Seven Strategies for Flexibility in Caregiving

I can guarantee that many family members and friends tasked with caring for a dementia patient would agree that “how-to” caregiving tips featured in current articles are purely theoretical. The nature of abstract words prevents you from feeling what it’s like, unless, of course, you are actually providing full-time care for a disabled person. The description alone can’t convey the soul-withering reality of 24-hour day-to-day care for those with cognitive diseases. When combined with the anguish of witnessing someone you care about with Alzheimer’s move inexorably toward death you can imagine the awful toll it exacts. Reading about, and experiencing caregiving are vastly different; just ask anyone who’s doing it. If I read that “Care provision for persons with dementia can be rewarding…,” I’ll lose it.

We know that one of the biggest challenges for care recipients is bedtime preparation and patient needs that awaken you in the night. You’ve already had a tough day, so now you need shortcuts that make your job easier. The NIH (The National Institute of Health) reports that “…caregivers’ greater nighttime awakenings were associated with caring for care recipients with higher fall risk, as well as caregiver characteristics of more chronic medical conditions and emotional difficulty of the care role.

Night duty can be particularly onerous, so depending upon the stage of the patient’s dementia, e.g. ambulatory, bedridden, etc. you want to make these activities as safe for the patient, and quick and efficient as possible so you can get back to sleep:

1. Set up a counter or simple shelves near the bathroom door that should contain everything you need for your patient’s nocturnal bathroom visits. Stack diapers, vinyl gloves, bed pads, paper towels, and toilet paper rolls, wipes, change of clothing in case of accidents, and plastic garbage bags for wet diapers.
2. Dress your patient in mid-calf or ankle-length nightshirts instead of pajamas – it makes diaper changing easier.
3. Install motion-sensor lights along the route from bed to bathroom.
4. Place unobtrusive nightlights in key bedroom areas, including the bathroom.
5. Remember to take your patient to the bathroom before bedtime.
6. Make sure that the patient is properly hydrated during the day so that you can restrict beverages two hours before bed.
7. Avoid turning on the bathroom lights if possible, ideally by using blue-light-free night lights (not your phone).

One of the most disconcerting mood changes in a patient is “sundowning syndrome,” a phenomenon that occurs in the late afternoon or when the sun goes down. Symptoms include insomnia, anxiety, agitation, pacing, hallucinations, paranoia, and confusion. Overstimulation, caused by caffeinated drinks, or depressants such as alcohol can trigger it. Ensure that the environment is relaxing and soothing. Soft light and music are helpful in preventing or mitigating the condition.

Chill and be kind to yourself, particularly if your patient becomes argumentative or resistant to bathing, dressing, or any other chore. For example, forget the bath — do it another time; dementia patients are sometimes afraid of water, so a gentle shower might be calming; if your patient refuses to wear one outfit, offer another even if he or she wears it every day for a week; in that case, try purchasing a similar one.

While it’s helpful to establish a schedule for caregiving tasks, shake things up once in a while. Rigid schedules can be dispiriting and cause you to lose enthusiasm and sometimes hope. If you need a break from the monotony, without sacrificing the safety and comfort of your patient, rearrange the schedule. In doing so, sometimes you discover more efficient ways to complete chores.

We want to hear from you, so feel free to share tips, ideas, and resources for seniors and caregivers with Grannybooster. Email me, Maris Somerville, at info@grannybooster.com