges with planning or problem solving
- A difficulty with completing familiar tasks
- Confusion with time, place, or person
- Trouble understanding visual images and spatial relationships
- New problems with words when speaking or writing
- Misplacing things and losing the ability to retrace steps
- Decreased or poor judgment
- Withdrawal from work or social activities
- Changes in mood or personality
As apparent, a dementia care plan includes much more than simply planning out the daily activities. Make sure that you utilize the expertise of your family practice physician, medical specialists, and a professional geriatric care manager to help you along your journey to care for a loved one. You both deserve the best.