IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.

Prevention
Job Descriptions, Protocol and Care Plan Notes for Documentation
Your Professional Caregiver Responsibilities
On-Time Arrival: Always arrive on time or a few minutes early for your caregiver job. Call the

caregiver job supervisor immediately if you are running late.

Always Call the Senior Client by Their Last Name: Use the more formal, such as "Mrs. Smith,"

unless the client tells you it is acceptable to call them by their first name.

Get Acquainted: This is your first task. Make the senior feel comfortable and relaxed. Thank them

for allowing you to work with them and let them know you are glad to have the opportunity to be

their caregiver. Ask them to tell you about themselves and their preferences. Share some of your own

interests.

Review the Care Plan: This is your reference tool and where you will document the care in a Care

Plan documentation log. Make sure you discuss with the senior client where to keep it. Be sure to

refer to it each day and to record Care Plan Notes.

Discuss the Senior’s Meals and Favorite Foods: Begin to understand the dietary requirements of

your senior client and learn their nutrition guidelines.

Never Touch Pills or Medication: This includes non-prescription drugs.

Do Not Give Your Friends or Family the Senior Client’s Phone Number: If your family has an

emergency or needs to reach you at work, have them call the senior care company office and they

will contact you.

Cell Phone: Do not receive or make calls from your cell phone while at work. Your cellular mobile

phone should be turned off and out of sight unless told differently by your agency.

Do not Solicit Money at Any Time for Any Reason: Do not ask senior clients or family members

for money. Any senior shopping needs will be managed by a Care Manager or Supervisor.

Never Come to Work Under the Influence of Alcohol or Drugs: Random drug tests can be

conducted at any time.

Professional Caregiver Protocol

The word "professionalism" means good judgment, skills, and polite behavior that is expected from a

person who is trained to do a job well.

As a professional caregiver, you will want to conduct yourself with good manners and take

responsibility for delivering quality care, no matter if you are experiencing a good or bad day in your

personal life. You will set a tone of integrity by always showing up on time, dressing appropriately,

and communicating effectively with your clients, coworkers, and managers.

Professional caregivers demonstrate:

 Solid Work Ethic

  Appropriate Personal Appearance

 Self-Confidence

 Ability to Communicate and Listen

 Ability to Maintain Composure in Difficult Situations

 Compatibility with All Personality Types

 Focus on Getting the Job Done

Always be professional with your clients, co-workers, and managers.

Caregiver Job Description

As a professional caregiver, you will be given specific job duties and a routine to follow for each

client. As each client's care schedule, medical conditions, and needs may vary, you will be provided

with a Plan of Care for each client.

Follow the outlined Job Description in order to deliver quality care.

Your daily care plan for each senior care client will be customized.
 Assist with walking and light exercise

 Plan and prepare meals, followed by clean-up

 Monitor food expiration dates, plan future meals

 Make beds and change linens as needed

 Light housekeeping to include dusting and vacuuming

 Assist with bathing, dressing, and grooming

 Laundry and ironing

 Take out garbage

 Run errands (pick up prescriptions, dry cleaning, grocery shopping)

 Engage in physical and mental exercises

 Provide medication reminders (monitor medication)

 Escort on appointments with necessary updates (physical therapy, hair salon)

 Escort to religious services or events

 Maintain calendar and organize mail

 Engage in activities (games, memory books)

 Companionship

 Record daily care notes

 Report any significant client changes to the Senior Care Company office
Hourly Caregivers: Report to work at the client's home, assisted living community, or senior care

center and work for the scheduled hours of service. Receive hourly pay for the number of hours

worked.

24-Hour Caregivers: Term used for caregivers who may report to work at senior client’s home and

stay over-night with the senior for one or more nights, taking a break for down-time in the evening

and sleeping at night. Meals are usually provided by the client along with the costs of any shared

activities with the senior. Sometimes seniors receiving end-of-life care will progress to needing

active caregiving around-the-clock which will require a rotation of a day and night caregiver.

Medication Monitoring: Senior caregivers must take extra care to monitor the senior’s medications

according to the Care Plan. Medication reminders are an important part of senior care. When a

variety of medications are prescribed, taking the medications at the scheduled time and in the proper

manner is very important in order for the medication to have the proper results. Example:

medications may be prescribed to be taken with food or on an empty stomach or before bedtime.

Medication monitoring simply means following a medication schedule. Caregivers do NOT

administer medications as only a medical doctor may prescribe medications and authorize a

registered nurse to administer doses in some cases. Caregivers will document in the Care Plan the

medications taken and the time the medications were taken and also record any side effects they

may notice when a new medication begins.

Medication Problems: Sometimes seniors who have memory loss or other issues may refuse to take

their medicine as prescribed. Call your Care Manager for advice and guidance on how to handle the

situation. An experienced Care Manager can provide coaching on how to best convince the senior to

take their medication as prescribed. Sometimes doctors will prescribe medication in a liquid form or

change the dose if the senior has an adversity to taking a pill.

Observing, reporting, and documenting client status and the service furnished, including changes in

functional ability and mental status demonstrated by the client are presented in this section.

The Care Plan

A care plan helps manage your clients’ day to day. The care plan may be kept on paper or digitally

entered on a tablet or other mobile device.

Historically care plans were in paper formats, however more and more care plans are digital.
The HITECH Act of 2009 incentivized adoption of electronic health records and paved the way for

digitally recording care plans into Electronic Health Record Systems.

This means care plan notes will often be available to the clients’ care teams and families.

In January 2015, CMS transitioned Medicare to a more quality-based practice of reimbursing for care

management of eligible patients with 2 or more chronic conditions.

Why?

Medicare and all medical plans want to reduce hospital readmissions. Electronic linking of medical

records makes sure “everyone is on the same page” so to speak. Clear communication can mean

better care for the patient.

The care team is everyone who manages or provides care, including caregivers. It can also

include medical physicians, therapists, nurses, social workers, and others.

Currently, Care Plan content is not the same across every company or health care provider. You will

learn your company’s care plan procedures and their requirements for the digital care plan or written

care plan.

Care Plans are expected to evolve and contain more evidence-based content, in other words,

information about the disease(s) the person has and activities that should be done to help the person.

Topic Segmentation

Typically you will see topics arranged in separate sections, like this:

Nutrition

A nutrition plan must recognize the current problems in eating habits and consider chronic

conditions/symptoms, food preparation, and dietary restrictions of the individual.

Physical Activity
Regular physical activity is especially important for those with conditions like diabetes, high blood

pressure, or high cholesterol. Exercising regularly can lower blood glucose, blood pressure, and

cholesterol levels, and even reduce stress.

Patient Summary

Summarized history includes basic information such as demographics (name, age, contact info,

ethnic or religious beliefs), health metrics (weight, blood pressure, etc), allergies, or medications and

therapies. It can also contain past health history such as past hospitalizations.

Goals

Goals are used to measure progress. They give a care plan direction and are the first indicator of what

path a patient is taking to manage their health concerns. Care plans are typically made up of a few

high level goals that consist of many smaller short-term goals.

Health Concerns

These are the current problems in health. Identification of these concerns can involve reviewing

symptoms, general health behaviors, and any social or environmental factors on health. Collection of

vitals might also be involved in the identification of health concerns.

Documenting Client Care

Maintaining accurate client care notes assists families, medical doctors, care managers, and other

caregivers to stay current with the client’s status and enables higher quality care.

Senior caregivers working as companion caregivers, certified nursing aides, certified home health

aides, and personal care assistants are responsible for reporting and documenting information about

the client receiving care.

Client Care Documentation Components

  Care Plan Outlining Care Routine

 Care Plan Daily Note Sheet or Chart for Recording Daily Activities

 Confidentiality of Information

 Caregiver Duties and Performance Review

Names for Care Reporting and Documentation Include

 Care Plan Notes

 Clinical Record

 Patient Chart

 Medical Record

Legal Issues for Documentation

Quality care plan notes for each client care shift assist with the following legal protections:

1. Protects the caregiver by confirming the duties that took place.

2. Protects the senior care company by confirming the care duties were performed.
3. Confirms specific care items were performed at specific times, such as: "Turned the
client every 2 hours to prevent bedsores" or "Monitored medication, fluids, bathroom
visits." By confirming the care services took place as instructed, the caregiver is
protected should anything out of the ordinary occur.

Subjective vs. Objective Notes

Remember that everyone involved in the senior’s care will be reviewing the Care Plan Notes.

Care Plan Notes MUST BE OBJECTIVE

 Objective Notes are Facts

 Subjective Notes are Opinions
Do:

 Use EXACT quotes from the client when they are communicating pain or discomfort

 Only use abbreviations which are standard

 Use correct spelling

 Be specific

 Record important telephone calls

 Note activities throughout the day as they occur

 Note meals eaten

 Confirm medications taken

 Write neatly and legibly

 Proof your written documentation notes

Do Not:

 Share your opinions

  Wait until later to make notes about care events

 Share notes about your own personal incidents

 Wait until the end of your shift to record all activities

Important Items Often Monitored in Care Plans Are:

1. Meals
2. Hydration (fluids drank)
3. Bathroom visits
4. Sleep
5. Activities
6. Changes in mental awareness
7. Changes in physical condition and abilities

Most Senior Care Companies will have a Daily Care Notes form which you can fill out each day and

will include these types of items:

Sample Daily Care Notes

Health & Hygiene

 Transfer from Bed to Chair

 Bathroom Visit

 Catheter Care/Diaper Change

 Shower/Bed Bath

 Dressing Assistance

 Haircare

 Skin Care/Lotion

 Dental Care

 Medication Reminder

 Exercise Routine
Nutrition

 Grocery Shopping/Meal Plan

 Meal Preparation

 Set-Up Meal

 Assisted with Feeding

 Feeding Tube Care

 Breakfast

 Lunch

 Dinner

 Snack

 Fluid Monitoring: Drank __ Glasses of Water

Activities
  Physical Therapy AM/Walk

 Physical Therapy PM/Walk

 Read Newspaper or Book

 Mental Exercise Game

 Other Activities:______

Client Routine/Vitals

 Wake-up Time:_____

 Nap A.M.____

 Nap P.M.____

 Bed Time:_____

 Bathroom Visits:_____

 Weighed Client____lbs.

 Doctor Appointments:___

 Indicate Client Status: Good, Fair, Poor

Household Cleaning

 Changed Bed Linens

 Laundry

 Sorted Mail

 Cleaned Kitchen
  Cleaned Bathroom

 Swept Floors

 Mopped Floors

 Dusted Rooms:_______

 Vacuumed Rooms:____

 Errands:____________

 Pet Care: ___________

 Other:______________

Watch Video on Ideas for Activities with Seniors with Alzheimer's Disease and Memory Loss:

5 Minutes, 32 Seconds

Legal Issues
Poor Care Plan documentation could make it look like a caregiver is giving poor care or indicate

neglect. Caregivers must be sure to provide solid care notes each day.

 Long-term Care Insurance Companies: Care Plan Notes may be required in order for the
insurance to pay the claim. This is why it is very important to maintain professional notes
daily and correctly document daily care activities.
  Medication Reminder Charts: Medication monitoring is not the same as medication
administration. Caregivers only “monitor” the medications to be sure the person receiving
care took the medications as authorized in their medication chart.
 Incident Reports: If a work injury occurs, such as a fall or damage of property (you dropped
a vase and it breaks,) this is separate from the Plan of Care. Call your supervisor and follow
your company system for incident reports.
 Care Plan Safety: Protect both yourself as the Caregiver and the Care Client by
IMMEDIATELY REPORTING any significant changes in health conditions, safety
concerns, or new developments. If Elder Abuse by a family member or friend seems apparent
when you arrive for a care shift, act immediately by calling your Senior Care Company
Manager and documenting what you observe.
 Observe: We have two ears and one mouth so we can listen twice as much as we talk.
Observe with all of your senses—listen, smell, and touch to observe changes in condition.
 Quality of Care Plan Information: Remember that a long-term care insurance company,
family members, doctors, nurses, and in some cases, an attorney acting as a legal guardian
may be reading the Care Plan Notes. Keep them professional and be sure to proof them at the
end of your work shift.

Tip Sheet
Arrive 5 Minutes Early, Never Touch Pills, Never Solicit Money, Get Acquainted, Turn Cell Phone

Off, Never Come To Work Hungover, Job Description Duties, Hourly Caregivers Receive Hourly

Pay, Live-in Caregivers Receive Daily Stipend, Live-in Caregivers Do NOT Move-in Permanently

with the Senior, Monitor Medications, Do NOT Administer Medications

A Care Plan Might Be on Paper or in an Electronic Format, Make Objective Observations, Document

Care Services Daily, Understand Objective vs. Subjective Notes, Medication Monitoring is Just That

—a Reminder to Take a Medicine as Scheduled, Protect Yourself and Your Care Company and

Document Care Provided

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.
Prevention
HIPAA : Confidentiality of Client Info, HITECH Act, and Scenarios
Confidentiality of Client Personal, Financial, and Health
Information
HIPAA stands for:
Health

Insurance

Portability and

Accountability

Act

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) sets guidelines for

health care organizations to maintain client confidentiality and privacy of medical records.

HIPAA provides many details for medical doctor offices and hospitals to follow, even mandating that

a computer screen cannot be in a high-traffic area where someone might walk by and see patient

information.

Protect Client Information Always

Watch Video on Security and Accessing Public Wifi: 4 Minutes and 20 Seconds

The Privacy Rule was added on December 28, 2000.

These rules provide federal protections for patient health information and give patients rights for who

can see their information and how it can be used.

Confidentiality means: the state of keeping a secret or maintaining trust and confidence of secrets

and private affairs.

What Caregivers Need to Know About HIPAA

Clients receiving senior care services may have medical records and medical instructions from their

doctor, including medications. This information remains private to the caregiver—meaning you are

not allowed to share this information with people other than those involved in the care of your client.

Personal Information: PHI = Protected Health Information

As senior care involves staying with a senior in their home, it will be natural to hear personal

information about the senior’s family and friends. Maintain confidentiality of any information you

hear or which the senior may share with you.

Just as when you work for any company, the company information remains confidential, so does

your senior’s personal information remains confidential.

Example: You find out that your client has a terminal illness. The client's niece comes to visit: you

cannot mention the fact that the client is terminal.

Financial Information

Money matters of a client should remain confidential. Remember that seniors can become especially

sensitive about money issues. This is because most seniors are no longer earning income but rather

living on a fixed income. Be mindful that they may have many emotional issues surrounding money.

Do not discuss your financial issues with a client and simply change the subject if a senior you are

caring for begins discussing finances with you.

 Do not share a senior care client’s information with others

 Verify the identity of doctors, pharmacists, or any other providers who may call and refer
them to the Care Manager

 DO NOT get involved in information transfers to a medical professional in order to protect

yourself

 Never exchange money with a senior client in order to protect both yourself and the client

 Personal information about your senior client remains confidential to you

ALL MEDICAL INFORMATION SHOULD BE COMMUNICATED BY A SENIOR CARE

MANAGER

(Or the person with Power of Attorney for Healthcare)

HIPAA Protects Individually Identifiable Health Information
Information about health care or payment for health care is protected, such as:

 Why a person is visiting the clinic or center

 The type of treatment a person is receiving

 The fact that a person is receiving Medicaid (for low-income consumers)

Information that Identifies the person or Could Possibly Identify the Person

Examples of such information include your client or care recipient's name, address, social security

number, medical record number, or photograph.

PHI (Protected Health Information) is all individually identifiable health information in any

form:
1. Paper
2. Verbal
3. Electronic
Exceptions:

 Employment records (including employees’ medical information).

 Certain education records.

Protected Health Information can be stored:

1. On paper
2. In files
3. On computers
4. On electronic devices
5. On cell phones
6. On tablets

And also be the knowledge remembered by a caregiver

You are allowed access to the minimum amount of Protected Health Information necessary for you

to perform your job duties.

You may only disclose the minimum amount of Protected Health Information necessary to satisfy

a request and only request the minimum amount you need to perform your job duties.

The minimum necessary rule does not apply to:

 Disclosures to, or requests by a health care provider for treatment

 Uses or disclosures made to the client or participant

 Uses or disclosures that the client authorized

 Disclosure made to the Secretary of HHS

 Disclosures required by law.

Verification Requirements
Make sure you know the identity of anyone requesting information. Verify the person's identity and

authority for access. Document the request which means write down the person's name, phone

number, and the time of the call or visit to show you verified the information.

Rules for Permission to Use or Disclose Protected Health Information and TPO:

Treatment, Payment, Operations

 Authorization is not needed before you disclose your care recipient's Protected Health
Information, or "PHI" for treatment, payment, or health care operations
 TPO = Treatment, Payment, Operations (for Health Care) such as quality assessments,
medical reviews and auditing, planning, and budgeting

 For Abuse Reports and Investigations

Generally, however, you do need specific, written authorization from your client or care recipient

before you can use or disclose his or her Protected Health Information for anything other than

TREATMENT, PAYMENT, OPERATIONS (unless specifically permitted by the Privacy Rule).

Situations which could lead to violations of confidentiality are:

1. Discussing work with family and friends
2. Informal discussions with colleagues
3. Social gatherings
4. Incoming phone calls
5. Attentive repairman
FAILURE to COMPLY with HIPAA is a Violation of Federal Law: You
Could be FINED or JAILED if you break this law.

If you hear someone who is in violation of HIPAA requirements and procedures, tell your manager

or supervisor about the situation, as it is your duty to make sure the law is being upheld. Employers

are bound by law to protect a workforce member from harassment or retaliatory actions if they report

a suspected privacy violation.

Law Enforcement Officers: You are allowed to disclose PHI to law enforcement without the

client/participant's authorization when:

1. The PHI disclosed is about the person suspected of a criminal act
2. The PHI disclosed is limited to information relevant to identifying the suspect and
nature of any injury

ASK YOUR SUPERVISOR: if you are ever unsure of how to proceed in a situation involving

sharing private health information.

NEVER DISCUSS PHI you see or hear while performing your job with anyone unless

necessary!

Watch Video from the U.S. Dept of Health and Human Services on HIPAA: 1 Minute, 55

Seconds

Who Must Follow HIPAA & What is HIPAA?

The HIPAA law applies to BAs and CEs.

A BA is defined as a Business Associate meaning anyone who performs or assists in doing an

activity that includes access to health info.

A CE is defined as a Covered Entity

Who are Covered Entities under HIPAA?

1. CAREGIVERS
2. Healthcare Clearinghouses
3. Healthcare Providers who electronically transmit any health information in
connection with transactions for which Health and Human Services has adopted
standards such as hospitals, medical centers, senior home care agencies, doctors,
nurses
4. Health Plans

Caregivers Must Protect All Client Information

Example 1: As a caregiver, you go with your client "Mary" to the doctor. You learn that Mary's

diabetes is out of control, her circulation has worsened and she needs to see a specialist about

possible amputation. You return to her home and her daughter stops by, her daughter does not have a

healthcare power of attorney. Mary does not mention the diagnosis and tells her daughter that the

visit went well and her health is good. Even though you would like to tell her daughter about the

diagnosis, you cannot. Mary has decided not to tell her daughter and it is not your right to pass on the

information. You may be familiar with an attorney and client confidentiality when a lawyer cannot

speak to others about your case. This is similar, you are not allowed to speak to others about Mary's

diagnosis.
 1. As you learned in the previous section, this information is called Protected Health
Information or PHI
2. Other things you can't share: information about the individual’s past, present, or
future physical or mental health or condition, and past, present, or future payment for
the provision of health care to the individual

Example 2: You learn that Mary, from Example 1, has Stage 1 Alzheimer's Disease, and you know

the condition will not get better. Mary decides to tell no one. Her neighbor stops by and tells Mary "I

told you we were having bridge today, I don't understand why you aren't ready, you are always

ready." You cannot tell the neighbor that Mary has Stage 1 Alzheimer's disease and that is why she

does not remember that she was to play bridge today.

 A Medical Record, Laboratory Report, or Hospital Bill would be PHI (Protected Health
Information) if they include a patient’s name or other identifying information.
 The Security Rule: sets the standard for security of electronic Protected Health Information,
also known as ePHI.
 The Breach Notification Rule: requires BA's and CE's to tell (notify) when confidential
information has been breached or not secured.

The HITECH Act

was added to HIPAA in 2006.

The Health Information Technology for Economic and Clinical Health Act (HITECH Act or "The

Act") is part of the American Recovery and Reinvestment Act of 2009 (ARRA) and increases the

potential legal liability for non-compliance.

Speeding up the electronic health record (EHR) systems among providers was the motivation for

the act to be created.

What Does This Mean?
1. The government wants all providers to use Electronic Health Records
2. There are security measures in place that must be followed for security
3. There can be a liability for not following the new rules and laws
4. There is more ability for the government to enforce the new rules- meaning
companies can get fined for not following the law

You know what happens when you park in a no-parking area- your car can be towed or you can

receive parking tickets. The same situation happens if a company does not properly safeguard a

patient's information.

A major provider of Home Health was fined $239,000 for not properly safeguarding client

information. Learn more about the case in the next section.

In each section, you will be given multiple scenarios. Write down what you think the answer is and

then check your answers at the end of each section.

Disclosure in Conversation
There are so many ways we can disclose information in normal conversation. It's very important to

think before you speak.

Scenario of Vivian and Rose:

You are at the grocery store and see Vivian. Vivian is a good friend of Rose. Rose is your client and

Vivian knows this, as she often comes over while you are caring for Rose. Vivian asks how Rose's

doctor's appointment went yesterday, as she knows you go to Rose's appointments.

1. You respond that it didn't go very well, Rose's blood pressure was high and her
blood sugar was not controlled. You also mention for her not to tell Rose you gave
her any information.
2. You politely tell Vivian you really appreciate her concern. Then politely tell Vivian that
HIPAA rules require you to keep all information private.
3. Ignore her comment and walk away.

Answer for the Vivian/Rose Scenario is 2)

Scenario in a Coffee Shop:

You meet a coworker for coffee in a busy coffee shop and both begin talking about your clients. You

use the person's first name only, but also talk about the drive to the client's home, the neighborhood

and then tell your friend about the client's heavy use of alcohol and failure to pay medical bills. The

conversation continues and at the next table, one person has been sitting within earshot for the entire

conversation.

1. None of the information is identifiable, so it doesn't matter.

2. Since the first name was used, street location and other information, it could be
identified and considered a HIPAA violation.
3. Talking to your coworker also violates HIPAA, as she does not care for your client
and does not have access to her health information

Reporting to your agency-client information and changes in health is not considered a HIPAA

violation, as anyone that requires access to the information to perform care is bound by the same

HIPAA standards.

Answer for the Coffee Shop Scenario is: 2) and 3)

----------------------------------

Talking to your co-worker who does not work with your client is a violation of HIPAA.

Talking to your family or friends about a client in a way they can figure out who the client is—

or if you only have one client and they automatically know who it is, also violates HIPAA.

Did you know it's even a HIPAA violation for a person in a hospital to "look someone up" in the

computer when not needed for their work?

Example: If you have a friend who works as an ER nurse and she tells you that she saw 25

cases of people with the flu during her last shift, that would not be a violation of HIPAA. She

did not give any information to identify a person or violate HIPAA.

Likewise, if you say it's common to see depression in your senior clients, then you aren't giving

any specifics on a client and you are not discussing any personal identifiable protected health

information.
Failure to Physically Secure Information:
Did you know some of the biggest healthcare data breaches were caused by a lost or stolen device?

If your agency still uses paper for Care Notes you should remember that even lost care notes are also

a HIPAA breach.

Real-Life Case:

A Home Health Aide had copies of patient records in her home. When she moved out after a divorce

she did not take the documents with her. Her ex-husband had full access to the records. She also

sometimes stored paper documents in her car. The agency claimed the documents were taken from

their office without their knowledge. It did not matter because the agency was fined $250,000

because they failed to protect PHI (protected health information).

When your company follows strict security procedures for client information, know they are required

to under HIPAA.

You go to see your client in the morning for a half-day shift, then go to the gym. Your company

gives you a tablet that travels with you to each shift.

1. You figure it is fine to leave the tablet in the car and lock your door
2. You take it with you to your yoga class and leave it in the corner of the room with
your shoes, unattended
3. You take it into the gym and lock it in your locker with your other belongings
In this case, the best option is probably 3, as it is safely locked in your locker with your other

belongings and not in a car which can be hot and damage devices, but also can be broken into.

Watch Video on Securing Private Health Information on Devices: 4 Minutes, 42 Seconds

Using Unsecured Devices:

In the previous section, you learned about the HITECH ACT which is part of HIPAA. Under this act

the way information is stored and transmitted is very strict. Not only are there specific encryption

rules and rules for storage, but even require companies performing EHR (electronic health record)

tasks to have pricey insurance policies in case of a breach.

Text message—NOT SECURE

Using your home computer to send emails about your client to your agency—NOT SECURE

Posting to Social Media- VIOLATION of HIPAA

You are with the client and have a specific question for your manager about their care. You decide to

send a quick text, remind your manager who your client is by name and then ask a care question.

That is a violation of HIPAA. Do NOT TEXT information about your senior care client.
You've been with your client for 3 years and you had a very special day. Your client has late-stage

Alzheimer's, but you were able to enjoy a lovely day at the park. You decide to post a selfie of you

and your client at the park to your Facebook page.

1. It's fine, you didn't put your client's name
2. Your client has late-stage Alzheimer's so is not aware of Facebook or that you
posted, so it doesn't matter
3. Your client's face can still be recognized, so it was a violation of HIPAA

The answer is 3

Posting to Facebook is a violation of HIPAA, in this case, the situation is made worse as the person

cannot give permission due to their late-stage Alzheimer's condition.

Release of Information after Expiration Date

Do you ever wonder why you have to sign forms you previously signed at the doctor's office for

HIPAA? HIPAA authorization forms expire. When your agency takes on a new client, the client or
the person legally able to act on their behalf gives your agency consent to know their health

information. It is illegal to have access to PHI after the expiration date.

Say Rose was supposed to be a client for 6 months but is now on her 2nd year of care.

Your agency must have signed forms that are current or not expired.

What if a client refuses to sign a HIPAA form?

They cannot be denied access to care and the agency/provider must still adhere to HIPAA standards.

They keep a note on file that a client/patient refused to sign.

Caregiver Thoughts to Ponder

Can it be awkward or uneasy to not answer questions when in the home as a caregiver?
Let's say your client's son comes to visit and he asks pointed medical questions.

You know he has not been given access to medical information and does not have the medical power

of attorney.

However difficult the situation may be, you have an obligation to your client and your agency to

keep all PHI private.

Think of ways you can respond:

Jake, I understand you have questions about your father's health, as that is normal for a child.

I know you are concerned about his well being.

Please understand I cannot share the information, as I am bound by HIPAA and it is against

the law for me to give you information.

If you know the client is in good mental health and is able to communicate, encourage Jake to talk to

his father or mention to your client that Jake is requesting information. The client can make the

decision to share the information. If the client is not sharing the information, there is probably a

reason, respect for your client's PHI always comes first.

In some situations, you may feel that you have to watch what you say and do, but remember you are

being paid to be a caregiver and keeping your client's best interests at heart will always help you be a

better caregiver.

Tip Sheet
HIPAA means Privacy of Information Between Healthcare Providers and Clients, Senior Caregivers

Must Keep Client Financial and Personal Info Private, Keep it to Yourself, a BA is defined as a

Business Associate, a CE is defined as a Covered Entity, Privacy Rule protects Any and All Health

Information, Security Rule, Breach Notification Rule, Privacy Rule, HITECH Act Widens Scope of

HIPAA Privacy and Security Protections, Increases Potential Legal Liability for Non-Compliance,

Makes it Easier to Enforce. 

Caregiving is Your Career, Rules of HIPAA Must be Followed, HIPAA Rules are Legal

Requirement for You, Your Agency and Your Client, HIPAA Privacy Protects You and Your

Agency from Possible Fines and Jail Time

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.

Prevention
How to Detect, Report, and Prevent Abuse and Neglect

Behaviors that would constitute abuse or neglect and the legal prohibitions against such behaviors, as

well as knowledge and understanding of abuse and neglect prevention and reporting requirements.

Abuse and Neglect

Elder abuse and neglect are serious problems that occur in our communities and in our senior care

institutions. People are most at risk for abuse and neglect when they are unable to take care of

themselves mentally and physically. This makes children and elders targets for abuse and neglect.
Senior Caregivers need to understand abuse and neglect to protect themselves and the seniors in their

care.

Abuse and Neglect Skills

 Know the Signs of Abuse and Neglect

 Watch for These Signs
 Know how to Appropriately Report Suspected Abuse and Neglect
 Protect Yourself from being Charged with Abuse or Neglect of a Patient

Learn about examples of Elder Abuse and how to report in each state through a phone line for elder

abuse, or contact the local police.

Watch Video on Learning the Signs of Elder Abuse: 6 Minutes, 12 Seconds

Senior Care Abuse Defined

Abuse is any action by a trusted individual that causes physical or emotional harm to the victim.

There are a number of different kinds of abuse including:

 Physical Abuse
 Sexual Abuse
 Emotional Abuse
 Financial Abuse
Neglect Defined

When someone fails to do tasks that are necessary to meet the needs of an elderly person this is

considered neglect. Neglect can happen by a family member or a caregiver who does not provide the

required caregiving services.

There are 3 types of neglect:

1. Passive Neglect: when people don’t mean to do harm. This can happen because of a
lack of knowledge about a situation or medical condition.
2. Active Neglect: when people know the care needs but fail to do what is necessary for
the care of the elderly person.
3. Self-Neglect: proactively choosing to neglect your own personal care needs such as
eating, bathing, and maintaining your home when you are physically capable of
caring for yourself.

Abuse and neglect can happen anywhere, both in the home or in an institutional caregiving setting. In

order to regulate the industry to prevent abuse, nursing home violation reporting systems were

created. Because even in facilities, abuse and neglect can occur. Unfortunately, sexual abuse also

occurs in institutional settings as predators can target these types of communities. All caregivers need

to know how to recognize signs of abuse.

Sometimes neglect happens because caregiving staff is overworked, stressed, or poorly trained. It is

important to understand that even if you are having a difficult day, you must remain professional and

not become verbally abusive to a senior nor neglect a necessary task. Sometimes family members are

exhausted by the rigors of senior care or may be battling their own drug or alcohol challenges which

may expand into elder abuse. Know the signs and take action to protect both the senior and yourself.
If you feel yourself getting stressed, take a breather—step away, take deep breaths, and return when

calm and collected.

Elder Abuse Defined

Elder abuse is harm done to people over the age of 65 by someone in a position of being trusted to

provide care and support.

Adult children and spouses are often abusers, as they are the people who are most trusted. Many

times the senior will not report the abuse because of shame. Sometimes caregiver stress leads to

abuse.

Signs of Abuse:

 Lack of necessary items

 The senior is punished for being incontinent or forgetful

 Family members are abusing drugs or alcohol

 You hear two different stories about how the senior got a bruise or other injury

 A family member refuses to allow you to complete the patient’s care

 Home is not kept up

 Grocery shopping not kept up

 Bills not paid

Physical Abuse

The use of physical force may cause pain, injury, or impairment.

Examples of Physical Abuse include:

 Hitting

 Slapping

 Shoving

 Shaking

 Kicking

 Pinching

 Burning

 Physical restraints

 Forcing food or taking food

 Restricting food or water

 Unprotecting someone in severe weather

 Physical punishment
  Inappropriate sexual contact

Sexual Abuse

Using force for sexual contact with another without consent.

Examples of Sexual Abuse:

 Inappropriate Touching

 Unsolicited Sexual Intercourse

Emotional Abuse

Causing pain and anguish by the use of words and actions (what you say and what you do).

Examples of Emotional Abuse:

 Insults

 Threats

 Intimidation

 Humiliation

 Harassment

 Silent treatment

 Keeping away from friends

  Dishonesty

 Controlling activities

Financial Abuse

Theft or misuse of someone’s money by a trusted individual.

Examples of Financial Abuse:

 Forging checks

 Committing fraud

 Stealing ATM card

 Over-charging for a service

 Cashing someone else’s check

 Keeping someone away from their money

 Forcing a change in a will

 Forcing a transfer of property

 Keeping “the change” after grocery shopping

 Charging for services not needed

 Ordering items on a senior’s credit card

Appropriately Reporting Abuse or Neglect

 1. Keep your suspicions confidential
2. Report the item to your Care Manager
3. Report only the facts
4. Document any specific incidents when you observe them
5. Do not make assumptions

Watch Video on Signs of Elder Abuse and the Importance of Reporting: 1 Minute, 49 Seconds

Remember, you are required by law to report elder abuse and neglect and can even be fined or

punished with jail time if you fail to report the abuse and neglect in most states. Every state in the

U.S.A. maintains a special department of trained experts to investigate elder abuse and these

professionals will effectively manage an abuse or neglect allegation.

Tip Sheet
Report Abuse or Neglect to your Manager, 3 Types of Neglect are Active, Passive, and Self-Neglect,

4 Types of Abuse are Financial, Physical, Emotional, and Sexual

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.

Prevention
Basic Hygiene and Basic Infection Control
Basic Hygiene and Basic Infection Control Practices

Good hygiene for both the caregiver and the care client is essential for maintaining good health.

Preventing infection requires thinking about how to protect the client you are caring for along with

maintaining cleanliness practices throughout your caregiving duties.

Handwashing
Prevent Contamination and Spread of Disease
1. Handwashing is the caregiver’s best friend
2. Handwashing is the single best way to avoid infection with contagious diseases
3. Handwashing prevents germs from spreading

Handwashing Tips: Sing “Happy Birthday to Me” twice: Singing “Happy Birthday” to yourself

twice while washing your hands helps you remember the length of time necessary to properly wash

your hands with soap and water which should be:

30 seconds = Minimum Length of Time to Wash Hands

Professional Caregivers Should WASH EACH HAND for 15 seconds

 BEFORE Direct Contact with the Care Client

 AFTER each contact

Watch Video from the CDC on Hand Hygiene for Fighting Infections - Clean Hands Matter: 1

Minute, 41 Seconds

Handwashing Techniques:
1.  Wet each hand thoroughly and apply antibacterial soap.
2.  Rub your hands together, making sure you scrub the entire hand, including in-
between the fingers.
3.  Scrub each hand for 15 seconds.
4.  Be sure to clean under the fingernails as most germs hide under and around your
fingernails.
5.  Artificial nails should be avoided as they are difficult to clean.
6.  Jewelry can serve as a nest for germs so remove when washing your hands.
 7.  Rinse both hands in warm water. Avoid very hot water as it can harm the skin and
add to infections.
8.  Be sure to rinse ALL the soap off of your hands.
9.  Dry hands completely. Paper towels are suggested, although motion-activated
dryers are the best (but obviously not usually present in a senior’s home.) However,
when in a public bathroom, the motion-activated dryers are the best option.

Remember, always wash your hands:

 After contact with the senior client

 Before and after situations in which your hands are going to be contaminated

 After bathroom breaks

 After lunch breaks

 Before preparing food

 After preparing food

 After sneezing

 After coughing

 Before putting on gloves

 After taking off gloves

Strict hand-washing routines are the gold standard for reducing infections associated with health

care. Infections communicated in nursing homes, hospitals and doctor’s offices are linked to nearly

100,000 deaths a year affect more than 1 million patients. When accompanying as senior to any of

these facilities, always ask the medical professionals: “Have you washed your hands?”.

Watch Video from the Centers for Disease Control on the Most Common Infection Sites: 1

Minute, 34 Seconds

Electronic sensors, thermal imaging, and video cameras are being used to help monitor consistent

hand-washing at health care facilities.

Take hand-washing seriously, for your health and for the senior’s health.
Types of Soap:
1. Plain Soap: Removes surface residue but does not kill microorganisms that are on
the skin, instead it suspends the microorganisms.
2. Anti-Microbial Soap: Removes dirt and residue from your skin and uses an agent
that will kill most microorganisms. Some agents in this type of soap will continue to
kill microorganisms after your hands are dry.
3. Anti-Septic Handrubs: This gel-type of disinfectant will decrease the microorganisms
on your skin, but soap and water are always best.

CAUTION for HAND-SANITIZER USE: SOAP AND WATER ALWAYS BEST

Washing hands with soap and water assures you will reduce the number of germs and should always

be your preferred cleanser. If soap and water are not available, use an alcohol-based hand sanitizer

that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of

germs on hands in some situations, but sanitizers do not eliminate all types of germs and might not

remove harmful chemicals.

Hand sanitizers are not as effective when hands are visibly dirty or greasy.

Watch Video from the World Health Organization on Proper Hand Washing: 1 Minute, 26

Seconds

Now practice what you saw in the video, re-play if necessary. Practice makes perfect; use the proper

handwashing technique in your everyday life, even when not working with a client and it will

become a habit.

Personal Protective Equipment:

 1.  Disposable Gloves: required when you may come into contact with blood or body
fluids. Discard after use.
2.  Disposable Aprons: wear to protect clothing from being contaminated with blood or
body fluids and when there is a known infection.
3.  Face Masks: wear if concerned the nose or mouth will be splashed when caring for
someone with a contagious infection.

About Gloves: Gloves may protect the person wearing the gloves but microorganisms can be passed

from the outside of the glove to the senior client.

Be Sure the Gloves are Clean on the Outside and DISCARD AFTER USE

Gloves do NOT take the place of proper hygiene.

PUTTING ON GLOVES
1. Remove any sharp jewelry
2. Gloves come in small, medium and large. Be sure to use the right size for your
hands.
 3. Remove gloves from the box.
4. Most gloves are rubber latex and are pre-powdered. If allergic to latex then use vinyl
gloves.
5. Hold glove with your thumb and forefinger and insert hand into gloves
6. Work fingers into proper places

REMOVING GLOVES WITHOUT CONTAMINATING YOUR

HANDS
1. Pinch the palm of one glove and pull away from the palm.
2. Push fingers of the pinching hand up inside the other glove, stretching glove material
towards the cuff of the other glove until it emerges by the wrist.
3. Pull the fold-down until the glove is almost off (you will be pulling the glove inside-
out).
4. DO NOT take the glove completely off.
5. Hook the ungloved thumb between the wrist and the skin of the other gloved hand
and pull down, pulling both gloves off (both gloves will now be inside out.)
6. Dispose of the gloves properly.

Key Situations where Hand Hygiene Should be Performed Include:

1.  Before touching a patient, even if gloves will be worn
2.  Before exiting the patient’s care area after touching the patient or the patient’s
immediate environment
3.  After contact with blood, body fluids or excretions, or wound dressings
4.  Prior to assisting with performing an aseptic task such as the implementation of an
I.V.
5.  If hands will be moving from a contaminated body site to a clean body site during
patient care
6.  After glove removal

How Infections Spread: Microorganisms are also called germs and are tiny living things seen only

with a microscope. This is why thoroughly washing your hands is important. Pathogenic organisms

can produce diseases referred to as infections. Avoid infections by avoiding microorganisms.

SPILLS

 Put on clean gloves

 Wipe up immediately by cleaning from the outside (cleanest) to the inside (dirtiest)

 Use the appropriate cleaning agent

 Never pick up glass, even with gloved hands

 Dispose of gloves and cleaning equipment and supplies

Watch Video on the Benefits of Handwashing, Food Safety and Caring for Someone who is Bed

Bound: 6 Minutes, 10 Seconds

Remember, as a professional caregiver, your skills in managing a clean and safe household include

infection control. As we age, our immune systems ability to fight infections also weakens. Proper

cleanliness delivers better health and happiness.

Tip Sheet
Gloves Do Not Take the Place of Good Hygiene, Fingernails Harbor Germs, Wash Hands Before and

After Patient Contact, Wipe Spills from Outside to Inside

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.
Prevention
Maintaining a Clean and Healthy Environment

Learning how to maintain a clean, safe and healthy environment will be explained in this section.

Environmental cleanliness enhances the lifestyle and creates a pleasant and safe environment for both

the caregiver and the senior receiving care services. A tidy home environment creates a happy home

and eliminates the chaos caused by disorganization.

How Do You Maintain a Clean Environment

 Organize care tools

 Keep up with daily cleaning tasks

 Obtain necessary custom-cleaning materials for special care needs

 Create daily and weekly cleaning schedules

Cleanliness is contagious. If you keep yourself and the care environment neat and clean, everyone

who visits will also want to keep the area neat and tidy, which will make the caregiver’s job much

easier.

Standards of cleanliness indicate a sign of overall care provided. It will be a cause of concern if the

care premises are not kept clean and in order.

To Maintain a Clean Environment:

 Wash soiled clothing, sheets, and towels immediately

 Toss disposable gloves, needles, and wipes into trash

 Remove trash daily (take to garbage bin outside)

 Wash dishes immediately after meals

 Discard mail and newspapers

 Clean out refrigerator weekly

 Be sure glasses, plates, and utensils are sanitary

 Maintain clean bathroom and kitchen

 Vacuum and mop floors at least weekly

Cleanliness for Safe Food Handling

Keep food properly cooled to avoid contamination with unclean surfaces and utensils and to keep

bacteria from spreading. Be careful to keep food items separated as meat can contaminate other food

items. Immediately place meat in the freezer or refrigerator when returning home from the grocery

store or upon delivery. Cooking temperatures must be followed to destroy pathogens. Always handle

any meat, such as fish, chicken, pork and beef, with extra care. Wash your hands and utensils before

and after preparing meat, just as you do before and after cooking any other foods.

Using a food thermometer when cooking food on the grill or oven will help you confirm the food is

heated to a high enough temperature to kill germs. Most bacteria cannot live above 120 degrees

Fahrenheit. Meat usually requires higher temperatures, such as whole chicken requiring at

least 180 degrees Fahrenheit.

Read Cooking Instructions and Use a Thermometer to Safely Prepare Meat.

Food poisoning is an illness caused by eating foods with harmful bacteria.

Watch Video from the Center for Disease Control on Food and Kitchen Safety: 2 Minutes

Cleaning Products
Use special antiseptics and bleach to clean in order to eliminate germs, making allowances for any

special allergies or preferences by the senior.

If an outside cleaning service is used, make a cleaning instruction list. Inform them of any special

areas that are overused and need extra cleaning attention. Check to be sure everything is cleaned

afterward to maintain high quality.

Note: Kitchens and Bathrooms are Used the Most and Require Daily Cleaning Maintenance

Integrate Daily Cleaning Into Your Daily Care Plan Duties

Stay Organized. Create a space for all of the care tools you will be using so that everything has a

place for you to find it and return it after use.

Tidy Up

As the saying goes, a messy house equals a messy mind. Less is sometimes better. Try to remove

clutter from your work area and be mindful that you can more easily maintain a clean environment

by being organized and getting rid of any unnecessary items. While you need to respect your client's

home and lifestyle, you can make sure that the tools that you use are well organized and limit the

items to only what is necessary.

Remember, a person’s home is their castle. Some seniors may have lived with extra “clutter” in their

homes their entire lives while other seniors lived the minimalist lifestyle. You will not be able to

change a senior’s style but can assist them to maintain cleanliness and order.

Tip Sheet
Create a Cleaning Schedule, Tidy Up Kitchens and Bathrooms after Each Use, Use the Right

Cleaning Products, Organize Your Environment

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.
Prevention
Personal and Environmental Safety Precautions, Emergency Plan,
Including Basic First Aid
Personal Protective Equipment
Personal Protective Equipment is also called PPE. This will include special clothing, such as a scrub

outfit and clogs, along with gloves, face masks, eyewear goggles, and aprons.

Remember to always wash your hands before and after wearing gloves as gloves do not take the

place of handwashing.

Senior caregivers should follow the senior’s care plan for the use of protective equipment.

Cleaning Products
For off-the-shelf cleaning products, always review their ingredients and usage and warning

guidelines. If you are using any special products, find out what you need to do to keep yourself and

your client safe while using the product.

SDS: Safety Data Sheets are User-Friendly, in a 16-Section format

A document that contains information on the potential hazards such as: physical properties, fire,

reactivity, the toxicity of a chemical product and how to work safely with the chemical product.
The government's Occupational Safety guidelines have you protected by requiring all chemical

manufacturers to provide the details of their product for anyone to access something called the Safety

Data Sheets or SDS.

Off-the-shelf cleaning product precautions may be found by doing a GOOGLE Search with the

product Name followed by "SDS"

The Hazard Communication Standard requires that all chemical manufacturers, distributors, and

importers provide Safety Data Sheets or SDS's (formerly called MSDS or Material Safety Data

Sheets) for each hazardous chemical to downstream users to communicate information on the

potential hazards.

The SDS includes:

 Properties of Chemical

 Physical, Health and Environmental Health Hazards

 Protective Measures

 Safety Precautions for Handling, Storing and Transporting the chemical

Watch Video on OSHA-Required Safety Data Sheets (SDS): 2 Minutes, 3 Seconds

Infection
Be Safe - Be Able to Quickly Identify Infections: Infection is Spread in 3
Stages:

Stage 1

Germs live in a host. The host may be a person or an animal

Stage 2

The germs move out of the first host

Stage 3

The germs move into a new host

How Germs Spread

Germs use many routes to get from one host to another. Here are some ways that germs spread:

1. Through the air: coughs or sneezes

2. Through animal bites
3. Through insect bites
4. Through eating or drinking infected food or water
5. Through touching
6. Through body fluids

Fluids enter the host through:

 Blood

 Fluid from a cut

 Fluid from a penis or vagina

 Mucous

 Pus

 Saliva

 Stools

 Urine

 Vomit

Germs get into the new host when infected body fluids:

 Are on a needle or other sharp thing that goes into the skin of
the new host

 Get into a cut or scratch

 Touch mucous membranes, like those inside your mouth

Some people are more likely than others to get sick from germs. They are susceptible.

Susceptible people may be:

 Already sick

 Under stress

 Very old
  Very tired

 Very young

Susceptible people may be people who:

 Don't eat a healthy diet

 Don't wash their hands well

 Have a weak immune system. That means their body is not good at fighting off things from
outside.

Signs an Infection has Started

If a cut is infected:

 Fluid comes out of the cut

 The cut hurts

 The skin around the cut is red and puffy and feels warm

If a body part or body system is infected, a person may feel:

 Pain in the infected area

 Sick to their stomach, or throw up

  Very hot or cold

 Very tired

Personal Safety Precautions Include the Following:

 Protect Your Face and Hands: Wash Your hands, wear gloves
 Protect Your Lungs (if the client has a contagious infection): Wear a face mask or respirator
 Avoid Falls: Wear non-slip shoes or clogs
 Avoid Back Injuries: Practice safe lifting techniques
 Report Sexual Harassment From a client or co-worker or manager
 Emotional Abuse: Ask for assistance if a senior exhibits aggressive behavior as sometimes
seniors with Alzheimer’s disease or other age-related illnesses will have a change in
personality.
 Chemical Hazards: Be aware of ingredients in cleaning products, detergents, and
medications that you will come into contact with while performing caregiver duties.
Remember that cleaning products contain chemicals and use with care.
 Oxygen: Some seniors will be using oxygen to assist them with breathing. Oxygen tanks
cannot be used near a lighted flame. Read the instructions in the care plan for the oxygen tank
precautions and follow them. NEVER SMOKE near an oxygen tank.
 Cooking: Use extra caution when cooking in a senior’s kitchen. Be sure to use timers when
baking in the oven or cooking on the stove as it is easy to have the need to be interrupted
when working as a senior caregiver. Know where the fire extinguisher is located.
 Community Safety: Be aware of safety precautions in the senior’s neighborhood. Be sure to
follow basic safety guidelines when arriving or leaving at nighttime. If you feel the senior
lives in a neighborhood which has safety issues, discuss ways to plan around this with your
Care Manager.
 Pet Safety: Seniors may have a pet such as a dog or a cat. Understand any special personality
needs of the pet and be sure you feel comfortable working as a caregiver in a home with a
pet. If you have any issues at all, discuss them with your Care Manager. If you experience an
 incident with a pet, such as a dog bite, immediately report it to your Care Manager and go to
the Emergency Room for treatment.
 Fire: Follow Emergency Procedures in Care Plan
 CALL 911 for medical emergencies, fires, or other severe weather threats.
 Call your Office if you ever have questions about how to handle a situation or may be
unsure about a plan of action for emergencies.
 Medical Equipment is labeled by the manufacturer as either reusable or single-use. All
reusable medical equipment must be cleaned and maintained according to the manufacturer’s
instructions to prevent patient-to-patient transmission of infectious agents.

Violence in the Workplace

As a home caregiver going into homes, you can face unpredictable and unprotected situations which

could include verbal abuse.

Verbal abuse from the client, family members, or people in the community is a form of workplace

violence. Verbal abuse may be subtle, such as asking for help beyond the scope of the job, or it may

be obvious, such as complaining about job performance or worker appearance—or even threatening

to cause harm.

Violence is a major disruption in providing quality care and disrupts the therapeutic and calming

setting.

Violence Against Healthcare Workers is NEVER Acceptable

Workplace Violence Defined by The National Institute for Occupational Safety and Health:

"....any physical assault, threatening behavior, or verbal abuse occurring in the work setting."

YOUR RIGHTS
  You have a right to a safe place of employment free from hazards that are known or likely to
cause death or serious physical harm

 You have a right to know about any potential security hazards and how to respond and
protect yourself should a situation arise

YOUR RESPONSIBILITIES

You are responsible for knowing your workplace policy for handling a difficult individual.

If you are in a situation where you feel threatened by a client, co-worker, family member or

stranger, follow these steps:

1. Quickly and calmly end the interaction without making the situation worse
2. Get help
3. File an incident report

Watch Video from Oregon Public Health on Staying Safe and Alert when Going into a Client’s

Home: 7 Minutes, 42 Seconds

Dress for Safety

Do not wear anything that can be used as a weapon or grabbed by someone

 Long Hair should be tucked away so that it can't be grabbed

 Jewelry: Avoid earrings or necklaces which can be pulled or attract attention
 Overly Tight Clothing can restrict movement and slow you down
 Scarves and Overly Loose Clothing can be caught on things
 Glasses, Keys, or Name-tags dangling from cords or chains can be hazardous

Always be sure to use breakaway safety cords or lanyards.

Be Attuned to Behaviors

Most violent behavior is preceded by warning signs. The following cues (signs) are indicators of

possible violence.

Cues

o Speaking loudly or yelling

o Swearing

o Threatening tone of voice

o Non-verbal or behavioral cues

o Physical appearance (clothing and hygiene neglected)

o Arms held tight across the chest

o Clenched fists

o Heavy breathing

o Pacing or agitation

o A terrified look signifying fear and high anxiety

o A fixed stare
 o Aggressive or threatening posture

o Throwing objects

o Sudden changes in behavior

o Indications of drunkenness or substance abuse

More cues exhibited indicate a greater risk of violence.
Be Aware of Your Body's Responses

Part of violence prevention is to be aware of your own feelings, responses, and sensitivities. Pay

attention to your instincts. For example, your "fight or flight" response can be an early warning sign

of impending danger, to get help or get out.

Intuition—that gut feeling—it’s usually right—LISTEN TO IT!

Effective communication skills are an important tool for violence prevention. Self-

awareness includes acknowledging if you have a personal history of abuse which might affect how

you respond to situations that may spark flash-backs to your own past experiences.

Avoid Fatigue, Practice Self-Care: Be sure you are getting enough sleep, eating a healthy diet, and

making time for exercise and relaxation.

TIP: HAVE A CODE

Call your office and use the code word to let them know you're in trouble if you can't call the

police.
Personal safety and the safety of others is paramount. ALWAYS TELL YOUR MANAGER IF

YOU FEEL UNSAFE!

Observing an out-of-control person is frightening and may trigger your own "fight or flight"

response. Emotional containment is important so that proper procedures and protocols are

remembered and followed.

Always Be Alert

Maintain behavior that helps to diffuse anger:

1. Act with a calm, caring attitude
2. Do not match threats
3. Do not give orders

Watch Video on De-escalation Techniques: 5 Minutes, 20 Seconds

Avoiding Slips, Trips and Falls

Slips, trips, and falls are the 3rd leading cause of accidental death, behind poisoning, which includes

drug overdoses and motor vehicle accidents. Don't take a fall while you are working. Learn how to

protect yourself and your future ability to enjoy life and enjoy your caregiving job by being in good

health.

Typical Injury Areas:

  Knee

 Ankle

 Foot

 Back

 Shoulder

 Hip

 Head

Slip

o Too little friction or traction between feet or footwear and walking surface, resulting in loss

of balance

Trip

o Foot or lower leg hits an object and the upper body continues moving, resulting in loss of

balance

o Stepping down to a lower surface and losing balance

Fall—happens when too far off-center of balance

o Fall on the same level, fall into or against objects (fall against a stack of books that are on the

floor)

o Fall to a lower level, fall to below walking or working surface (fall from one step to the one

below)
Falling Properly- Is There Such a Thing? Yes!

MOST IMPORTANT - PROTECT YOUR HEAD

1. Best case scenario, pivot to your side and tuck in your head
2. You never want to fall flat on your back, banging your head on the ground or
landing on your stomach, extending the head and neck back. The first can
result in a concussion and the second whiplash.
3. You also don’t want to fall on outstretched hands which could damage your
wrists or on your knee and damage the kneecap.
4. You should bend your elbows and knees and try to take the hit on the
fleshiest parts of your body, like the side of your thigh, buttocks, and
shoulder.
5. Aim for the meat, not bone. Your instinct will be to reach out with hands or try
to catch yourself with your knee or foot, but they are hard and not forgiving
when you go down.
6. The key is to not fight the fall but to just roll with it.
Stay Strong and Healthy with Regular Exercise Routine
Find a healthy exercise routine that you enjoy and can do at least 3 times per week, to stay physically

fit as a caregiver.

Remember - All the Precautions were Created to Protect You and Keep You Healthy and

Smiling!
Recognizing emergencies and knowledge of emergency procedures, including basic first aid and

implementation of a client’s emergency preparedness plan are presented in this section.

Natural Disasters
Natural disasters do occur and many times with short notice.
Natural Disasters Are Defined As the Following:
 Hurricanes

 Tornadoes

 Earthquakes

 Flash Floods

 Wind Storms

 Rain Storms

 Forest Fires

Fires in the house are usually preventable and because of this are not considered a natural disaster.

Preventing household fires and how to respond safely are also part of emergency planning.

Prepare Ahead of Time for Natural Disasters and Emergencies

Think through what you would do for each of the possible natural disasters and if the home lost

electricity or experienced a fire or flood. If you are providing caregiving services at a facility such as

a nursing home or assisted living community, learn their disaster and emergency procedures. They
will have instructions available and notices on doors and exits for evacuation procedures. Know

where the flashlight and matches and candles are at a senior’s home.

Follow these steps when you begin to care for a senior in their home:
1. Home Assessment: Know the layout of the entire home, including the basement and
attic to be prepared for an emergency
2. Know where smoke and water can go
3. Power Failure—Have a Plan: Know where to find flashlights, batteries, candles, and
matches
4. Smoke and Fire Alarms: Check batteries monthly
5. Where Do You Go? If an evacuation were necessary for fire, hurricane, flood, wind-
storm, or tornado, know the evacuation plan

Always call the office of the home care agency first and know the evacuation plan and for immediate

emergencies call 911.

Hurricanes: As hurricanes show up on weather radar, you will have a prior warning before a

hurricane will strike and time to prepare yourself and your client for this disaster. Many times areas

are evacuated prior to a hurricane and your company will provide guidance.

Tornadoes: Tornadoes often strike suddenly. A Tornado Watch means a tornado is a possibility

due to the weather conditions. A Tornado Warning means a tornado has been spotted and is in your

area. You should take cover immediately, going to a basement or tornado shelter if possible. Be sure

to know where to take cover if you are located in a tornado alley.

Earthquakes: Earthquakes usually happen without warning. While earthquakes are more common in

California, there is also the New Madrid fault line near the Mississippi river, causing earthquakes to

even occur in Illinois and Missouri. Know where to go for safety in the home when a sudden

earthquake happens and where to go for shelter after the earthquake.

Watch Video on Earthquake Preparedness: 6 Minutes, 25 Seconds

Floods: Floods usually are predicted but be aware that flash-floods occur quickly. Find out if the

senior’s home is in a flood zone and know the evacuation procedure if you are in an area that

experiences flash floods.

Forest Fires: Usually you will have prior notice to evacuate. Take the warning seriously as fires can

advance more quickly than you can imagine. Implement the emergency plan and take the necessary

items and evacuate.

Fire: As most fires can be prevented it is important to review fire safety tips.
1.  Do not smoke while working.
2.  Do not allow a senior client to smoke in the home, if possible. If they must smoke in
the home, make sure they only smoke while using an ashtray.
3.  Do not allow them to smoke in bed or when oxygen is in use.
4.  Check electrical cords to be sure they are not cracked or frayed.
5.  Notice if light bulbs blink or seem to burn-out quickly. This could be a sign of an
electrical issue that should be reported.
6.  Turn off and unplug electrical appliances when you are not using them.
7.  Be cautious to turn off ovens and stoves when not in use—always check everything
twice.
8.  Keep flammable items away from the stove, radiators, and reading lamps.
9.  Do not use candles.

CANDLE DANGER: If candles must be used for a dinner celebration or birthday, be very aware of

the importance to extinguish them when you leave your work assignment as a senior may not

remember to do so. Seniors also may have lost their sense of smell, making it even more dangerous

to have candles in the home. Candles are one of the leading causes of fires. Be mindful to keep

candles away from flammable objects and burn them only for short time periods.
Fire Preparedness

Watch Video on Fire Preparedness: 1 Minute

1.  Know where fire extinguishers are located
2.  Fire extinguisher directions: know how to use it
3.  Blankets: Know where extra blankets and sheets are kept in the home. A blanket
can be thrown over the fire to extinguish it.

Should a Fire Start:

1. Call 911
2. Extinguish the fire if possible (such as a small kitchen fire on the stove-top)
3. Escort the senior out of the home
4. Confine the fire by closing doors of empty rooms to slow the spread of smoke and
flames

Note: Fire Extinguishers should be in the senior’s home if you are doing senior home care. Make

sure the location of the fire extinguisher is known to you and make sure it works.

Being PREPARED is Your Best Defense for Natural Disasters

and Emergencies
Emergency Preparedness Plan Includes This Information
 How to evacuate
  Where to evacuate (where to go)

 How to help clients during the emergency (must-have items to take)

 Who does what (call the family to help or will a back-up caregiver arrive?)

 How to know when an emergency plan is being implemented

Make sure your employer provides you with an Emergency and Disaster Plan when you are hired.

Ask them to review it with you. If you work in an area that has had previous disasters such as

earthquakes, hurricanes, or tornadoes and has a high probability of these natural disasters happening

again, ask your senior care employer to share experiences and stories on how the previous natural

disaster emergencies were handled.

Watch Video on Tips for Making a Home Emergency Kit: 3 Minutes, 20 Seconds

Safety Tips During Natural Disasters and Emergencies

Know the must-have items for the senior in your care:

 Medications

 Clothing

 Medical Equipment (walker/oxygen)

 Food

 Water

 First Aid Kit

Make a list of these items so you will be prepared if an emergency occurs:

1. Know the “Emergency Plan” for your senior care company and know the steps you
are to take when it is implemented.
2. Review the Emergency Plan for your company each year so you are familiar with the
steps.
3. Exercise safety throughout your workday. If equipment isn’t working properly, notify
your manager.
4. Know your Game Plan for your Must-Have Items (create a natural disaster kit).
5. Check your weather forecast each day before you go to work.
Basic First Aid

First aid means being the first to treat an emergency injury such as a cut finger or a twisted ankle

which just needs some basic “aid.” Thus the name, Basic First Aid.

Cuts: Clean with an antiseptic (alcohol or antiseptic wipe) and apply a bandage. Deep cuts should

have a butterfly wound closure applied (tape together) to link the torn skin.

Sprains: Apply ice and elevate, then apply elastic brace.

CPR First Aid: CPR stands for Cardiopulmonary Resuscitation which is performed on people in

cardiac arrest and involves chest compressions and exhalations into the person’s mouth. Training in

CPR should be taken if you are caring for someone with heart disease. Sometimes additional heart

defibrillator life vests or machines are maintained in the home of seniors with heart disease. Proper

training should be provided for the use of these devices.

Tip Sheet
Call 911 for Medical Emergencies, Personal Protective Equipment is also called PPE, Infections can

be Avoided by Washing Hands and Wearing Gloves, Oxygen cannot be Near a Flame, Household

Cleaning Products can be Chemical Hazards, Natural Disasters Include Earthquakes, Hurricanes,

Floods, Tornadoes, Emergency Preparedness Plan provides an Action Plan for How to Evacuate,

Where to Go, How to Help the Senior, Who to Call and Who Does What, Basic First Aid is Just That

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.

Prevention
Bathing and Dressing, including Sponge Baths and Compression Hose

Performance of personal care tasks for clients, including: bathing, skin care, hair care, mouth care,

dressing, feeding, toileting, medication reminding, and transfers, positioning, and exercise.

Personal Care
Just think of personal care as all the activities you do when you wake up each morning:

 Toileting

 Bathing

 Brushing your teeth and hair

 Dressing into your clothing

Caregivers assist seniors as they may have physical challenges or memory loss which require

assistance to keep their personal care on track for the day. They may also have difficulty with easily

moving and coordinating physical activities due to age-related illnesses and the natural aging

process.

Personal Care Activities include the following:

 Bathing

 Skin Care

 Hair Care

 Mouth Care (Brushing Teeth/Denture Care)

  Dressing

 Eating

 Feeding

 Assistance with Ambulation

 Exercise

 Transfers from chair, toilet, bed

 Positioning

 Toileting

 Medication Reminders

Bathing
Bathing is a very important part of proper hygiene and infection control.

It is also something that is very ingrained into us, a task which the person may have a very specific

way they prefer to bathe. It is also one of the most personal tasks we perform, and maintaining

respect and dignity is important.

If the person can still perform the task on their own, it is important to maintain dignity and allow the

person to do so. In this case your role may be running the bath water to the proper temperature,

setting out supplies and towels and helping the person into and out of the bath.

How often?

Bathing once or twice a week is all that may be needed to avoid skin breakdown and infections.

After bathing, it is important to put on clean clothes, including fresh undergarments.

Purpose of Bathing
1. Cleans the skin
2. Eliminates odors
3. Refreshing and relaxing
 4. Stimulates circulation throughout the body

What can affect hygiene needs?

 Many older people do not require the same frequency of bathing as young, active people

 Fever or other illness may cause a person to need more frequent bathing

 Religious or other routines which influence how often a person bathes

General Guidelines

Assisting seniors with bathing first requires assessing the bathroom to make sure the necessary safety

items are in place, such as grab bars and floor mats and shower chairs. Understand the size of the

senior and obtain special instructions from the senior’s medical doctor or physical therapist for

special equipment needed if physical challenges are present. Seniors recovering from a stroke or hip

replacement, for instance, will receive physical therapy and advice on medical equipment for their

bathroom.

1.  Water Temperature: Check to be sure the water is warm and not hot
2.  Secure soap, washcloth and bathing utensils before the senior steps into a shower
or bathtub
3.  Discuss how you will assist the senior in and out of the shower or bathtub
4.  Discuss tasks senior can do themselves and promote their dignity by allowing them
to do so
5.  Towels and bathrobe: be sure the senior immediately has a warm, dry towel and
clothing to put on
6.  Non-slip mats and rugs: be sure the bathroom has non-skid and non-slip mats and
rugs
7.  Be sure necessary grab-bars are installed
8.  Men may find warm water prompts an erection—stay professional and either ignore
it or use light humor but be aware that this can happen
9.  Seniors may sometimes refuse a shower or bath—call your Care Manager for
guidance
10.  Reassure the senior throughout the bathing or showering process
Always Promote Comfort

 Make sure the bath water is warm and comfortable

 Wash and dry one body part at a time

 Make a mitt from a washcloth to keep tails and edges tucked in

 Give a massage or backrub with warmed lotion (can heat tube of lotion in hot water bath)

Tub Bath

 Make sure the water temperature is comfortable, not too hot or too cold.

 NEVER leave the client unattended, even for a second.

 Pay attention to skin folds, area breasts, underarms and anywhere dirt can hide.

Shower
  Make sure the water temperature is comfortable before allowing the client to enter. The client
can either use grab bars in the shower to stay standing or use a shower chair.

 Make sure there is a nonslip mat so the floor is not slippery.

 Dry the clients' skin before helping them move from the shower.

Bag Baths

Occasionally you may use a bag bath in the home, possibly during end-of-life care. You will

probably follow the bed bath instructions later in this section and not use a bag bath, but you should

be familiar with bag baths.

Bag baths come prepared with 8 to 10 washcloths in a plastic bag. The cloths already contain a

cleaning agent which does not require rinsing from the skin.

 Warm the bag in the microwave according to directions.

 A new washcloth is used for each body part.

 The air dries the skin.

Sponge Bath (Bed Bath)

There are times when you will need to wash someone while they remain in bed. Maybe they don’t

feel well, maybe they are injured, maybe they are in the late stage of the disease.

Just like in other situations, bathing is still important to maintain proper hygiene. Not only will a bath

clean the skin to help prevent infection, but it helps the person stay relaxed.
As in other situations, let the person do for themselves if they are able. What tasks are they able to

perform to stay part of the process, think about it and help them feel empowered and in control.

If they cannot physically help but are able to communicate, talk them through the process and asked

them for permission, ask them their preferences.

Gather the items needed and make sure the items are close at hand.

What will you need?

 Disposable gloves

 Water basin, bowl or small bucket to hold the water

 Soft, lightweight cotton or flannel blanket

 Soap, lotion, deodorant, comb, hairbrush, mouth care supplies, nail supplies

Before you begin:

1. Close any windows or doors to maintain privacy
2. Turn up the heat to keep the room warm
3. Fill the bowl or bucket with warm water, not above 115 degrees Fahrenheit
4. If you don’t have a thermometer, use your elbow instead of your hand to test the
water temperature
5. Alternately use a bath thermometer
6. Put the soft blanket over the top sheet that is covering the person
7. Help remove the person’s clothes, remember they may need a little or a lot of help,
always ask and walk through the steps verbally

Giving the bed sponge (bed bath):

1. Wear disposable gloves
2. Wet the washcloth without soap.
3. Gently wipe one eyelid by wiping from the inner corner of the eye to the outer corner.
Dry eyelid with towel, rinse the washcloth and wash and dry the other eyelid.
4. Using mild soap, wash the face, neck, and ears. Rinse off the soap and dry the
washed areas. Put the towel under an arm. Wash the person’s hand, arm, and
underarm. Rinse off the soap and dry the arm well, especially under the arm.
5. Wash, rinse, and dry the other hand and arm.
6. Fold down the blanket to wash the chest and stomach (belly). Wash, rinse, and dry
these areas. Cover the chest and stomach with the blanket.
7. Remove the blanket from one of the legs and put a towel under the leg to keep the
bed dry. Wash, rinse, and dry the foot and leg. Do the same for the other leg.
8. While lying in bed, the person may enjoy soaking his feet in a basin. Put a towel
under the basin to keep the bed from getting wet.
 9. Help the person put one foot into the basin. You may need to support the leg while
washing the foot. Take the foot out of the water and dry it. Put the other foot into the
basin. Wash, rinse, and dry the foot. Make sure to gently dry between the toes.
10. Empty the dirty water from the basin or bucket into the sink.
11. Fill the basin with clean warm water. Put the lotion bottle into the basin. This will
warm the lotion before use.
12. Ask or help the person to roll on his side so you can wash the back. The person
should not be too close to the edge of the bed to avoid a fall.
13. Put the towel on the bed along the person’s back. Fold down the blanket. Wash the
person’s neck, back, buttocks (rear end), and thighs (upper legs). Rinse the
washcloth in the basin and remove the soap from the washed areas. Dry the back,
buttocks, and thighs.
14. Ask the person if he would like to have a back rub with the warmed lotion.

Watch this video demonstrating the procedures for Bed Sponging an Elderly: 4 minutes, 48

seconds

Perineal Care

The perineum (pair-uh-nee-um) is the last area to be washed. Wear disposable gloves when washing

this area.

This area is also called the pubic area or genital area. It is the area between the thighs and includes

the genitals and anus. This part of the body should be washed every day. Washing the perineum

keeps the body from smelling and becoming infected.

Always wash the perianal area with a fresh cloth. Remember to wash from front to back on females.

Gently wash a male's penis, testicles, and foreskin if not circumcised. Dry the perianal area well with

a towel.

1. Can perform during a bath or anytime needed

2. Use terms the client understands which are in good taste professionally
3. Always work from cleanest to dirtiest, use a clean area of the cloth for each stroke

Washing a woman’s perineum

1. Fill a basin with clean warm water. Fold the towel in half. Ask or help the woman to
lift her buttocks. Put a towel under the buttocks. Ask the woman to bend her knees
and spread her legs. With a soapy washcloth in one hand, separate the labia (“lips”
of the vagina) with the other hand. Wash the labia from front to back. Do not touch
the anus with the washcloth. Germs from the anus could get into the vagina and
cause an infection.
 2. Rinse the washcloth and remove the soap from the perineum. It is important to
remove all the soap because it can irritate the skin and cause stinging. Dry the area
with a dry towel. Do not put powder on the perineum.
3. Wash the anus next. Ask the woman to turn onto her side so that she is facing away
from you. Ask her to raise up her top leg. This will let you see and clean the skin
around the anus. Slide the towel under the woman’s buttocks. Use toilet paper or a
paper towel to remove BM that may be on the skin. You may need to wet the toilet
paper or paper towel if the BM has dried. Throw the toilet paper or paper towel away
in a trash bag. Wash, rinse, and dry the anal area.

Washing a man’s perineum

1. Fill a basin with clean warm water.
2. Ask or help the man to lie on his back. Fold a towel in half and put it under the man’s
buttocks. Ask the man to bend his knees slightly and spread his legs. Hold the penis
with one hand. With the other hand, wash the tip of the penis with a soapy
washcloth. Rinse the washcloth and remove the soap from the penis.
3. If the man has a foreskin, gently push it back. The foreskin is the skin that covers the
rounded end of the penis. Wash the end of the penis. Rinse the washcloth and
remove the soap from the end of the penis.
4. Using a soapy washcloth, wash the rest of the penis and scrotum. The scrotum is the
bag of skin that hangs under the penis. Rinse and dry well.
5. The anus should be washed next. Ask the man to turn onto his side with the top leg
raised. This will let you see and clean the anal area easier. Fold the towel in half and
put it under the man’s buttocks. Use toilet paper or a paper towel to remove BM that
may be on the skin. You may need to wet the toilet paper or paper towel if the BM
has dried. Throw the toilet paper or paper towel away in a trash bag. Wash, rinse,
and dry the anal area.
6. Remove your gloves and put on clean ones.

This can be a delicate situation and cause embarrassment. Have you ever had a procedure done by a

physician where you felt uncomfortable? Oftentimes the physician may ask you about something

completely unrelated to the task to take your mind off the situation. Maybe you tell a story or talk

about something funny in the news. Your professionalism during the task and how you make the

person feel comfortable, is why the client and their family hired a professional. Think about how you

would feel in the same situation and help the person feel at ease.

After the Bath:

1. Rub lotion onto the person’s arms, legs, feet, or other dry skin areas. Remember,
you can warm the lotion bottle in a warm water bath while you are bathing the
person. Who likes cold lotion after a nice warm bath? You got it, NO one!
2. Help to dress the person. Offer to help him with mouth, hair, foot, or nail care.
 3. Throw away the dirty water and clean the washbasin. Put away items used to give
the bath.

Watch for the following and follow your company’s guidelines for reporting:

 The person has shaking chills or his temperature is over 101 degrees F.

 The person has skin that is red or sore. These may be areas where the skin is broken down or
getting infected and could be the start of a bed sore.

When a Senior Displays Resistance to Bathing

Sometimes you will care for a senior who no longer desires to keep up with their personal care habits

and maintain personal hygiene. This can happen because the senior is experiencing:

 Memory loss

 Depression

 Physical challenges

 Fear of falling

 Loss of smell or eyesight or continence

Nobody likes to be embarrassed because they can no longer easily maintain a daily function. Most

seniors also fear losing control over their daily activities and reminders of the natural aging process

happening to them. Perhaps they have heard about a neighbor or friend who no longer can live alone

after falling and breaking their hip. They will often resist bathing when they feel they cannot easily

do this on their own.

Seniors with memory loss such as Alzheimer's disease also can become resistant to bathing. There

are ways to combat this by implementing a strategy and supporting them to overcome their fears.

Watch Video on Tips for Assisting Seniors who are Resistant to Bathing: 4 Minutes, 20 Seconds

Dressing Clients
A daily routine with your clients will very often include assisting with dressing your client.

Dressing Best Practices

 Encourage appropriate dress, depending on the weather and daily activities.

Remember, senior clients will often have poor circulation and possibly lower body fat. They may

complain of being cold, even when you are warm. Your client may need a sweater in the summer

when you are comfortable in a sleeveless shirt.

 Encourage independence in selecting what to wear.

Have you ever seen a toddler in an amazing princess dress, complete with tiara and little heels at the

store? It is immediately evident the child took great pleasure in selecting their outfit and feels like a

million dollars. That “little princess” is in all of us—the need to feel like we are wearing what we

want, what we selected. We like how it looks; we like how it feels. Do not underestimate the need for

your client to select what they want to wear and the impact it has on their self-esteem.

Does your client want to wear a bra or camisole or undershirt? Does your client want to wear

underwear over a protective brief?

Let them decide.

 Assist as needed, but promote independence.

Again, think back to the toddler who wants to get dressed by themselves and may spend over 5

minutes tying their shoes when you can do it in mere seconds. Be patient, monitor, and assist as

needed with buttons, zippers or hard-to-reach areas.

Some of your clients will need more assistance. You will know this from the Care Plan.

Steps to Help Clients who Need More Help in Dressing

1. Wash your hands: As with any activity when you will be touching your client, it is necessary to

follow proper hand hygiene steps to prevent the spread of infection.

2. Gather necessary clothing: Remember, ask their input. As long as items are clean and

appropriate for the weather, let them dress how they wish.

3. Explain what you are going to do each step of the way: “Mrs. Smith this is the time you get

dressed every day. Do you know what you would like to wear?”

This all depends on their ability to communicate. You may offer the choice between a few shirts if

the person has mid-stage Alzheimer’s Disease. Or the client may know exactly what they want to

wear.

4. Provide privacy: Remember, your senior client grew up in a different era and may have a

completely different sense of privacy. As a caregiver, you may have seen “everything” and modesty

is not a big deal to you. For your client, the loss of privacy can be tough. Make sure you respect them

and help them maintain their dignity.

5. Provide assistive devices, per the Care Plan: Please reference the adaptive dressing devices later

in this section.

6. Personal assistance: Assist your client in removing gowns, pajamas, or soiled clothing.

7. Dressing the bedbound: If the client is in bed, you can help them put on underclothes, stockings,

and pants while lying down.

Putting on underpants(disposable protective briefs if worn by the client) or pants (when lying

down)
1. Put both legs in pants; slide up to hips.
2. Have the client lift his hips and pull his pants up.
3. If the client is unable to lift his hips, turn to one side and slip pants over one hip, then
turn to the opposite side and pull pants over the other hip.
4. Zip the zipper and fasten snap or button).
5. If the client has a catheter, leave the fly open to allow for tubing then pin the fly shut.
6. If the client has a leg bag, make sure it is not visible when he is dressed.

Putting on a bra
1. Have the client slip arms through the shoulder straps.
2. Position the bra properly and fasten.

Putting on socks
1. Fold the stocking down from the opening to just beyond the heel.
2. Support the client’s ankle and slip folded stocking over the toes.
3. Position it over the heel and pull it up smoothly over the leg.

Putting on shoes—Remember, socks should ALWAYS be worn for comfort and safety
1. Always help the client put on shoes before standing up from bed to avoid slipping on
the floor.
2. Loosen laces and pull the tongue of the shoe forward and up.
 3. Support the client’s ankle as you slide the toes, foot, and heel into the shoe.
4. NOTE: USE A SHOEHORN, IF AVAILABLE.
5. If possible, have the client stand and tie his shoelaces.

Putting on a shirt
1. Raise the head of the bed to a near sitting or assist the client into a sitting position on
side of the bed or into a chair at the bedside.
2. Assist or have the client put their weaker arm in the sleeve of the garment first while
there is more “give.”
3. Put the other arm in next.

WASH Your HANDS when finished dressing your client

Steps to help clients who need more help in undressing

Care also has to be taken to undress your client. Check the care plan to understand how much

assistance is needed.

1. Wash your hands: As with any activity when you will be touching your client, it is necessary to

follow proper hand hygiene steps to prevent the spread of infection.

2. Let the client know it is time to change. Instead of saying I am going to change your clothes, get

their agreement when possible. “Mrs. Smith, it is almost the usual time to get changed, are you

ready?” In later stages of dementia, you may have to say “Mrs. Smith it’s time to change into your

comfy clothes, so you can get a great night’s sleep and have a great day tomorrow.” In this instance,

you are telling Mrs. Smith a benefit to her for changing clothes. It all depends on your client’s

willingness.

3. Gather clothing: Remember, your client should decide what they are going to wear, if possible. If

changing to night clothes, “what do they want to wear?” It may be an easy choice, as all could be the

same, but it is still important to ask. “Mrs. Smith, you have 3 nightgowns in your drawer. Do you

want to wear the purple, pink, or blue one?”

4. Provide privacy.

5. Provide assistive devices: See your Care Plan.

6. Assist your client from the chair to the bed: If they are able, have the client sit on the side of the

bed. If the client is unable, help them to lie down.

Remove shoes and socks (if the client is lying down)
1. Loosen shoelaces and pull the tongue of the shoe forward and up.
2. Support ankle and slide foot out of the shoe.
3. Store shoes in the closet.
4. Remove stockings.
5. Fold stocking down to the ankle.
6. Support ankle and slide stocking off the foot.

Remove pullover sweater or shirt

1. Loosen (unzip/unbutton) and grasp the bottom of the garment at back and pull to the
neck.
2. Pull the garment over their head.
3. Pull the garment off the arms.

Remove a dress or shirt

1. Loosen and remove the sleeve of the garment from the strong arm first.
2. If the client is lying down, roll the client and tuck the half-removed garment under the
client.
3. Return the client to back; turn him slightly in the opposite direction; grasp the
garment and pull out.
4. Remove the garment from the weaker arm.
5. Follow the same sequence if the client is sitting up.

Remove pants/underpants:

 Unfasten pants at the waist and unzip.

 Have the client stand if able and pull their pants down their legs.

 If the client is lying down, have him lift his hips up and slip his pants down over his buttocks.

 If the client is unable to do this, roll the client towards you, slip pants down over the hip, then
return the client to the back, roll to the opposite side, and pull pants down over the other hip.

Remove bra

 Unfasten the bra or assist your client in unfastening the bra.

  Slip arms out of shoulder straps.

Hang clothes that can be used again without washing, like sweaters in closet.

Place soiled garments in an appropriate container.

Wash your hands.

These are conditions that can cause your clients to have difficulty dressing unassisted

Partial paralysis or loss of muscle control caused by

 Stroke

 Parkinson’s Disease

 ALS or MS

 Injury

 Rheumatoid Arthritis

 Alzheimer’s Disease

General weakness caused by

 Cancer

 Other diseases

 Pain mediation

Adaptive Equipment and Clothing

There are many dressing aids that can help your client have more independence in dressing. There

are also clothing options that can help dress your client easier.

You may want to suggest some items if they are not currently being used. This is apparel specially

designed to make dressing easier and more comfortable.

There are many products available with built-in features like velcro tabs and magnetic snap buttons.

You can suggest pants that stretch or shirts that button open or zip open to allow for them to be put

on and removed easily. Elastic waistbands or adjustable waistbands can be comfortable and helpful

to encourage independence.

Caution in going UP a size

When clothes and shoes do not fit well, it can lead to injuries and falls. This is especially dangerous

when going up in shoe size, as feet normally only change in width due to swelling.

Adaptive Equipment:
 Adaptive Belts: One-handed belts to help clients who had a stroke or injury on one side.
 Extended Shoe-horns: Helps the clients to put on shoes without bending over.
 Elastic Shoelaces: Inexpensive to switch out traditional shoelaces, plus they look good.
 Sock Aids: Help by forming the sock in an open, rigid shape and the person can guide their
foot in.
 Buttoning and Zipping Devices: Wide range of rings, pulls and grips for zippers and
buttons that help a person dress with ease. If there is a person who can do simple sewing,
button shirts can be switched out to close with velcro.
 Reacher and Dressing Stick: Other devices which help in dressing.
Proper socks and shoes are important to reduce slips, trips, and falls. If your client does not want to

wear shoes, encourage slippers that fit securely and are non-skid, or non-kid socks. Shoes and socks

are the first choices.

Assisting the Senior with Applying the Compression Device

A compression bandage is a stretchable bandage that is used to wrap around a body part that has a

sprain or strain to put pressure on it which helps reduce the swelling and help make the injured area

feel better. It is often used in First Aid as a part of therapy that is known as RICE (rest, ice,

compression, and elevation).

Applying a compression bandage is easy, just make sure you apply the right amount of pressure to

prevent swelling and help stabilize the injury. The bandage should be snug but not so tight to let the

blood flow.

Home services workers, or caregivers, may assist a client with dressing.

This may include assistance with ordinary clothing and the application of
support stockings of the type that can be purchased
without a prescription from a health care professional.
A non-medical caregiver MAY NOT ASSIST with applying an elastic bandage that can be purchased

only with a prescription from a health care professional or with applying a sequential compression

device that can be purchased only with a prescription from a health care professional unless the

following requirements are met:

 The client's prescribing health care professional has issued an order allowing the home
service worker caregiver to apply the compression device as a part of daily activities of living

 The client or client's representative shall be able to provide ongoing feedback to the home
services worker including indications of potential harm and discomfort and advocate for their
needs.
  The home services worker caregiver shall have completed training in the application of the
compression device, including observations of indications of potential harm or discomfort
and completes a competency exam.

Compression Bandage on a leg or arm:

1. If the bandage isn't rolled already, roll it up.
2. Hold the bandage so the start of the roll is facing up.
3. Hold the limb to keep it in a neutral position.
4. Start wrapping at the furthest end of a limb.
5. Continue wrapping, overlapping the edges by an inch or so each time you go
around.
6. When finished, secure the end with clip fasteners or tape.

Compression Bandage on an ankle:

1. If the bandage isn't rolled already, roll it up.
2. Hold the bandage so the start of the roll is facing up.
3. Keep the ankle at about a 90-degree angle.
4. Start wrapping at the base of your toes, wrap the bandage continuously until you
reach the heel.
5. Leaving the heel exposed, circle the bandage around the ankle.
6. Then, circle the bandage in a figure-8 pattern around the arch of the foot.
7. Continue wrapping in a figure-8 pattern, moving down toward the heel on the bottom
and up toward the calf at the top.
8. The wrap should cover the entire foot from the base of the toes to about 5 or 6
inches above the ankle.
9. Secure the end with clip fasteners or tape.

Compression Bandage on a wrist:

1. If the bandage isn't rolled already, roll it up.
2. Hold the bandage so the start of the roll is facing up.
3. Wrap the bandage around the hand starting at the base of the fingers.
4. Then wrap the bandage around the hand between the thumb and index finger.
5. Continue wrapping around the hand and toward the wrist, overlapping the bandage.
6. Circle the wrist several times, ending about 5 to 6 inches above the wrist.
7. Secure the end with clip fasteners or tape.

Do's and Don'ts in Applying Compression Bandage

Do's

 The compression bandage should only be used in the first 24 to 48 hours after an Injury.

 You must combine rest and elevation with compression whenever possible.

 Remove the bandage at least twice a day for a few minutes before placing it back again.
  Ask the doctor if the senior need to wear the bandage at night. If so, loosen it slightly before
bedtime.

Don'ts:

 Applying ice and compression at the same time can cause frostbite, so please don't.

 Don't wrap the bandage too tightly. This can cut off blood circulation.

 Don't use a compression bandage to prevent re-injury. The bandages can help stabilize joints,
but they neither support nor protect them.

Watch this video on Compression Bandages Systems: 3 minutes, 35 seconds

What’s Going On?

Your Client Wants to Wear the Same Clothes Every Day.

As people age, various causes can affect the brain and its thinking processes.

It can be caused by dementia or Alzheimer’s Disease or could be a completely different cause, like

wanting to save money or being bothered with laundering clothes.

Be non-confrontational

“I notice you wear that shirt often, is it your favorite?”

This allows your client to give their reasoning instead of, “You’ve been wearing that outfit for days!

Don’t you realize it needs washing?”

1. Decide if this is a problem:

 It may not be such a big deal if they only change clothing every couple of days, especially if
they’re content in them.

 If proper hygiene is an issue, like the outfit is visibly dirty, has an odor or is ragged, then
there is cause to help persuade your client to rotate their clothing more often.

2. Involve them in the process to make other choices

  Organize their closet or drawers and draw attention to items they may like but have forgotten
about.

 Use their input to make a clothing schedule, if they are up for it, be creative (Floral Friday,
Striped Saturday, or items to match the time of year, like a Pumpkin sweater in the fall.)

3. Sameness can be a good thing

 Encourage them to buy doubles or triples of favorite items, so one item can be washed while
the other is worn.

 Having extras of bras, underwear, and socks can encourage them to be bought in the same
color and style so they all are the same.

4. Be positive and have steps to promote the result you want

 Promote laundry day: “Mrs. Smith, today is laundry day, all of your clothes will be clean and
fresh for next week.” It is positive and you’ve promoted it in a favorable light. Involve your
client in the laundry, maybe they can help you sort like colors or fold the clothes and put
them away with your assistance.

 Place the clothes for the next dressing on a chair. Have the client help pick out the clothes
ahead of time. Oftentimes your client will be more alert and willing in the morning, so you
can use that time to select items. “Mrs. Smith, I see it is time for you to change for the
evening. You did a great job picking out your comfy night clothes this morning.” Now the
senior is tired and it is one less thing they have to think about.

Person-Centered Assistance

Assist the seniors in getting dressed each day based on their needs. Realize that getting dressed for

the day is part of a healthy daily routine. If a senior does not want to get dressed, this could be a sign

of depression or indicate they are not feeling well and you should explore why they are not in the

mood to get dressed. Assist the senior with choosing their outfits, if this is needed. If a senior has

physical limitations and needs help with dressing, discuss how you will be tackling the task ahead of
time so that everyone will be comfortable. Remember to keep a sense of humor and to respect the

senior’s dignity.

Tips for Assisting with Dressing

 Layout the clothes in the right sequence and focus the attention on the next step

 Demonstrate what comes next and make dressing one of the main activities each day

 Try buying similar underwear and exchange it discreetly if changing underwear becomes a
problem

 Buy comfortable clothing that will be easy to put on and wash

 Buy easy-to-put-on shoes that are non-slip and comfortable and can be put on and taken off
easily (perhaps a velcro closure)

 Don't use belts or other accessories which just get in the way

Tip Sheet
Bathroom Safety Equipment Includes Grab Bars, Shower Chair, and No-Skid Rugs, May use a bag

bath in the home during the end-of-life care, Make sure to prepare every item needed to use when

Sponge bathing (Bed Bathing), Perineum is the last area to be washed, Encourage independence to

clients in selecting what to wear and if they want to dress by themselves.

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.

Prevention
Skin, Hair, Nail and Mouth Care with Shampooing and Shaving Rqmts.
Skin Care

Skincare becomes more vital when a senior becomes bedridden. The aging process causes the skin to

lose elasticity and become what we call “wrinkled” and thinner and more susceptible to bruising. In

addition, dryness can also be a challenge. Avoid bed sores and maintain healthy skincare by doing

the following:

 Keep skin clean and dry

 Use mild soaps, rinse well and dry thoroughly

 Keep bed linens clean

 Use disposable bed pads to wick away dampness and keep skin dry

 Reposition the senior every 2 hours if they are bedridden

 Massage skin gently when repositioning if confined to a wheelchair or bed

 Use pillows, gel cushions, water cushions or foam wedges to help reposition the body when a
senior must remain in bed or chair

 Investigate using plush sheep rugs or a foam egg-crate mattress which can spread weight over
a larger skin area

 Encourage appropriate exercise to stimulate circulation or assist with moving the arms and
legs if the senior cannot do so on their own

 Avoid Moisture: Dampness or thick layers of lotions or general wetness can promote the
formation of pressure sores

 Friction can cause a pressure sore on aging skin — avoid sliding, moving or sitting on a hard
surface

 Rashes or skin irritations may cause a break in the skin and promote pressure sores — mind
these closely to prevent a pressure sore from forming

Just remember skin becomes delicate, just like you must be careful when handling an object you

don't want to drop and break, you must be very careful when caring for a senior's skin.
A home services caregiver MAY apply a simple bandage as first aid ONLY when:

 Skin is unbroken

 No present chronic skin problems

 Shall have completed training in first aid for a lay person.

Observe and Report

You can tell when a person has a problem with their skin as it will turn pale, white, red, or even

purple in some areas. The person may also get blisters or bruises. Complaints of tingling, warmth, or

burning are common feelings to observe.

Other symptoms may include:

 Dry or flaking skin

 Rashes or skin discoloration

 Swelling

 Cuts, boils, wounds, abrasions

 Fluid or blood draining from skin

 Broken skin

 Changes in moistness/dryness

 Changes in wound or ulcer (Size, depth, drainage, color, odor)

 Redness or broken skin between toes or around toenails

 Scalp or hair changes

 Skin that appears different from normal or that has changed

Hair Care

Seniors experience the natural aging process with hair care which includes hair loss or natural hair

color “going gray” (or white).

The process can be stressful, especially if a senior has hair loss or hair thinning accelerated because

of medications or a newly diagnosed disease.

 Hair Salon or Barber Shop Visit: Try to facilitate visiting a hair salon or barber as long as the
senior is able to leave their home as this establishes a feeling of inclusion in social life and
also can be a fun activity

 Dry Shampoo is available if the senior is bedridden

 Comb, brush, and style hair daily

 Maintain all facial hair care (waxing and tweezing by professionals if the senior cannot
maintain facial hair upkeep themselves)

 Explore wigs as options

Note: Discuss bringing a hair-care professional to the home for cuts, styles, and waxing if the senior

cannot easily go to the salon or barber. Our hair texture, color, and thickness changes as a natural part

of the aging process. Each person has to decide how to manage these changes. Haircare experts can

help to discuss options for caring for these changes.

Shaving

Refer to the Care Plan for the senior’s shaving routine. If the seniors can shave themselves, this is

preferable, as they are able to maintain their dignity and a life-long routine. However, the caregiver

should monitor the senior before and after shaving and assist the process to go smoothly.
Age causes thinning of the skin and dryness which can complicate the shaving process. To prevent

uneven hair, cuts, and infections follow these basic steps:

 Prepare the skin by washing with warm water.

 Apply enough shaving foam on the area and spread thoroughly. Make sure to use the
appropriate shaving foam as there are special ones for sensitive skin, depending on the
client's needs.

 Always use sharp and quality blades. Make sure they are cleaned and regularly changed.

 Shave in bright light.

1. Start by shaving downward from ear to chin.

2. Clean razor between strokes.
3. Carefully shave the neck upward to the chin.
4. Shave under the lip in one direction
5. Shave the chin.
6. Keep the skin pulled tightly.
7. DO NOT USE PRESSURE. If you need to use pressure, the razor is not sharp
enough.
8. Shave the other side of the face.
9. Rinse the skin with cold water after shaving and use an aftershave balm that suits
the client's skin care needs.

Electric razors are a good alternative.

Nail Care

Maintain healthy nails with the cleaning of hands and fingernails. Caregivers may assist with nail

maintenance including filing nails for clients with a medical condition ONLY when the client's
healthcare provider issued an order allowing the filing of nails. But caregivers are not manicurists

and should coach the seniors to keep their nails trimmed. Encourage a weekly nail care routine.

Volunteer to help with a manicure but avoid nail scissors or cuticle care which must be left to a

licensed nail professional. As we age, both fingernails and toenails become thicker and may require a

medical professional for trimming.

Mouth Care

We perform oral hygiene to:

1. Prevent mouth inflammation

2. Prevent tooth decay
3. Keep gums healthy
4. Prevent bad breath

Did you know?

Gum disease is linked to many health problems, such as heart attack, stroke, and diabetes.

General guidelines for healthy teeth and gums

 Brush teeth after every meal, at the very minimum after breakfast and last thing before bed

 Inspect the mouth for sores and broken teeth

 Check dentures regularly to make sure they are fitting properly

 If the client has experienced a stroke, be sure to check the side of the mouth affected by the
stroke, food tends to gather in that area. Gently wipe out the mouth with a soft cloth.

Brush a minimum of twice daily with a toothpaste that contains fluoride

Floss once per day

Rinse with an antiseptic mouthwash once or twice per day

Common oral issues in seniors

Darkened teeth

The outer enamel layer can thin over time and can allow yellower dentin to show through. It can also

be a sign of a more serious problem and should be checked out by a dentist.

Dry mouth

Reduced saliva flow can be caused by cancer treatment and some medications

Loss of taste

Medications and dentures can cause loss of taste

Root decay

Gum tissue recedes and the roots of the teeth are exposed and can cause sensitivity.

Gum disease

Generally caused by plaque and made worse by food stuck in teeth, use of tobacco, poor-fitting

dentures, poor diets, and diseases like anemia, cancer, or diabetes.

Tooth loss

Gum disease is the leading cause of tooth loss

Thrush

Diseases or drugs that affect the immune system can cause an overgrowth of fungus Candida albicans

Age is not a dominant or leading factor in determining a person’s oral health, but conditions like

arthritis in the hands or fingers can make brushing or flossing very difficult.

How to brush someone else’s teeth

Before you begin

  Begin by putting on disposable gloves

 Use a towel to protect the person’s clothing and for wiping the mouth

 Good light is helpful—a camping head-light will keep your hands free and allow you to see
inside the mouth

How to brush
1. Encourage the person to relax their lips and cheeks
2. Introduce the toothbrush at the corner of the mouth
3. Start on the gum line
4. Brush one or 2 teeth at a time in small, gentle circles
5. Clean all surfaces of the teeth, outside, inside, and chewing surfaces
6. Gently brush inside the cheeks, gums, and under the tongue
7. Have the person spit out any toothpaste left in the mouth
8. Provide a glass of water for rinsing

Tips

 If the person has trouble holding the toothbrush, use a strap, the same one used to help a
person hold a fork or spoon

 You may be able to create a holder with a rubber band or elastic, make sure it isn’t too tight.

 Some people use a racquetball or piece of a pool noodle to make a bigger handle.

 There are many options for power toothbrushes now, and they may be more effective and do
the work for the client.

 Try “tell-show-do” Tell what you are going to do, show what you are going to do, then do the
procedure.

How to floss someone else's teeth

If the person you care for cannot floss their own teeth, it is important you help floss. Flossing is very

important for proper oral hygiene and health.

Before you begin

Have the person get in a comfortable position. One of the best positions for flossing is to have the

person lie down on the bed or reclined in a recliner, while you sit alongside. Think of how your
dentist or hygienist positions themselves while you are in the dentist's chair, try to repeat the same

set-up, with you on a small stool or kneeling.

How to floss
1. Begin by putting on disposable gloves
2. Use a string of floss about 2 feet long. Wrap that piece around the middle finger of
each hand
3. Grip the floss between the thumb and index finger of each hand
4. Start on the bottom teeth and work from one side to the other, then repeat on the
upper teeth
5. Make sure to ease the floss gently between the teeth until it reaches the gumline,
don’t snap or force the floss into place
6. Curve the floss like the letter “c” around each tooth, keeping in contact with the side
of the tooth
7. Slide the floss up, down, and under the gum
8. Repeat for every tooth, one side at a time
9. Adjust the floss as you move, so you have clean floss

Teeth and Denture Care

Special dental care needs should be included in the senior’s care plan. Denture care will have a plan

of action for cleaning to follow. Regular teeth cleaning includes brushing the teeth after meals and

after waking each morning and before retiring to bed. Some seniors will experience challenges with

bad breath due to their own loss of smell and because of medications or certain digestive issues.

Assist the senior to obtain a mouthwash and mints to maintain fresh breath throughout the day.

Remember, our sense of smell changes as we age too. This is why it can be easier for a senior to have

bad breath or spray on too much cologne—they simply are not able to smell as well anymore.

Provide kind feedback to them to know if there is an unpleasant odor or perhaps too much of a good

thing.

Watch Video on How to Clean Dentures: 2 Minutes

Dental Tips for Seniors

1. Toothbrushes: Gums become more sensitive as we age. Brush teeth using a soft
toothbrush. One way to make toothbrush bristles softer is to soak the brush in hot
water or use a gauze-wrapped popsicle stick or cotton swab.
 2. Rinse mouth with baking soda and 2 cups of water if do not have mouthwash
3. Keep lips moist for mouth comfort: Use lip balm
4. Use a flashlight to identify specific issues inside the mouth before reporting to a
doctor
5. Contact a Care Manager if: gums bleed, you find sores or cuts in the mouth

Watch Video on the Importance of Dental Health: 2 Minutes

Hearing Aid Care

Care of Hearing Aids and Cochlear Devices:

 Assist to make sure the hearing device is properly placed in the ear

 Make sure the hearing aid is functioning

 Replace batteries

 Clean according to instructions

 Store according to instructions

Watch Video on General Hearing Aid Care: 2 Minutes, 19 Seconds

Tip Sheet
Comb or Brush Hair Daily, Monitor Shaving if Client can Do This Themselves, Nails Become

Thicker as We Age, Use Soft Toothbrushes for Sensitive Gums, Not All Hearing Aids Are Alike

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.

Prevention
Toileting, Bladder and Bowel Care
Toileting
Safety and respect must both be considered when assisting a senior with toileting. As our body ages,

the bowels and urinary tract may lose functionality. Diseases, medications, and loss of physical

capabilities from a stroke, hip replacement, or heart surgery can all cause changes to toileting needs.

Types of toileting assistance include the following:

 1. Catheter Care
2. Incontinence Care
3. Constipation

Catheter Care

Follow the instructions provided based on the type of catheter.

 Usually, you will just need to empty the container the catheter empties into

 Be very mindful that respecting the challenges of catheter care is vital

 One of the ways to successfully discuss this challenge is to put yourself in their shoes and tell
the senior you know it is a challenge and that you want their feedback on how to make the
process go smoothly

 Discuss the schedule for the catheter care and ask them if they would like you to check it at
certain times throughout the day.

Incontinence Care

Loss of bladder and bowel control are not normal parts of aging. However, women who have had

children are very likely to have a loss of bladder control eventually. Medical solutions exist for loss
of bladder control and bowel control and as a caregiver, you should discuss the situation with the

senior to be sure their medical doctor has been informed.

Adult diapers are one solution that can be used if more advanced medical solutions or retraining

programs are not performed. Today's adult diapers use modern technology and come in many shapes

and sizes to make it very easy to be discreet.

Pee-Proof Underwear: these are also now available, in all shapes and sizes and even younger

people are wearing these for protection. Share with seniors that people of all ages are now wearing

underwear that protects them from leakage.

In addition, going to the bathroom every 2 hours may be helpful.

Also, discuss bedtime solutions such as special bed sheets or bed pads.

Remember, a regular eating and drinking schedule will result in regular times for elimination

and will be helpful for seniors who are incontinent.

Watch Video on How to Apply and Change Adult Diapers: 1 Minute, 45 Seconds

Constipation

Inactivity and medications can contribute to constipation. There are both natural remedies as well as

medications that can help “loosen” the situation! Discuss the following with the senior and make sure

they have informed their medical doctor:

 Stool Softeners

 High Fiber Foods: fresh fruits, vegetables, prune juice

 Drink More Water: a full glass of water upon waking and throughout the day

 Avoid foods such as cheese, rice, bananas

 Exercise as much as recommended

  Review medication side-effects

 Call the doctor if bowels aren’t “moving” regularly — daily bowel movements are a sign of a
healthy digestive system.

Bowel and Bladder Care

Medical conditions and natural changes that happen with the body's aging process sometimes impact

the ability to go to the bathroom in the usual ways.

The discomfort of bowel and bladder conditions have the added complication of bringing social

embarrassment. Caregiving includes showing compassion and understanding, along with assisting

with the care needs in this area.

Bladder dysfunction: Little or no control of urine

1. If the problem has come on suddenly, the person should see their health care provider. It may be

an infection. Try to find out why the incontinence has occurred.

  Consider using an incontinence pad that will keep the person’s clothing or bedding dry

 Take the person to the toilet at times close to when they find themselves wetting.

 Keep track of the time the person urinated to help determine a schedule

 Males may find using a bedpan more convenient

 Use a waterproof sheet under the bedsheet.

 Think about non-slip floors or non-slip mats

 Ensure adequate lighting on the way to the toilet.

 Use walking aids, grip rails, and night lights to assist.

2. If the person suddenly CAN’T pass urine, call the office. THIS COULD BECOME A MEDICAL

EMERGENCY.

Medications that may lead to bladder (urine) incontinence:

 Fluid tablets (diuretics)

 Antihistamines (for hay fever)

 Blood pressure tablets (antihypertensives)

 Strong painkillers (analgesia)

 Antidepressants

 Parkinson’s tablets

 Sleeping tablets

 Constipation medicine

 Antipsychotic and other tranquilizing medications

Bowel dysfunction: Little or no control of the bowel

1. If the problem has come on suddenly, seek medical care.

2. Look for causes such as food poisoning, or eating different foods from usual.

3. When possible, to prevent this from happening again, try to remove or avoid these foods.
4. Stress can bring on diarrhea. Is the person anxious or worried about something?

5. Check for new medications, to find out if that may be the cause.

Some medicines cause problems.

Antibiotics often cause diarrhea.

Painkillers may cause constipation.

Consider using an incontinence pad for protection.

Use a cream to protect the person’s skin, the same ones that are used for diaper rash. Bowel motions

and extra wiping can make skin red and sore very quickly.

Wear disposable gloves to protect yourself as a caregiver.

Use proper handwashing techniques.

If possible, have a commode chair handy for the person you are caring for.

Use air fresheners/neutralizers to clear the odors from the air.

Medications that may affect the bowel

 Antidepressants

 Sleeping tablets

 Parkinson’s tablets

 Anti-inflammatory tablets

 Strong painkillers

 Laxatives/aperients

 Fluid tablets

 Medications used for bladder control

 Calcium or magnesium products (for strong bones or heartburn/indigestion)

 Antipsychotic and antidepressant medications

  Antibiotics

Cleaning and Washing Clothing and Linen in the Home

 Wear disposable gloves to protect yourself.

 Dispose of used pads by wrapping in a plastic bag and placing in your garbage bin for
disposal

 For clothing and linen, set up a soaker bucket with water and soaking solution

 It is important to think about safety, so once you have soaked the clothing or bedding
overnight the bucket can be emptied into the washing machine

 A full bucket is heavy, so use proper lifting techniques

 Consider wash-and-wear and easy-to-change clothing and bedding

 Consider the easiest way to clean your floors and chairs

 Plastic-backed disposable pads can be used around the chairs and beds to protect carpet and
rugs

Food and Fluids

Some foods, such as fruit and vegetables, can be pureed or blended.

This helps to soften the stools and improve bowel health and also add fluid to the body.
If the person you are caring for has constipation or diarrhea it may be helpful to look at the amount of

fiber in their diet.

Too little fiber can make the stools hard and dry. Too much can make the stools soft and runny.

Having constipation can cause urinary incontinence too.

Keep Them Hydrated

It is important for people with incontinence to remain well hydrated, so unless you have been advised

differently you need to provide the person you are caring for with between 6 to 8 cups of fluid every

day, including:

o Water

o Fruit juice

o Tea and coffee — in moderation. (coffee can spark bowel movements)

o Fluids should be consumed throughout the day

Water is your body's principal chemical component and makes up about 60 percent of your body

weight. Your body depends on water to survive.

Every cell, tissue, and organ in your body needs water to work properly. For example, water:

 Gets rid of wastes through urination, perspiration and bowel movements

 Keeps your temperature normal

 Lubricates and cushions joints

 Protects sensitive tissues

Lack of water can lead to dehydration — a condition that occurs when you don't have enough water

in your body to carry out normal functions. Even mild dehydration can drain your energy and make

you tired.
DO NOT RESTRICT FLUIDS unless advised by a physician.

Jellies, custards and ice cream can also add fluid.

Take care with caffeinated and alcoholic drinks, such as coffee, tea or cola as these make the bladder

irritable and cause people to go to the toilet more often.

Alcoholic drinks and some medicines make the body produce more urine, so the bladder fills faster

than normal, which means that it may need to pass urine more often. It may also mean there is less

control over the bladder or bowel.

Mobility

People who live with incontinence may be unable to get to the toilet in time because they have

difficulty walking or moving.

It may be that if the person can reach the toilet in time, they are no longer incontinent.

1. Set up the house to make access to the toilet as easy as possible.

2. For men, try a bedpan/urinal for urine.
3. Alternatively, for either men or women, a commode chair brings the toilet to the
person
4. Make sure walking aids, hand grips, bed rails (if bedbound), wheelchairs and
commode chairs with wheels are easily accessible to help with mobility.
5. Make safety your first concern: ensure floors are made ‘non-slip’ by using washable
grip backed rugs and try ‘stick-on’ or ‘paint-on’ etching, tiles or non-slip compounds
over linoleum and floor tiles.

The Bladder:
Many people believe that drinking water may increase the risk of wetting themselves, so they refuse

to drink to avoid this risk.

While this belief is understandable, it is not the whole picture. In fact, not drinking enough water will

cause urinary incontinence, constipation, and dehydration.

The normal, healthy bladder can comfortably hold 1 ½ - 2 cups during the day and 4 cups at night. It

is able to completely empty itself when we go to the toilet.

A healthy adult will only pass urine up to six times in the day and up to twice overnight. More than

twice overnight might suggest a problem.

Did you know?

It's common for seniors with incontinence issues to become dehydrated, sometimes so severely that

they must be admitted to the hospital.

Have you ever felt you had to go pee after you just went?

Watch Video about How to Stop Overactive Bladder: 7 Minutes, 30 Seconds

Signs of Urinary Tract Infections or UTIs

Urinary tract infections, also known as (UTIs), are very common for many people and they may

develop symptoms including:

o High temperature

o Stinging or burning when urinating

o Urge to go to the toilet more frequently

o Strong-smelling urine

o Confusion
Seniors may not have all of these signs. Instead, they may just have a sudden onset of incontinence or

a worsening of existing incontinence.

They may also be tired with less energy than usual and may not be able to tell you how they feel.

When prescribed antibiotics for a UTI, it is very important that the patient finished the full course of

antibiotics. If the antibiotics are stopped before the whole course is completed, the infection may

return. When a person is taking antibiotics to help them recover from a UTI, it is important to

remember that they need to drink more fluids than usual which may help flush germs from the

bladder. The bladder finds it hard to hold smelly or infected urine.

Prevent Future Infections from Developing:

1. Encourage the person to drink more water-based fluids (e.g. fruit juice, mineral
water). About 6 to 8 cups of fluid each day is recommended
2. Some people find it very hard to drink that much fluid so you can try jello, soup, or
soda water instead
3. Make sure the person is not rushed and they sit on the toilet and comfortably with
their feet on the ground (insures bladder empties fully)
4. In women, always wipe between the legs with toilet paper from the front of the body
towards the back.
5. Use the toilet paper once and then dispose of it in the toilet bowl
6. After using the toilet, ensure the person you are caring for washes their hands
thoroughly
7. If you assist the person, ensure you wash your hands using proper handwashing
technique

REMEMBER: Wipe from the front of the body to the back — remind your senior clients to do this!

The bowel: The best way to keep your bowel healthy is to avoid constipation and have regular bowel

movements. Bowel regularity varies depending on the person. Fluids and fiber keep the bowel

healthy- it needs sufficient fluids, good fiber, and some exercise daily

The following will help develop regular bowel movements

 Encourage the person to drink more water-based fluids (e.g. fruit juice, mineral water).

 Encourage a minimum of three servings of vegetables and two serves of fruit daily.
  Fruit can be fresh, preserved or stewed. It is important to mix different fibers from fruit,
vegetables, whole grain cereals, bread and products such as kidney beans, lentils, and butter
beans.

 Encourage a hot drink before or during breakfast.

 Train the bowel to pass a motion about 30 minutes after breakfast or lunch.

 Encourage the person you care for to walk whenever they can, even if it is for a short
distance

 If they cannot walk, sitting exercises are helpful.

 Avoid bowel medications (laxatives) where possible.

Bowel problems
Constipation

Constipation occurs when the stools become dry and hard. This can make the bowel movement slow

and difficult to pass through the colon. The normal frequency of bowel movements in adults is

between three per day and three per week. Less than 3 bowel movements per week is normally

considered constipation.

The person for whom you are caring may have fewer bowel movements than usual and start straining

to pass these dry hard motions. People who have trouble with constipation may not feel hungry or

may become listless, tired, have headaches or stomach cramps.

The constant straining may also lead to the start of a condition called piles or hemorrhoids.

The most common causes of constipation are

 Low fiber intake

 Dehydration or low fluid intake

 Too little exercise

  Not going to the toilet when you feel the urge or not ‘going’ when the urge arises

 Some medications

 Long-term use of laxatives/aperients, which reduce the strength of the bowel

 Not emptying the bowel fully

 Long-term illness

Watch Video on Dietary Fiber and Constipation: 1 Minute, 39 seconds

Fecal incontinence: losing control of the bowels is called fecal incontinence or diarrhea. Diarrhea is

when bowel motions are loose and watery. The bowel motions feel urgent, are difficult to control and

are more frequent.

If it is difficult to get the person you are caring for to the toilet or you have difficulty undoing their

clothes, this can be a sign they are incontinent.

Diarrhea can be caused by many things including:

1. Food poisoning
2. Infection
3. Too much fiber
4. Too many laxatives
5. Some medications (antibiotics)
6. Some illnesses (ulcerative colitis)
7. Some mental health conditions

When someone you are caring for has diarrhea:

 Protect the skin

 Wash the person’s buttocks and between their legs after each bowel motion with warm soap
and water.

 Make sure the skin is kept as dry as possible.

 Loose motions can make the skin red and sore.

 Use a barrier cream sparingly to waterproof the skin.

 Settle the stomach- Certain food and drinks can make diarrhea worse.

 Avoid milk-based drinks, spicy foods, caffeinated drinks, and alcohol, which can irritate the
bowel further.
  Prevent the spread of infection-remember that if the person you are caring for has an
infection that is causing diarrhea, you need to avoid

 infecting yourself and others (cross-infection).

 Wash your hands after assisting with toileting or handling soiled garments.

 Wash the person’s hands including between the fingers and scrub their fingernails after using
the toilet.

 Prevent dehydration

Keeping track of a person’s bowel movements can be useful for a short time to help you know when

the person you are caring for has a bowel motion.

The Prostate
Men can have continence problems because of the enlargement of the prostate gland. Prostate

enlargement is part of the normal aging process. This may not necessarily mean cancer or cause

problems.

Look for the following signs:

1. Disturbed sleep because the person needs to pass urine more often at night
2. Increased risk of falling because of poor mobility or unsteady balance
3. Passing small frequent amounts of urine
4. Feeling like the bladder is not fully emptying; needing to ‘go again’
5. A slow start; having to wait a long time for the urine flow to begin
6. A weak stream; a slow flow of urine taking a long time to finish
7. After dribble; drops of urine in the underwear after finishing
 8. Urinary incontinence; unable to hold on until the person gets to the toilet
9. A strong odor to the urine
10. Blood in the urine.

They should seek medical attention if these signs happen to a man you care for and they should take

a urine sample or be prepared to give a urine sample at the visit. It may not be a prostate problem but

it needs to be investigated.

Protecting the home

 Washable chair pads are designed to protect furnishings. They only have a small absorbency,
but do have a waterproof backing. They are not designed to be used alone; the person still
needs to wear a pad.

 Absorbent bed sheets have a stay-dry surface and a thick absorbent underlayer. They must be
used over a waterproof undersheet (unless there is one already on the back) to protect the
mattress. They are highly absorbent, have a stay-dry surface that helps protect the skin,
require less need to change the bed during the night, and may be laundered at home.

Dementia and Incontinence

Watch Video on Dementia and Toileting: 8 Minutes, 25 Seconds

In an older person with dementia, incontinence may become more of a problem as the person:

 Forgets where to find the toilet

 Forgets how to unfasten their clothes

 Forgets what to do when they get to the toilet

 Is more susceptible to urinary infections because of the prostate or gynecological changes

 Becomes more prone to bowel changes such as diarrhea or constipation from medication side
effects

The burden for the caregiver may increase if confusion and memory loss leads to the person resisting

assistance with post-toileting or incontinence hygiene.

TIPS and TOOLS to HELP in the HOME

Bathroom:

 If there is limited room in the toilet for a second person to assist, have the door adjusted to
open outwards.

 Make sure the way to the toilet is clear, remove all clutter and loose mats from the bedrooms,
hallways, and bathrooms

 Make sure there is adequate lighting to and from the toilet.

o Small ‘night lights’ that plug into a socket or sensor lights are useful for directing the

way.

o There are affordable motion-activated, battery operated lights available that have a

peel and stick backing.

 For someone with dementia, place a picture of a toilet on the door. This will help the person
to remember the toilet and find their way there. It is important to keep the sign within their
line of vision, so place it at chest height.

 Make the surface on the toilet floor non-slip.

 Grab rails mounted on the toilet wall or a toilet surround or toilet seat will help to get on and
off the toilet.

 Wipe up any spills to prevent slipping or falling. Keep cleaning supplies and disinfectant
handy.

Bedroom
  Protect the bed with an absorbent bed sheet.

 Clean waterproof fitted mattress protectors to keep odors to a minimum.

 Give men the option of using a urinal.

 Protect, or if possible, remove the carpeting.

 Place a rubber-backed absorbent mat on the floor by the bed.

 If possible, move the person to a bedroom nearer to the toilet. In the living room (Some men
with mental health problems prefer to urinate outside).

 Give free access to the toilet by making sure you remove all clutter from doorways and along
the passageway to the toilet.

 Arrange the living room furniture to allow free access from a favorite chair to the doorway.

 Keep a bedpan nearby in case of emergencies. Make sure it gets washed and disinfected
regularly to prevent odors.

 Protect chair seats with a waterproof chair pad.

Tip Sheet
Seniors May Need Assistance with Eating, Make Sure the Senior is Getting Enough Fluids, Practice

Safety and Respect When Assisting with Toileting, Medications May Affect the Bowel, Keep

Seniors Hydrated, Healthy Urine is Almost Clear

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.
Prevention
Bedbound Care, Repositioning, Exercising
Safe Techniques for Caring for Those Confined to a Bed
Bedsores, also known as pressure ulcers, should never occur in bedridden patients. Learn how to

prevent them and the additional discomfort, pain and infection risks by properly positioning and

moving a bedridden patient. Bedsores can lead to infections such as meningitis, cellulitis,

endocarditis (inflammation of the heart's inner lining). They should be avoided.

Common Hot-Spots in the Body for Bedsores to develop are:

 Shoulder Blades

 Tailbone

 Elbows

 Heels

 Hips

These areas of the body have less fat, allowing for the pressure of the bones against the bedding to

develop sores from the weight of supporting the body. Just like a shelf will eventually fall if you

stack too many books upon it, the same thing happens to your body if you are in the same position

ongoing.
When the body doesn’t get any movement, it can reduce blood flow to the skin, depriving it of

nutrients and oxygen. If your patient is currently on bed rest, there are several things you can do to

prevent bedsores.

1. Change positions frequently: When you change positions often, there will be less
pressure on your skin, reducing the risk of developing pressure ulcers. It is a good
idea to reposition the body at least every couple of hours. For example, if they’ve
been lying on their back for a while, turn them to their side.
2. Keep skin clean and dry: The cleaner and drier the skin is, the less likely it will
develop bedsores. Dip a cloth in a bucket of warm water and mild soap and clean
the skin with it. Then, pat the skin dry with a towel. If you rub too hard, it can lead to
skin irritation. Older adults often have delicate skin, so press gently.
3. Use pillows: Another effective way to prevent bedsores is to put pillows between
parts of the body that press against each other. Place a pillow under the tailbone,
shoulders, heels and elbows. If they are lying on their side, it is better to put the
pillow between the knees and ankles.
4. Exercise: When you can’t even get out of bed, the idea of exercise seems daunting.
However, performing a few range of motion exercises in bed can help reduce the risk
of bedsores.

Safe Bed Care

Sometimes you will assist a client who must stay in bed because they are diagnosed with a terminal

illness or recovering from a medical condition. Making sure they are repositioned regularly and

managing skin care and muscle movement are vital to both maintain comfort and prevent bedsores.

Move or Reposition Anyone Confined to a Bed Every 2 Hours

 Pillows: Use soft, yet firm pillows or foam rollers or wedges to position legs and arms
  Egg Crate Mattress

 Extra Sheets to use as draw sheets to reposition the person

 Bed pads for incontinence or as back-up for comfort

 Bedside table for supplies

Pressure Points: Be aware of where the majority of the weight of the body rests on the bed, and

where bones are resting with the body weight. Elbows, hands, buttocks, feet and face. Reposition

from one side to the other side and use pillows and rolled towels, rolled blankets or foam wedges to

reposition. Try to assist the person to sit up in bed, if possible, and then move from one side to the

other. Monitor skin to be sure no redness develops, which indicates the beginning of a bedsore.

Repositioning in Bed
Pulling a patient up in bed

A patient's body may slowly slide when the person is in bed for a long time. The person may ask to

be moved up higher for comfort or may need to be moved up so a health care provider can do an

exam.

ALWAYS AVOID INJURY

You must move or pull someone up in bed the right way to avoid injuring the patient's shoulders and

skin. Using the right method will also help protect your back.

Friction from rubbing can scrape or tear the person's skin. Common areas at risk for friction are the

shoulders, back, buttocks, elbows, and heels.

Never move patients up by grabbing them under their arms and pulling. This can injure their

shoulders.

Preparing to Move the Patient

A slide sheet is the best way to prevent friction. If you do not have one, you can make a draw sheet

out of a bed sheet folded in half. Follow these steps to prepare the patient:

1. Tell the patient what you are doing.

2. Make the bed flat.
3. Roll the patient to one side, then place a half rolled-up slide sheet or draw sheet
against the person's back.
4. Roll the patient onto the sheet and spread the sheet out flat under the person.
5. Make sure the head, shoulders, and hips are on the sheet.

Pulling up

The goal is to pull, not lift, the patient toward the head of the bed. The 2 people moving the patient

should stand on opposite sides of the bed. To pull the person up both people should:

1. Grab the slide sheet or draw sheet on either side. If using a slide sheet, remove it
when you are done.

If the patient can help you, ask the patient to:

1. Bring the chin up to the chest and bend the knees. The patient's heels should remain
on the bed.
2. Have the patient push with the heels while you pull up. the side of the bed closest to
you.
3. Put one foot forward as you prepare to move the patient.
4. On the count of three, move the patient by pulling the sheet toward the head of the
bed. You may need to do this more than once to get the person in the right position.

Watch Video on Moving Toward the Head of the Bed: 3 Minutes, 3 Seconds

Turning a Patient:
Preparing the Patient

The following steps should be followed:

1. Explain to the patient what you are planning to do so the person knows what to
expect. Encourage the person to help you if possible.
2. Stand on the side of the bed the patient will be turning towards and lower the bed rail
(if present).
3. Ask the patient to look towards you. This will be the direction in which the person is
turning.
4. Move the patient to the center of the bed so the person is not at risk of rolling out of
the bed.
5. The patient's bottom arm should be stretched towards you. Place the person's top
arm across the chest.
 6. Cross the patient's upper ankle over the bottom ankle.

If you are turning the patient onto the stomach, make sure the person's bottom hand is above the head

first.

Turning

The following steps should be followed when turning a patient:

1. If you can, raise the bed to a level that reduces back strain for you. Make the bed
flat.
2. Get as close to the person as you can.
3. Place one of your hands on the patient's shoulder and your other hand on the hip.
4. Standing with one foot ahead of the other, shift your weight to your front foot as you
gently pull the patient's shoulder toward you. Then shift your weight to your back foot
as you gently pull the person's hip toward you.

You may need to repeat steps 3 and 4 until the patient is in the right position.

When the Patient is in the Right Position

1. Make sure the patient's ankles, knees, and elbows are not resting on top of each
other.
2. Make sure the head and neck are in line with the spine, not stretched forward, back,
or to the side.
3. Return the bed to a comfortable position with the side rails up. Check with the patient
to make sure the patient is comfortable. Use pillows as needed.

Watch Video on Turning a Person in the Bed: 3 Minutes, 39 Seconds

Exercise Moves for Bedridden Clients

In or out of bed, daily exercise delivers both mental and physical health benefits and helps the body

to maintain better circulation and muscle tone.

Exercise assists in preventing problems that can arise when someone is immobile.

Caregivers should monitor for constipation, swelling of joints, poor appetite, poor sleep, and

breathing issues.
CHECK with CARE MANAGER to CONFIRM SAFE EXERCISES APPROVED by DOCTOR

 Create a Daily Exercise Routine

 Make it Fun

 Keep Regular Schedule

 Play Music (Create a Custom Playlist, Ask about Favorite Songs)

 Move Legs Up and Down, Side-to-Side, Bend Knees and Straighten Knees

 Bend Arms and Straighten

 Move Neck from Side-to-Side

 Do Breathing Exercises: Inhale, Hold Breath, Exhale

 Do Bed-Sit-ups, if Possible

Remember that exercising daily also assists with mental health, even if the exercises are performed

by the caregiving moving and repositioning the bedridden person's limbs and only involve minimal

movement by the client.

Breathing exercises can also be very beneficial.

Use Household Items

 Arm lifts with Soup Cans

 Leg Lifts with Towel

 Stand-up from Chair

Remember, finding an exercise routine that fits the capabilities will deliver positive mental benefits,

too, even when there are very limited capabilities.

Tip Sheet
Bedsores or pressure ulcers develop when there is too much pressure on the skin. Sores can cause

pain and discomfort, but also infection, even meningitis. Repositioning the patient in bed can reduce

or eliminate the occurrance of bedsores. Exercise can be beneficial for bedridden clients.

 
IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.
Prevention
Safe Transfers with Adaptive Equipment and Ambulation
Assistance with Ambulation
Understand the senior’s walking limitations. Always be near a senior when they are walking and if

they need a cane or walker, use the guard method of maintaining an arm near their waist or under

their arm and shoulder. Always be next to a senior with ambulatory challenges in order to be able to

block a fall.

Beware of Balance

Remember, balance issues can happen from changes in the inner ear canal and even a senior with

strong and healthy legs may lose their balance more easily as part of the aging process. Always stay

near a senior you are caring for when they are walking.

Exercise

Physical exercise should be part of everyone’s routine at every age. Develop a healthy exercise

routine you can do with the senior. Walking, leg lifts, arm lifts, and dancing may all be options. An

exercise routine should be included in the senior’s care plan. The National Institute of Health (NIH)

also offers a booklet on senior exercises. Muscle mass loss will progress if a senior does not use their

muscles. Especially if there has been a hip or knee replacement, exercise is vital to maintain the

joint’s movement and avoid pain.

EXERCISE REMINDER: IF YOU DON’T USE IT, YOU LOSE IT!

Positioning

Being in a comfortable position in a bed or chair can be a welcome pleasure for a senior who may be

struggling with age-related diseases. Discuss what position the senior prefers while sitting or sleeping

and honor this. You will assist some seniors who have slept in a reclining chair for their naps for 20

years and this is what they prefer, rather than a bed. By understanding how the senior finds comfort

while sitting or sleeping, you can assist them to be in a comfortable position. REPOSITION

EVERY 2 HOURS, if the senior is bedridden or has memory loss and may not be aware of the need

to reposition.

Ability to assist in the use of specific adaptive equipment, such as a mechanical lifting device, when

working with clients who use the device.

Safe Lifting Tips:

1.  Think with the End in Mind: Communicate to the senior how you will assist them
2.  Clear the Area: Move furniture and prepare the wheelchair or chair (are the brakes
on or off? Any rugs or clothing in the way?)
3.  Bend at the Knees, Widen Stance: Maintain a wide stance with your feet apart to
balance your weight on your knees, not your waist, by squatting.
4.  Keep the Client Close to You: Place a secure hold on the client and use a gait belt
when necessary
5.  Stand and Pivot: By keeping the wheelchair or chair close to the bed, a pivot works
best
6.  Practice: Be sure you "go-through-the-motions" before you make the transfer
7.  Gait Belts: These belts are the most commonly used tool for making safe transfers.
The gait belt has a big loop buckle and is placed around the senior’s waist to help
steady them during a transfer

Bending at the knees allows your buttock muscles and thighs to do the work for you. Always bend

forward from the hips, not the waist.

Lifting Devices

A physical therapist or occupational therapist should diagnose necessary transfer equipment and

provide training for the senior and caregiver. If a senior’s condition changes while you are caring for

them and they begin to need more assistance with transfers, be aware that the following devices and

techniques may be used.

1.  Back Belts
2.  Gait Belts
3.  Roller Boards
4.  Slide Boards
5.  Drawsheets
6.  Trapeze
7.  Mechanical Lifts
Proper training in using each of the devices is required, by a Care Manager or therapist.

Watch Video on Moving from a Bed to a Chair: 8 Minutes, 37 Seconds

Talk Your Senior Client Through the Process: Remember, for a senior, fear of falling can make

them extra anxious about a transfer. Be sure to make the senior feel at ease and confident in your

ability to transfer them. Be sure you are feeling well and understand how to use the transfer

equipment. If you have any doubts, don’t do the transfer alone. Call your Care Manager. Better safe

than sorry.

Safely Transfer from Bed to Chair

Helping a client move from a bed to a chair may be simple or difficult, depending on the size of the

client, the type of chair and bed, and the client's medical condition.

Consider these factors and think about how to plan for them when you are assisting the client to

transfer:

 How much does the client weigh?

 How well can the client move their legs and arms?

 Is the client "connected" to medical devices such as a catheter bag or leg brace?

 Can the client support their own weight without a walker or cane (stand by themselves)?

Be careful to perform safe transfers based on what is required for the size and capabilities of the

senior.

 Guard and assist when walking: Drape your arm under the senior’s arm and around their
opposite shoulder when escorting for safe ambulation
 Gait Belt: Use to assist with transfer from bed to chair and toilet and back
 Transfer from Bed to Edge-of-Bed: Take another folded flat sheet (drawsheet), position
under the senior from their neck to calves, roll the senior to one side, place the sheet under
 them, then use the sheet to pull the senior to the edge of the bed. Then swing their legs to the
side of the bed to proceed with the transfer.
 Transfer from Bed to Wheelchair or Toilet: Use the gait belt and stay near the senior’s
body

Decide Upon a 1-Person or 2-Person Transfer. If you feel you could not help the client to stand and

prevent them from falling by yourself, then choose the 2-person transfer.

1-Person Transfer (Hands on Client's Shoulders, NOT UNDER

ARMPITS)
STEPS:
1. Dress person appropriately in socks, slippers, or shoes that will allow them to stand
without slipping.
2. Assist them to first sit up in bed. Let them sit for a moment to feel comfortable and
secure.
3. Communicate each step of the way with the client to allow them to be prepared.
4. Lower the bed to the lowest position, if this is an option, as sometimes beds may be
very high.
5. Move the chair into a position close to the bed. If the chair has wheels, be sure they
are locked.
6. Does the client have a "good side" of their body that is stronger? If so, structure your
transfer accordingly.
7. Usually, the "good side" of a person's body connects to being right or left-handed.
8. Assist them to swing their legs over the side of the bed. Support their knees by
placing your knees directly in front of them being careful not to lock your knees.
9. Using proper body mechanics, support their shoulders with your hands, rock them
forward to standing position, tightening both your abdominal and buttock muscles.
10. It is a good idea to count to 3 with the client and on "3" make the transfer - you may
so a verbal practice first.
11. Ask the client to hold onto your shoulders or waist but never around your neck, then
bend your knees slightly and pivot your feet to turn your body along with the client's
body.
12. Lower the client slowly into the chair seat, being careful to keep your back and
shoulders strong (do not round your back). Assist the client to position themselves
comfortably.

NOTE: All of us have nerves under our armpits and while it seems to make a lot of sense to grab

someone under their armpits when transferring them, this can be very uncomfortable for the client
and can pinch a nerve and cause them to lose balance. It is important to support the client by holding

onto their shoulders.

2-Person Transfer for Clients Unable to Stand on Their Own

STEPS:
1. Ask the client to fold their arms in a locked position across their stomach.
2. Position the chair at the level of the client's hips next to the bed (side of the chair is
next to the side of the bed). One person stands behind the chair and reaches for the
client's shoulders while the other person stands in front of the chair and reaches
under the client's thighs and calves.
3. Count to 3 and lift the client into the chair using safe body mechanics.

Using a Drawsheet

Drawsheets are a safe way to assist a client to move up in bed or to transfer them from bed to

stretcher or to the side of the bed for a transfer to a chair.

 Drawsheets can be made from a regular flat bed sheet: fold the sheet in half from top to
bottom and place the folded sheet on the bed with the fold toward the head of the bed.

 Position drawsheet under client from neck to calves.

 Carefully slide a drawsheet under a client by rolling them to one side or lifting their legs and
arms to pull the slide the sheet under them.

 Two people may stand on each side of the bed and roll the edges of the drawsheet up as close
as possible to the client's body in order to use them as handles to then pull the person's body
up in bed or reposition their body for a transfer.
Using a Gait Belt

The gait belt allows caregivers to assist clients who have difficulty walking or who are recovering

from bedrest to feel more secure.

Watch Video on How to Transfer Using a Gait Belt: 1 minute, 43 Seconds

Gait belts allow caregivers to more securely guide and support a client and are long canvas straps

with an adjustable loop closure

 Place the gait belt around the client's waist and tighten the loop buckle to be comfortable yet
secure

 Hold onto the gait belt while the client is transferring from a bed to chair (for clients able to
support themselves this serves as a safety net if they should lose their balance or strength)

 Use the gait belt to help steady a client when they are walking

 Always communicate with your client to know when they are ready to walk or move in order
to be ready to support them with the gait belt

Follow the same system each time you transfer your client and they will learn the routine. By

knowing what to expect, your client will become more comfortable with the process. Be consistent!
Fall Prevention
Growing older will naturally impact some of our capabilities and eventually, the "Oldest Old" (80+)

will sometimes fall. Certainly, there are trips and slips, but the elderly can also fall because their

equilibrium, or balancing, no longer works at 100%.

Remember: Equilibrium Problems Cause Balance Issues, Which Lead to

Falls

65% of seniors older than age 60 will experience dizziness or loss of balance, sometimes on a

daily basis.

Some level of imbalance will be present with all older adults. As part of the aging process, we may

lose:

 Muscle Strength

 Joint Flexibility

 Near and Far-sighted Vision

 Vestibular System Function in the Inner Ear which Monitors Motion and Provides
Orientation Clues
Why? Something called "Functional Degradation" begins to happen in the body.

This means falls will happen because the body can no longer react quickly, and is called "Sensory

Degradation." Even if the senior wants to slow down and react quickly when their foot hits a

slippery surface, they may simply not be able to react quickly enough because of the body's

degradation, or loss, of this ability to quickly communicate to the muscles.

Think of your body as a computer. By the time you are over age 60, you are operating on an older

computer system that cannot process information as quickly as it could when it was new.

Understanding the body's loss of the ability to respond as quickly as a teenager, helps you to

understand that the best way to prevent falls will simply be to make sure the senior does not place

themselves in a danger zone.

Tools to Prevent Falls

Use these guidelines to assist in making sure seniors you care for avoid being in a situation where

they are likely to fall.

Encourage seniors to do the following:

 Wear Sensible Shoes: sturdy shoes with non-skid soles
 Physical Exercise for Strength and Balance: Tai Chi, Yoga, Walking, Water Workouts
 Avoid Steep Stairs: use the railing when walking up and down stairs
 Use Medical Alert System: most falls happen in the home or are in close proximity to the
home and a medical alert bracelet or necklace allows for a quick response
 Use Caution When Walking: walk on smooth, level surfaces with good visibility (tripping
while walking causes falls most often for seniors)
 Keep House Tidy: don't leave books, clothes and other items on the floor
 Rugs: tape down the edges of throw rugs that are necessary and remove ones that may not be
required
 Grab bars: install grab bars in the bathtub, shower, and next to the toilet
Watch Video on the 6 Steps to Prevent Falls: 1 Minute, 39 Seconds

Managing Falls

Risk of falls will always be present when you are assisting a senior with care needs. Follow these

guidelines:

 Assisted Falls — These are falls where the client begins to fall but the impact of the fall is
lessened either because the caregiver is able to hold the client, or the client breaks the impact
of the fall by holding onto something. In these cases, if there is no obvious injury, the
caregiver should make the client comfortable and ask if they have any type of injury or pain.
The caregiver should then contact the emergency contact person listed on the Care Plan (or
follow their company guidelines for whom to call for an emergency), and explain what has
taken place and ask if they would like anything further done. This discussion will determine
what further action, if any, should be taken.
 Witnessed Falls — These are falls the caregiver observes when the fall is not broken in any
way and the client directly falls to the floor or ground. These types of falls can result in
serious injuries including internal bleeding, fractures, and dislocations. In this type of
incident, the caregiver should reassure the client that help will be on the way and determine if
and where the client has pain. The client should not be moved, and 911 and your Care
Manager should be contacted and advised of the fall and the location of the client. The Care
Manager will manage the next steps and an incident report.
 Unwitnessed Falls — These are falls where it is discovered that a client has fallen but the fall
has not been observed by the caregiver or anyone else in the area. In these cases, 911 should
be called and the client comforted until their arrival. The Emergency Medical Technicians
will determine the next course of action. These types of falls require the Care Manager to be
contacted.

Remember that when someone falls, in addition to bruises and broken bones, internal damage may

happen.
Fall Danger Zones

Be aware that it can be easier to fall in situations that require better footing, simply because the older

adult's "computer system" works more slowly.

Hold on to railings when walking up and down stairs, avoid walking on icy sidewalks and streets

(coach seniors to stay home when there can be slippery snow and icy weather conditions, as a fall can

lead to even more health challenges.)

More than 10,000 people die because of a fall injury every year.

The Centers for Disease Control and Prevention reports 1 million Americans are injured and

17,000 die annually as the result of a slip or fall injury.

BE CAREFUL to PREVENT FALLS

Tip Sheet
Bend Knees and Use Wide Stance for Safe Lifting, Communicate Transfer Game-plan, Receive

Transfer Device Training, Gait Belts and Drawsheets Work Well

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.
Prevention
Nutrition and Permitted Feeding Assistance Care
Nutrition for Seniors
As we age, our bodies need less calories as we move around less, have less muscle and our metabolic

rate goes down.

Nutrition is defined as the process of providing or obtaining the food necessary for body health.

Safe Food Handling

Safe Food Handling ensures seniors will receive the proper nutrition and protect them from diseases

and infections.

As many as 1 in 6 Americans will come down with an illness from food-borne

microorganisms each year reports the CDC. This means everyone should learn safe food handling

skills to protect themselves and others.

Tips to avoiding harmful bacteria:

 1. Wash your hands frequently when touching surfaces and before handling and eating
food.
2. Cook food at proper temperatures and save leftovers properly.
3. Do not trust the 5-second rule, bacteria can transfer very quickly.
4. Do not trust hand sanitizers completely, they can help but will never replace
handwashing.
5. Do not cross-contaminate, and keep raw foods away from other foods and utensils.
6. Wash all utensils and countertops thoroughly after cutting raw meats.

Always take the time to think through all aspects of the food you will be eating or providing to

others.

Watch this video from the Center for Disease Control on Food and Kitchen Safety Watch

Video: 2 Minutes

What is Metabolism?

Metabolism is the process by which your body converts what you eat and drink into energy. Calories

from food and drinks are mixed with oxygen to release the energy your body needs to function.

Metabolism includes all the activities your body does to turn food into energy and keep you feeling

good. Think of how you toss wood in the fireplace to keep the fire burning. When the fire burns

brightly, the room warms up and absorbs the heat energy produced by the logs. Your body does the

same with the food and water you consume.

A campfire, or fireplace in the home, will quickly burn dry wood or small twigs and newspapers but

take longer to burn the bigger logs you stack on top.

Your body's ability to process the food you consume, which can be calculated into a number of

calories, results in your "metabolic rate", or metabolism.

Muscle cells require more energy than fat cells and the more active you are,
the more energy you need.
This is what it means to "burn calories" by staying active. Going for a walk, a run, doing situps, or

lifting weights burns calories. Just like a car will operate better when it has the right gas and oil and

regular service visits, you will be able to feel better and provide care services better when you are

Fewer Calories are Needed Every Decade as We Age

As we age we are typically less active and lose muscle mass. Due to these changes, people require

fewer calories. As you age, your body does need the same amount of protein, vitamins, and minerals,

or nutrient-rich foods. And your body needs more of certain vitamins. A nutrient-rich diet is very

important for older adults.

The National Policy and Resource Center on Nutrition and Aging from Florida University

reports that:
 Men aged 50 to 70 need approximately 2,200 calories per day
 Women aged 50 to 70 require 1,980 calories per day.

The calories required after age 70 will lower slightly if the person is living a more sedentary life

(mean sitting most of the day). The U.S. Department of Agriculture defines a sedentary lifestyle as

one in which the person is limited to the activities of daily living.

Walking briskly for more than 3 miles a day is considered active. A person needs more or fewer

calories than what’s recommended based on their metabolism.

Protein

 Males over 70 should aim for 56 grams of protein a day

 Females over 70 should get 46 grams of protein ia day
Foods high in protein: meat, chicken, fish, beans and dairy products, lentils, and nuts are good

sources of plant-based proteins.

Fiber

 Males over 70 should take in 28 grams of fiber daily,

 Females over 70 should consume 22 grams of fiber a day

Fruits, vegetables, legumes (beans, lentils), nuts, and seeds are all foods that deliver fiber.

Fiber moves quickly and easily through your digestive tract and helps it function properly. It keeps it

moving, as many people say!

A high-fiber diet can also help reduce the risk of obesity, heart disease, and diabetes.

Drink Fluids

Drinking plenty of fluids when eating a high-fiber diet will help your digestive system process

everything.

Vitamin and Mineral Needs as we Age:

  B-12: after age 50, the body's ability to absorb the vitamin often lessens due to less stomach
acid
 B6: seniors can have a lower ability to absorb from diabetes, kidney problems or rheumatoid
arthritis. Found in whole grains, and organ meats such as liver and potatoes.
 Vitamin D: aging skin loses the ability to change sunlight into Vitamin D which then
impacts the body's ability to absorb calcium
 Calcium: for strong bones
 Folate: Folic Acid helps the body make and maintain new cells and prevent changes in DNA
which can lead to cancer. Found in broccoli, spinach, nuts, and citrus.
 Potassium: lack of potassium can raise blood pressure, can be found in bananas, potatoes,
yogurt
 Fiber: found in beans, whole grains and veggies and keeps you regular for intestine health
and prevents diabetes

Both vitamins B-12 and D are needed to prevent bone loss.

Breakfast cereals with added vitamins are one way to make sure you are eating enough of the B-

Vitamins and Folate, or Folic Acid.

Did you know? Too Much of a Good Thing is Bad?

Taking too many vitamins can be bad for your body and can actually be toxic at high levels.

Watch this video on Promoting Healthy Aging through Nutrition 5 Minutes, 43 Seconds

Learn and Understand Doctor Suggested Nutrition and Meals for your
Senior Clients

 Review Special Diet Requirements

 Understand Areas of Caution or Possible Deficiencies

Always follow the Senior's Care Plan for Meals and Aim for a Balanced Plate
Make notes in the Care Plan and call the Care Manager to discuss if there are issues with eating

certain foods. Also realize that there may be a number of different factors for why a senior may not

be eating properly, from medication side effects to depression.

Nutritional Support
Here are tips and reminders to use to stay on track for healthy eating.
1. Coping with Loss of Appetite
2. Relax and Do Not Rush through Meals
3. Eat in the Company of Friends
4. Plan Small, Frequent Meals: snacking every 2 hours can achieve the same
nutritional goals as eating 3 meals
5. Serve Colorful Food
6. Sip a glass of wine with a meal, if approved by a doctor
7. Rely on Favorite Foods to help improve a Healthy Appetite
8. Keep Snacks on Hand
9. Leftovers may be Reheated as Snacks
10. Consume Nutrient-dense Foods (Nutrition Bars and Shakes)
11. Eat Largest Meal at Noon
12. Drink Fluids at End of Meal
13. Keep High-Calorie Foods and Beverages in Easy-to-Grab Locations
14. Create Pleasant Environment for Eating
15. Medications: Workout Best Way and Time to Take
Medications and Meals: Manage medications so they do not negatively impact meal time, based on

the senior's preference. Some medications can take away appetite, like pain meds. There could be

small changes made to medication schedules to help improve a senior's appetite.

Taste and Smell Changes

The ability to "smell" foods you taste weakens as you age and a large part of taste happens because

of the nose's ability to smell the food. Aromas are detected in your mouth and in your nose, as you

chew food which releases certain molecules. Medications and age-related physical and mental

changes and dentures will affect the ability to taste and smell.

Be aware that a lower interest in eating may be connected to the loss of taste and smell.

Find out what foods may still spark interest and what textures will still be appealing such as:

 Mashed Potatoes (Soft and Mushy)

 Ice Cream (Cool and Melting)

 Pasta (Shapes and Fillings)

 Pie (Soft or Crunchy)

 Soups (Warm and Soothing)

Talk with your senior client to learn about their favorite foods and think about how you can match

the sensations of eating these items, from melting cheese on top, adding ice cream on the side, or

slicing crunchy celery to sprinkle on top.

Ideas for Coping with Taste and Smell Changes and Dis-Taste of
Medications

 Seasonings: experiment with favorites such as cinnamon, mint, bacon bits, or lemon juice to
add a spark of flavor or tingling to the tongue

 Serve Food at Room Temperature or Cold: REDUCES smells or flavors

 Serve Food Warm or Hot: INCREASES Smells or Flavors

 Offer liquids such as Juice or Lemonade to disguise the taste of the medication

 Offer Applesauce with Medications

 Offer Chicken Broth (Bouillon Cubes for Instant Broth are Available)

 Add a Multi-Vitamin with Minerals such as Zinc (with Approval) which can improve taste
detection

 Rinse Mouth before Eating and After Eating

 Notice Foods that are Satisfying to Serve More Foods with the Same Texture and Feel

Memory Loss Causing Resistance to Meal Time

Some seniors with memory loss sometimes begin to resist meal time or become suddenly agitated

about sitting down to eat.

Repeated research studies, both clinical and impromptu studies conducted at nursing homes and

Assisted Living communities show that serving food on a blue plate provides a sense of calm and can

increase the willingness to eat of those with memory loss by as much as 40%.

Blue Plates are the Best

Nobody knows exactly what may be happening in someone's mind at mealtime when they have

memory loss. Research studies have tested all different colors of plates and designs and discovered in

study after study that serving food on blue plates delivers the best results for compliance at meal time

for seniors experiencing memory loss.

Serve food on a solid blue plate to help seniors be more willing to eat. Buy paper plates in solid blue

to test this out, perhaps, and if it makes a positive difference, let your Care team know.
  

Serving food on a Solid Blue Colored Plate lowers agitation and increases willingness to eat for

those with memory loss. Studies show that many seniors with end-stage Alzheimer's or other
dementia still have a craving for sweet foods. Making a healthy, somewhat sweet smoothie, could be

welcomed instead of savory food.

Swallowing Difficulty
Sometimes a senior will have difficulty with swallowing caused by illness or ongoing chronic

conditions.

 If Throat is Swollen: Serve thick liquids

 Problems Using Tongue or Ability to Chew: Serve Light Foods that Stick Together +
Smoothies

 Offer Easy-to-Chew Foods

 Allow Person to Feed Themselves

Discuss serving a pre-packaged nutrition shake with your Care Manager as there is a variety on the

market now offered in many flavors and textures.

Diabetic Diet
Seniors with diabetes must follow their prescribed diet and usually will monitor their blood sugar

levels daily. Requires eating the healthiest foods in moderate amounts and keeping regular

mealtimes. It should be a diet rich in nutrients. Whole fruits and vegetables and healthy protein

should be major parts of the diet.

The Diabetic Diet:

 Eating Healthy Whole Foods

 Keeping Regular Mealtimes

 Eating Foods Rich in Nutrients

 Monitoring Carbohydrates

Foods to Avoid

 Processed Foods (with additives you may not be aware of)

 Trans fats: found in processed snacks, shortening, stick margarine

 Sodium: salt can be added to many canned foods and frozen foods - always check for sodium
level

 Sugar-Sweetened Beverages

 White Bread, Pasta, and Rice: instead substitute brown rice, whole grain bread, whole wheat
or gluten-free pasta

 Fruit-Flavored Yogurt: high in sugar, instead use Greek yogurt

 Sweetened Breakfast Cereals

 Dried fruit: high in sugar and lower in fiber than whole, fresh fruit

What's the Latest?

There are recent studies that show eliminating non-fiber carbohydrates results in improving or

reversing diabetes.

They eliminated bread, pasta, rice, and increased fiber-rich carbohydrates-think fresh fruits and

vegetables, limiting regular carbohydrates to only 20 to 50 grams a day. There was a control group

that followed American Diabetes Association guidelines.

Both groups lost weight but the group that limited refined carbohydrates saw greatly improved

outcomes. However, the study group was very small. Most physicians still follow the American
Diabetes Guidelines for diet. As more research comes about, the recommended guidelines may

change.

Did you know carbohydrates are not an essential acid?

What are essential acids? They are necessary for sustaining life.

There are essential fatty acids (found in fat) and essential amino acids (found in protein).

Carbohydrates have become a big part of the American diet and reducing refined carbohydrates-

think most things pre-packaged, is not always easy to do.

The Healthiest Option

Foods in their simplest form - fresh fruits, vegetables, and fish - is always the healthiest option.

Remember that diet impacts how medications work and how much energy we have.

Learn the meal plan suggested by medical doctors and record daily meals in the Care Plan Notes.

Food provides fuel for our bodies and must be monitored as an important component of maintaining

good health.

Learn Meal Plan Suggested by Medical Doctor for your Clients

Record Daily Meals in Care Plan to Monitor

Feeding
Sometimes a senior will need assistance with eating and the caregiver will assist in feeding them and

helping them drink. Discuss the routine and be mindful of their feelings.

Feeding Tubes

A registered nurse, care manager, or medical doctor will manage the feeding tube. The caregiver

should follow the Care Plan instructions if assistance is needed in maintaining the liquid in the

feeding tube as prescribed, and draining and cleaning the feeding tube.

Spoon Feeding

Spoon feeding skills involve providing both safety and dignity to deliver a positive experience.

Assisting with eating will sometimes be necessary to help those recovering from illness to enjoy

meals and maintain nutrition.

As Alzheimer's disease or other related disorders advance, you may need to spoon-feed

Use a teaspoon

 Small bites, filling the teaspoon only halfway instead of full may be better for some

 Touch their shoulder and keep gentle touch as you feed, this lets them know you are there.

 If you are both right-handed, you will be sitting on their right side, slightly in front of them.

 Your left hand is gently placed on their right shoulder.

 You use your right hand to spoon food while keeping your left hand in place on their
shoulder.
Slowly feed

 Remember the sequence of events that must happen for eating.

 There are a lot of steps your body does to move food to your stomach.

 Go slow and give time for each step in the process to take place.

 Rushing can cause choking.

Look for Signs of Swallowing

 Watch the Adam’s Apple and make sure it has moved up and down. It may take more than
one movement up and down to move the food out

 Don’t assume the food is swallowed if you don’t see the movement, it could be in the
cheeks.

Follow the Client’s Lead

 Is their mouth open, are they slowing down?

 If possible let them lead, what do they want to eat first or next.

 Look for visual or verbal clues.

Rub Spoon on Lower Lip

 It can sometimes get a person to take the food in.

 Don’t shove it in, allow them to remove the food from the spoon.

Just like in setting up the table in a way that is best for the client, the same is true with feeding. Did

they have a stroke and one side of the mouth works better than the other?
Position yourself on the dominant side of the client (right-handed, right-side, left-handed, left-side).

Change Taste, Texture, and Temperature

Don’t give them one food in the entirety and move on to the next. You may have eaten that way as a

child, but most adults take bites from around their plates when eating. Doing the same when feeding

can help stimulate the senses and keep them engaged longer.

If they are able to communicate, let them tell you what they want to eat.

Keep Mealtime Client-centered

So even though they may not be able to feed themselves, they can still control the order in which

they eat their food.

Look for Signs of Eating Problems:

 Coughing/choking

 Frequent throat clearing

 Gurgly voice after eating

 Drooling

 Vomiting

 Food or drink coming out of the nose

 Complaints of pain or discomfort when swallowing

  Holding lips tight

 Food spilling out of the mouth

 Holding food and not swallowed

 Refusing to eat
What’s the latest?
Technology and spoons - Liftware, now owned by Google is helping people with different

conditions, like tremors, feed themselves.

Watch this video on Google Spoon Makes Eating Easier for People with Disabilities: 3 minutes,

5 seconds

Watch the video on Liftware Level to Help People Eat: 31 seconds

SIGNS OF CHOKING

 Excessive coughing

 Gagging or gasping for air

 Grabbing the throat

 Turning blue in the lips or face

STOP the Meal Process

Keep the Patient Upright

Follow First Aid Procedure

We take eating for granted in our younger years, but it becomes vital as a person ages. Do everything

you can to honor the mealtime experience and promote engagement.

Help nourish the mind and body of the person when you are providing care.

Caregiver Role in Mealtimes:

Provide nourishment

If you are working with a client in their home, make sure you are giving nutritious food that they

enjoy eating.

Help them be independent

For example—don’t spoon-feed a person if they can eat. Be patient and respect mealtime.

Describe the meal if they have low vision

For example—do they have shaky hands and spill their drink? Put the drink in a container with a lid.
Watch for any changes in eating and weight, record meals and changes in the care plan

Learn their mealtime style

 Do they pray before eating? Be respectful of their beliefs and customs, even if very different
from your own.

 Do they prefer water or another beverage?

 Do they like to take their food from a shared dish or pre-plated?

 Do they prefer a cloth napkin over paper?

 Take an interest—smile, engage in conversation.

Tip Sheet
Metabolism slows as we age, B-vitamins and Calcium are important for strong bones, Tastes and

Smell may Decrease and Impact Interest in Eating Well, Memory Loss may Cause Resistance to

Mealtime.
IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.
Prevention
Respiratory Care with Permitted Home Oxygen Safety Tasks
Delivering the Air you Breath - Home Oxygen Therapy

As a caregiver, at some point, you will most likely provide caregiving for a person who needs

assistance with their breathing. Their lungs may not be able to function well without the assistance of

an oxygen tank to deliver air to their lungs through their nose or throat.

Doctors will prescribe the amount of oxygen needed per minute and provide the tools for delivering

the air which usually will be through an oxygen system that in some cases will involve an oxygen

tank that can be switched from a stationary stand to a portable purse or backpack system to take with

them on-the-go for attending events, running errands and going to medical visits.

Let's learn all about why someone will be prescribed oxygen and how to assist them.

Oxygen Therapy Care

Receiving help with breathing in oxygen has been defined as "oxygen therapy".
  Oxygen therapy is a medical treatment. It must be prescribed by a doctor.

When oxygen is provided in the home, the terminology used for this is "home oxygen therapy". You

will see this in a Care Plan and then know you are assisting with monitoring and maneuvering these

oxygen tanks for your client.

The lungs work by bringing in the “good air” and getting rid of the “bad air.” As you breathe in

oxygen (O2), it is passed into your blood through the tiny air sacs (alveoli) in the lungs. From there it

goes to every part of your body. When your tissues and muscles use oxygen, carbon dioxide (CO2) is

made.

It’s important to get rid of CO2, the waste product of breathing. Carbon dioxide goes through your

blood and back to your lungs. You breathe out carbon dioxide.

Conditions sometimes requiring home oxygen therapy include:

 Asthma

 Bronchitis (chronic)

 Congestive Heart Failure

 COPD (chronic obstructive pulmonary disease)

 Cystic Fibrosis

 Emphysema

 Lung Cancer

 Pneumonia

 Pulmonary Fibrosis

 Sleep Apnea

 Out of Breath Easily Caused by Another Medical Condition (Cancer, etc.)

Oxygen therapy can help. In fact, getting oxygen can prevent all those bad effects that happen when

blood oxygen levels drop. Oxygen can reduce the strain on your heart. Oxygen can reduce shortness
of breath. It will help the person stay more active and exercise longer and harder. It will help them

think and remember better. And it will help them sleep better. Oxygen therapy CAN make a big

difference in how they feel.

The prescription the doctor writes will include:

 If the person needs oxygen for rest, exercise, and/or sleep, and how much in liters per minute
(lpm) for each activity.

 How many hours a day oxygen should be used?

 What type of oxygen system they should use?

Oxygen Safety
If a person is on oxygen therapy it is important they DO NOT RUN OUT. Be sure to educate

yourself on how to monitor the oxygen supply so that you can easily know the turnaround time for

refills and the system that is followed. In addition, learn where your client stores their backup

oxygen tank.
 The "Contents Indicator" or pressure gauge on the tank tells you how much oxygen is left.
 Have a backup oxygen supply in case of an emergency.

Watch this video on Oxygen Safety: 3 minutes 2 seconds

Oxygen Tips:

Oxygen does not burn, but it does support combustion. So, anything that can burn will burn much

faster in an oxygen-rich environment. "Don't fan the flames" has real meaning when oxygen tanks

are in the home. Be sure to keep them out of the kitchen or any room where there are flames.

Oxygen should NEVER be used near an open flame or anything that can produce intense heat,

flames or sparks, such as a burning cigarette, a lighted match, heaters, heating pads, hair dryers, a

stove or a pilot light.

Anything that can produce hot flames or sparks during operation should be kept at least 5 feet away

from oxygen equipment. The highest safe temperature for an oxygen tank is 125 degrees Fahrenheit.

1. Do not use oil, grease, Vaseline or any other flammable substance on your oxygen
equipment or on your skin near the equipment. Use water-based products only.
2. If frost forms on your liquid oxygen equipment, don't allow the frosted parts to come
into contact with skin. It can cause frostbite skin injury.
3. Store cylinders in an upright position and secured in an approved cart or another
storage device.
4. If there is a humidifier, use only the recommended type and amount of water. Due to
the increase in backpressure and resistance to flow, disposable humidifier bottles
should not be used for oxygen flows greater than 6 liters per minute. There are
humidifier bottles available for higher oxygen flows.
5. A high-flow cannula should be used for oxygen flows above 6 liters per minute.

Watch how to use a Home Oxygen Concentrator: 3 minutes, 9 seconds

Oxygen-on-the-Go

Some people who need help breathing will be prescribed to have oxygen around-the-clock. This

means they will need to switch over to a portable oxygen tank when they leave their home.
Learn the required steps to switch to a portable oxygen tank and be sure that your client has the

capability to help direct you as you support and assist.

Watch this video on How to Get Started with Oxygen Portable Concentrator: 2 minutes, 35

seconds

Pulmonary Rehabilitation

Pulmonary rehabilitation is a program of exercise, education, and support to help learn to breathe—

and function—at the highest level possible.

At pulmonary rehabilitation, the person works with a team of specialists who will help with

improving physical condition. They learn how to manage COPD to stay healthy and active longer.

Breathing Exercises and Techniques

Certain medical conditions will make it harder to breathe. And when it’s hard to breathe, it’s normal

to get anxious, making the person feel even shorter of breath.

There are two breathing techniques that can help get air without working so hard to breathe: Pursed-

lips Breathing and Diaphragmatic (also called Belly or Abdominal) Breathing.

Better Breathing Tip: It’s normal to hold shoulders tense and high. Before starting any breathing

technique, take a minute to drop your shoulders down, close your eyes, and relax.

Pursed-Lips Breathing

This breathing technique helps focus, slow breathing down, and stay calm. Pursed-lips breathing

should be used during and after exercise.

To use pursed -lips breathing: Breathe in through the nostrils. Breathe out slowly. Do not force the

air out. Breathe out through lips pursed like you would blow out a candle. Breathe out two to three

times longer than breathing in.

 Slows your breathing down

 Keeps airways open longer so your lungs can get rid of more stale, trapped air

 Reduces the work of breathing

 Increases the amount of time you can exercise or perform an activity

 Improves the exchange of oxygen and carbon dioxide

To do purse-lips breathing:
1. Breathe in through your nose (as if you are smelling something) for about 2 seconds.
2. Pucker your lips like you’re getting ready to blow out candles on a birthday cake.
3. Breathe out very slowly through pursed-lips, two to three times as long as you
breathed in.
4. Repeat.

Watch this video on how to do Pursed Lip Breathing: 2 minutes 26 seconds

Breathing from the Diaphragm:

This type of breathing is also called abdominal breathing. The abdomen should move down when

you breathe in. It should rise as you breathe out. The diaphragm is the main muscle of breathing. It’s

supposed to do most of the work. When you have COPD, the diaphragm doesn’t work as well and

muscles in the neck, shoulders, and back are used. These muscles don’t do much to move your air.

Training the diaphragm to take over more “work of breathing” can help.

Diaphragmatic breathing is not as easy to do as pursed-lips breathing. It is recommended to get

instruction from a respiratory health care professional or physical therapist experienced in

teaching it.

This technique is best used when your client is feeling rested and relaxed, and while sitting back or

lying down.

Instruct them to:

1. Place one hand on their abdomen. Place one hand on their upper chest.
2. Focus breathing on their abdomen.
3. As they breathe out, the hand on the abdomen should lower.
4. As they breathe in, the hand on the abdomen should rise.
5. Breathe in through the nose. Breathe out slowly through pursed lips.
6. Practice this 2 to 3 times a day for 5 to 10 minutes. Start by doing it while lying on
their back. Then try it while sitting. Then try it while standing. Finally, try it while doing
an activity.

Watch this instructional video on diaphragmatic breathing: 2 minutes, 42 seconds

As they become more comfortable with this type of breathing, they can use it to reduce their feelings

of shortness of breath. They can use it:

 With stair climbing

 With long walks

 After carrying or lifting

 When showering

 With all daily activities

 When exercising
Better Breathing Tip: Stop, Reset, Continue
When they are feeling short of breath during exercise or regular activities, use these 3 steps:

1. Stop your activity.

2. Reset by sitting down, relax shoulders, and do pursed-lips breathing until they catch
their breath.
3. Continue activity, doing pursed-lips breathing as they go. Go at a slower pace if you
need to.

 Avoid touching your mouth, eyes, and nose in public to help prevent germs from entering
your body

 Stay away from crowds, especially during cold and flu season

 Use your own pen, especially when signing in at the doctor’s office or other health care
appointments

 Don’t smoke as it makes it harder for the lungs to fight off an infection

 Get plenty of sleep. When the body is tired, it is more likely to get sick

Bonus Videos:

Getting started with Liquid Oxygen: 2 minutes, 34 seconds

Tip Sheet
Oxygen is required for life, Keep away the Oxygen from an open flame, Learn how to recognize

symptoms and teach breathing techniques to help your COPD clients.

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.
Prevention
Client Monitoring of Vital Signs and Medication Reminders
Monitoring and Recording Vital Signs and Medication
Reminders
1. Temperature
2. Pulse rate
3. Respiration rate
4. Blood pressure

Vital Signs are an indicator of your body’s overall functioning.

Pulse rate and respiration rate can indicate how well your heart and lungs are working. While the

typical ranges may vary based on age, health status, and activity level, knowing how to measure

these vital signs in other individuals can help determine whether they may need to seek medical

attention.

Temperature

Body temperature is a measure of your body's ability to make and get rid of heat. The body is very

good at keeping its temperature within a safe range, even when temperatures outside the body

changes a lot.

 When you are too hot, the blood vessels in your skin widen to carry the excess heat to your
skin's surface. You may start to sweat. As the sweat evaporates, it helps cool your body.
  When you are too cold, your blood vessels narrow. This reduces blood flow to your skin to
conserve body heat. You may start to shiver. When the muscles tremble this way, it helps to
make more heat.

Your body temperature can be measured in many places on your body. The most common ones

are:

 Mouth

 Ear

 Armpit

 Rectum

 Forehead

Thermometers show body temperature in either degrees Fahrenheit (°F) or degrees Celsius (°C). In

the United States, temperatures are often measured in degrees Fahrenheit. The standard in most other

countries is degrees Celsius.

Normal Body Temperature

Most people think a normal body temperature is an oral temperature (by mouth) of 98.6°F (37°C).

This is an average of normal body temperatures. Your normal temperature may actually be 1°F

(0.6°C) or more above or below this. Also, your normal temperature changes by as much as 1°F

(0.6°C) during the day, depending on how active you are and the time of day. Body temperature is

very sensitive to hormone levels. So a woman's temperature may be higher or lower when she is

ovulating or having her menstrual period.

A rectal or ear temperature reading will be a little higher than an oral reading. A temperature taken in

the armpit will be a little lower than an oral reading. The most accurate way to measure temperature

is to take a rectal reading.

Normal Temperature Range:

 Oral - 97.5 to 99.5 F

  Rectal - 98.5 to 100.5 F

 Axillary - 96.6 to 98.6 F

 Tympanic - 96.4 to 100 F

Fever

In most adults, a fever is an oral temperature above 100.4°F (38°C) or a rectal or ear temperature

above 101°F (38.3°C). A child has a fever when his or her rectal temperature is 100.4°F (38°C) or

higher.

A fever may occur as a reaction to:

 Infection. This is the most common cause of a fever. Infections may affect the whole body or
one body part.

 Medicines. These include antibiotics, narcotics and antihistamines, and many others. This is
called a "drug fever." Medicines like antibiotics raise the body temperature directly. Other
medicines keep the body from resetting its temperature when other things cause the
temperature to rise.

 Severe trauma or injury. This may include heart attack, stroke, heatstroke, or burns.

 Other medical conditions. These include arthritis, hyperthyroidism, and even some cancers,
such as leukemia and lung cancer.

Low Body Temperature (Hypothermia)

A very low body temperature (hypothermia) can be serious or even deadly. Low body temperature

usually happens from being out in cold weather. But it may also be caused by alcohol or drug use,

going into shock, or certain disorders such as diabetes or low thyroid.

Low body temperature may occur with an infection. This is most common in newborns, older adults,

or people who are frail. A very bad infection, such as sepsis, may also cause an abnormally low body

temperature.
High Body Temperature (Heatstroke)

Heatstroke occurs when the body fails to control its own temperature and body temperature keeps

rising. Symptoms of heatstroke include mental changes (such as confusion, delirium, or

unconsciousness) and skin that is red, hot, and dry, even under the armpits.

Heatstroke can be deadly. It needs emergency medical treatment. It causes severe dehydration and

can cause body organs to stop working.

There are two types of heatstroke:

 Classic heatstroke can happen even when a person isn't doing much, as long as it's hot and
the body isn't able to cool itself well enough by sweating. The person may even stop
sweating. Classic heatstroke may develop over several days. Babies, older adults, and people
who have chronic health problems have the greatest risk of this type of heatstroke.
 Exertional heatstroke may happen when a person is working or exercising in a hot place.
The person may sweat a lot, but the body still makes more heat than it can lose. This causes
the temperature to rise to high levels.

Why Check Temperature?

Body temperature is measured to:

 Check for fever

 Check for very low body temperature in people who have been exposed to cold

 Check for very high body temperature in people who have been exposed to heat

 Find out how well a fever-reducing medicine is working

 Help a woman plan for pregnancy by finding out if she is ovulating.

Check the temperature in both the morning and evening. Body temperature can vary by as
much as 1°F (0.6°C) during the day.

Before you take the temperature:

  Ideally wait at least 20 to 30 minutes after smoking, eating, or drinking a hot or cold liquid

 Wait at least an hour after hard exercise or a hot bath

Types of Thermometers

 Electric Thermometers: are plastic and shaped like a pencil. They have a display window at
one end and a temperature probe at the other end. These thermometers can be used in the
mouth, rectum, or armpit. They are easy to use and easy to read. If you buy this type of
thermometer, check the package for information about its accuracy.
 Ear thermometers: are plastic and come in different shapes. The small cone-shaped end of
the thermometer is placed in the ear. Body temperature is shown on a digital display. The
results appear in seconds. Some models also show what the oral and rectal readings would
be.
 Temporal artery thermometers: have a small "cup" that is moved across the skin over the
artery in the forehead. When used correctly, these thermometers are accurate.
 Disposable thermometers: are thin, flat pieces of plastic with colored dots and temperature
markings on one end. The color of the dots shows the temperature. These thermometers can
be used in the mouth or rectum. A patch form can be used on a baby's skin to measure
temperature for 48 hours straight. These thermometers are not as accurate as electronic or ear
thermometers.
 Forehead thermometers: are thin pieces of plastic with numbers on them. You press the
strip against a person's forehead. The temperature makes some numbers change colors or
light up. These thermometers are not very accurate.
 Pacifier thermometers: are shaped like a baby's pacifier. They have a display that shows the
temperature. You place the pacifier in your child's mouth to measure temperature. These
thermometers may take longer to get a reading and are not as accurate as other types.

Glass thermometers that contain mercury are not recommended. If you have a glass

thermometer, contact your local health department to find out how to dispose of it safely. If you

break a glass thermometer, call your local poison control center right away.
How to Take Temperature
Before you take a temperature, read the instructions for how to use your type of thermometer. Some

common ways to take a temperature are described below.

Watch Video on How to Take a Temperature: 1 Minute, 51 Seconds

How to Take an Oral Temperature

Oral (by mouth) is the most common method of taking a temperature. For you to get an accurate

reading, the person must be able to breathe through his or her nose. If this is not possible, use the

rectum, ear, or armpit to take the temperature.

1. Place the thermometer under the tongue, just to one side of the center. Ask the
person to close his or her lips tightly around it.
2. Leave the thermometer in place for the required amount of time. Time yourself with a
clock or watch. Some digital thermometers give a series of short beeps when the
reading is done.
3. Remove the thermometer and read it.
4. Clean a digital thermometer with cool, soapy water and rinse it off before you put it
away.

How to Take a Rectal Temperature

This is the most accurate way to measure body temperature. It is recommended for babies, small

children, and people who can't hold a thermometer safely in their mouths. It is also used when it is

very important to get the most accurate reading.

1. Apply a lubricant jelly or petroleum jelly, such as Vaseline, on the bulb of the
thermometer. This will make it easy to insert.
2. With a baby or small child, turn the child facedown on your lap or on a flat covered or
padded surface, such as a bed. Choose a quiet place so that the child won't be
distracted or move around too much.
3. Spread the child's buttocks with one hand. With the other hand, gently insert the bulb
end of the thermometer into the anus. Push it in about 0.5 in. (1.25 cm) to 1 in. (2.5
cm). Don't force it into the rectum. Hold the thermometer in place with two fingers
close to the anus (not near the end of the thermometer). Pressing the child's
buttocks together will help keep the thermometer in place.
4. Leave the thermometer in place for the required amount of time. Time yourself with a
watch or clock. Some digital thermometers give a series of short beeps when the
reading is done.
 5. Remove the thermometer and read it.
6. Clean a digital thermometer with cool, soapy water and rinse it off before you put it
away.

Do not use a thermometer to take an oral temperature after it has been used to take a rectal

temperature.

How to Take an Armpit (Axillary) Temperature

Taking a temperature in the armpit may not be as accurate as taking an oral or rectal temperature.

1. Place the thermometer under the arm with the bulb in the center of the armpit.
2. Press the arm against the body, and leave the thermometer in place for the required
amount of time. Time yourself with a watch or clock.
3. Remove the thermometer and read it. An armpit temperature reading may be as
much as 1°F (0.6°C) lower than an oral temperature reading.
4. Clean a digital thermometer with cool, soapy water and rinse it off before you put it
away.

How to Take an Ear (Tympanic) Temperature

Ear thermometers may need to be cleaned before they are used.

1. Check that the probe is clean and free of debris. If dirty, wipe it gently with a clean
cloth. Do not put the thermometer underwater.
2. To keep the probe clean, use a disposable probe cover. Use a new cover each time
you take an ear temperature.
3. Turn on the thermometer.
4. For babies younger than 12 months, gently pull the earlobe down and back. For
children older than 12 months and for adults, pull the earlobe up and back. This will
help you place the probe in the ear canal.
5. Center the probe tip in the ear, and push gently inward toward the eardrum. Do not
force it in.
6. Press the "on" button to display the temperature reading.
7. Remove the thermometer, and throw away the used cover.

How to Take a Temporal Artery Temperature

1. Remove the cap over the cup part of the thermometer, if it has a cap.
2. Turn on the thermometer.
3. Place the thermometer cup on the skin in the center of the forehead. Make sure
nothing is between the thermometer cup and the skin.
4. Press the button for making a measurement.
5. Slide the thermometer across the forehead to one side (not up or down).
6. Listen for a sound. Most of these thermometers make a beep or other sound when
they are ready to read.
7. Remove the thermometer from the forehead, and read the temperature.
How to Take a Forehead Temperature

Forehead thermometers are not as accurate as electronic and ear thermometers. If a baby is younger

than age 3 months or a child's fever rises higher than 102°F (39°C), check the temperature again

using a better method.

1. Press the entire plastic strip firmly against a dry forehead.
2. Hold the strip in place for the required amount of time. Time yourself with a watch or
clock.
3. Read the temperature before removing the thermometer.
4. Clean the thermometer with cool soapy water and rinse it off before you put it away.

How to Use a Pacifier Thermometer

Pacifier thermometers are not as accurate as electronic and ear thermometers. If a baby is younger

than age 3 months or a child's fever rises higher than 102°F (39°C), check the temperature again

using a better method.

1. Some pacifier thermometers can be used as regular pacifiers. Attach the
temperature part if you need to.
2. Let the child suck on the nipple for the required amount of time. Time with a watch or
clock.
3. Remove the pacifier, and read the temperature.
4. Clean the pacifier with cool, soapy water and rinse it off before you put it away.
How Does it Feel?

Taking an oral temperature causes only mild discomfort. You have to keep the thermometer under

the tongue and hold it in place with the lips.

Taking a rectal temperature can cause a little discomfort, but it should not be painful.

Taking an ear temperature causes little or no discomfort. The probe is not inserted very far into the

ear, and it gives a reading in only a few seconds.

Taking a temporal artery, forehead, or armpit temperature does not cause any discomfort.

Risks

There is very little chance of a problem from taking a temperature.

When taking a rectal temperature, do not push the thermometer in more than 0.5 in. (1.25 cm) to 1 in.

(2.5 cm). Pushing it farther can be painful and may damage the rectum.

Results

Body temperature is a measure of your body's ability to make and get rid of heat.

If taking a temperature using a method other than oral, mark the method used on the report.

What Affects the Test

A temperature reading may not be accurate if:

 The mouth is not kept closed around the thermometer when taking an oral temperature

 The thermometer is not left in place long enough before you read it

 Don't put the thermometer in the right place

 Don't follow the instructions that come with the thermometer

 The thermometer has a weak or dead battery

 Take oral temperature within 20 minutes after smoking or after drinking a hot or cold liquid

 Take your temperature within an hour of exercising hard or taking a hot bath
A few things to remember:

 Thermometers with a digital display usually have a battery. If your thermometer uses a
battery, make sure it is working before you take the temperature.

 Glass thermometers that contain mercury are not recommended. If you have a glass
thermometer, contact your local health department to find out how to dispose of it safely. If
you break a glass thermometer, call your local poison control center right away.

 A fever can make a person feel uncomfortable. To reduce discomfort, use light bedding. A
lukewarm (not cool) bath or shower can lower body temperature. A fever can also lead to
dehydration, so it is important to drink plenty of fluids.

PULSE
Your heart rate, or pulse, is the number of times your heart beats per minute. Normal heart rate varies

from person to person. Knowing yours can be an important heart-health gauge.

As you age, changes in the rate and regularity of your pulse can change and may signify a heart

condition or other condition that needs to be addressed.

Where is it and What is a Normal Heart Rate?

The best places to find your pulse are the:

 Wrists

 Inside of your elbow

 Side of your neck

 Top of the foot

To get the most accurate reading, put your finger over your pulse and count the number of beats in 60

seconds.

Your resting heart rate is the heart pumping the lowest amount of blood you need because you’re

not exercising. If you’re sitting or lying and you’re calm, relaxed and aren’t ill, your heart rate is

normally between 60 (beats per minute) and 100 (beats per minute).
But a heart rate lower than 60 doesn’t necessarily signal a medical problem. It could be the result of

taking a drug such as a beta-blocker. A lower heart rate is also common for people who get a lot of

physical activity or are very athletic. Active people often have lower heart rates because their heart

muscle is in better condition and doesn’t need to work as hard to maintain a steady beat.

Moderate physical activity doesn’t usually change the resting pulse much. If you’re very fit, it could

change to 40. A less active person might have a heart rate between 60 and 100. That’s because the

heart muscle has to work harder to maintain bodily functions, making it higher.

How Other Factors Affect Heart Rate

 Air temperature: When temperatures (and humidity) soar, the heart pumps a little more
blood, so your pulse rate may increase, but usually no more than five to 10 beats a minute.
 Body position: Resting, sitting or standing, your pulse is usually the same. Sometimes as you
stand for the first 15 to 20 seconds, your pulse may go up a little bit, but after a couple of
minutes, it should settle down.
 Emotions: If you’re stressed, anxious or “extraordinarily happy or sad” your emotions can
raise your pulse.
 Body size: Body size usually doesn’t change pulse. If you’re very obese, you might see a
higher resting pulse than normal, but usually not more than 100.
 Medication use: Meds that block your adrenaline (beta-blockers) tend to slow your pulse,
while too much thyroid medication or too high of a dosage will raise it.

Abnormal Heart Rate:

 A pulse under 60 for one full minute is referred to as bradycardia.

 A pulse rate over 100 for one full minute is tachycardia. Exercise or activity can cause a
temporary increase in pulse rate.

 An abnormal rhythm can feel like the beats are being skipped when the pulse is counted for
one full minute.

Watch Video on How and Why to Take a Pulse: 2 Minutes, 45 Seconds

Follow these steps to take a pulse (watch the video for exact instructions):

 Gently place 2 fingers of your other hand on the artery on the thumb side of your wrist.

 Do not use your thumb, because it has its own pulse that you may feel.

 Count the beats for 30 seconds, and then double the result to get the number of beats per
minute.

Now try it on yourself. Was it between 60 and 100? Don't be alarmed if it isn't, while it could be

cause for alarm, it might not be. Take your pulse throughout the day to find your "normal."

Respiration
Counting Respiration Rate

The respiration rate is the rate at which a person breathes in one minute. It increases with fever and

some illnesses. The best time to count the respiration rate is when a person is resting, perhaps after

you take the person's pulse while your fingers are still on the person's wrist. The person's breathing is

likely to change if he or she knows you are counting it.

 Count the number of times the chest rises in 1 full minute. (or 30 seconds and multiply by 2)

 Notice whether there is any sucking in beneath the ribs or any apparent wheezing or
difficulty breathing

Normal resting breathing rate:

 Newborn to 6 months: 30-60 breaths per minute

 6-12 months: 24-30 breaths per minute

 1-5 years: 20-30 breaths per minute

 6-12 years: 12-20 breaths per minute

 12 years and older: 12-20 breaths per minute

Listen
  Labored or difficulty breathing

 Noisy or sounds of wheezing or obstruction

 Shallow breathing or small amounts of air being exchanged

 Irregular breathing

Watch this video on How to Measure Blood Pressure: 5 minutes, 16 seconds

Medication Reminders
A medication schedule should be included in the care plan. Reminding a senior to take their

medication means monitoring the medication is taken.

As medications can impact appetite, sleep, and mood, it is very important to understand the

instructions for the medications and to monitor the medication schedule and any changes you may

notice when medications are changed.

Know the difference between prescription medications and over-the-counter medications.

Prescription Drugs

 Prescribed by a medical doctor

 Follow the medication chart created for the senior in their care plan.

Over-the-Counter Drugs
  Purchased over-the-counter by anyone at a store.

Over-the-counter drugs may change the way a prescription drug works.

This means a caregiver must require the senior to obtain permission from their medical doctor if they

want to take an over-the-counter medication. Sometimes the senior’s care plan will include which

over-the-counter medications are appropriate, but be sure to check with your Care Manager if a

senior requests an over-the-counter medication.

Medication Monitoring Means:

1.  Remind seniors to take their medication at the time prescribed in the
medication chart
2.  Observe the senior taking the medication orally or applying a lotion or liquid
3.  Document the medication was taken or applied
4.  If the senior is refusing the medication, inform a Care Manager and
document
5.  Monitoring when refills will be needed
6.  Pay attention to expiration dates on over-the-counter medications
7.  Be mindful of foods and fluids to take or NOT to take with the medications
8.  Documenting any new conditions which could be side effects when a new
medication begins

Watch this Video by Dr. Matt Tabakin to Learn Why Taking Medications at the Right Time

Really Matters: 2 Minutes, 9 Seconds

Note: A Care Manager will be managing the prescription medication refills.

Tip Sheet
Temperature Measures Ability to Make and Get Rid of Heat. Temperature Can Be Mesured in Many

Places n the Body, Low Temperature = Hypothermia, High Temperature = Heatstroke, How and

Why to Take Temperature, Pulse is Heart Beating, Respiration Rate is Breaths per Minute, Listen for

Odd Breathing. Medication monitoring means remind seniors to take their medication. Over-the-

counter medication may be in a senior's care plan but check with Care Manager if a senior requests it.
IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.
Prevention
Understanding Types of Dementia and Memory Loss

Alzheimer's disease has been classified as a distinct disease and type of memory loss.

Alzheimer's Disease differs from other dementia due to confusion and loss of

memory around Person, Place, and Time.
 Activities should be centered around understanding the person may not remember events and
people from their earlier years.

Definition of Dementia
The loss of intellectual functions (such as thinking, remembering, reasoning, and language) severe

enough to interfere with a person's daily life. Dementia is not a disease in itself, but a group of

symptoms that may accompany certain diseases or physical conditions.

In this video, Dr. Natali Edmonds, Board Certified Geropsychologist of Careblazers explains the

difference between Alzheimer's Disease and Dementia. A geropsychologist specializes in the branch

of psychology concerning mental health disorders, depression, anxiety, and age-related illnesses for

older adults.

Watch Video on Alzheimer's vs. Dementia: 2 Minutes and 58 Seconds

Causes of Dementia:

 Alzheimer's Disease: The most common cause of dementia, which is a degenerative disease

that begins gradually then progresses and attacks the brain resulting in impaired memory,
thinking and behavior. Confusion of Person, Place and Time.
 Multi-Infarct Dementia: Deterioration of mental capacity caused by multiple mini-strokes
or 1 large stroke.
 Parkinson's Disease: A progressive disorder of the central nervous system impacting brain
cells that produce dopamine, which controls muscle activity, deteriorating. It is characterized
by tremor, stiffness in joints and speech difficulties.
 Huntington's Disease: An inherited degenerative disease, causing physical and mental
disabilities which begins in mid-life and results in involuntary facial muscles and limb
movement, slurred speech, impaired judgment.
 Creutzfeldt-Jakob Disease: Fatal brain disorder causing rapid, progressive dementia and
neuromuscular disturbances, caused by a transmissible agent.
 Pick's Disease: A rare brain disorder; shrinkage of tissues in the frontal and temporal lobes
and abnormal bodies in the nerve cells of affected areas of the brain.
 Lewy Body Disease: Abnormal protein deposits in the brain with hallucinations and paranoia
are common in early stages with drastic behavioral changes.
  Frontal-Lobe Dementia or FLD: Personality changes, disregard for the feelings of others,
expressionless faces, or they may go to the opposite extreme and laugh when such behavior is
inappropriate. Total disregard for others which drives negative behaviors such as stealing and
loss of inhibition.
 Frontotemporal Dementia or FTD: Progressive and degenerative condition causing
language problems, personality changes, and memory loss and one unique factor is a
preoccupation with a fear of serious illness. May become convinced they have cancer or
another serious illness and will display no symptoms at all of the diseases while obsessively
thinking and talking about the nonexistent disease.
 Others: Physical conditions may cause or mimic dementia: head injuries, infections, drug
reactions, thyroid problems, nutritional deficiencies.

Definition of Alzheimer's Disease

More than 100 years ago, Alzheimer's Disease was identified by Dr. Alois Alzheimer, a German

Neuropsychiatrist.

Dr. Alzheimer had a female patient in her 50's who was having difficulty with her memory, trouble

with talking and visual spacing. She was becoming disoriented. Nobody knew how to help her. When

she died, Dr. Alzheimer performed an autopsy on her brain.

He discovered:

 Atrophy

 Amyloid Plaques

 Neurofibrillary Tangles

The discovery of these 3 items together are the keystones of Alzheimer's Disease.

Fast forward to now.

Little progress has been made in Alzheimer's Disease research and prevention because little money

has been provided for research as compared to other diseases and it was not until the 1970's that

some doctors began to try to diagnose the type of memory loss, rather than classifying all memory

loss as simply "hardening of the arteries", or atherosclerosis, which means that fat deposits have built

upon the inside of a person's blood vessels, or arteries, causing the arteries to narrow and making it

more difficult for blood to flow throughout the body easily. Arteries carry the oxygenated blood from

the heart to other parts of the body.

Cancer and heart disease have received more than $1 billion each for
research from the U.S. government.
In December 2015, the U.S. Congress included in a budget vote to provide $350 million towards

Alzheimer's Disease research to find better treatments and a cure for Alzheimer's Disease.

NO CURE EXISTS for Alzheimer's Disease. Part of the training for caregiving involves

understanding that more help is needed to find a cure for this disease. Over the last 100 years, as

compared with research on other medical conditions, very little has been done.

Neurology Lesson to Understand Alzheimer's Disease

 Nerve Cells Tangle Up and Die

 Plaques (also can be called "blocks") form from protein buildup in the brain

 Chemicals lacking in the brain cause information to not be connected properly

People with Alzheimer's Disease have "Tangles" or plaque in their brain but NOT

EVERYONE WITH this PLAQUE GETS THE DISEASE.

What we Know About Alzheimer's Disease
1. Progressive Disease: This means it continues to get worse and just like some people
can progress up a mountain climb at one rate, while others will zig and zag on their
climb up, the same is true with how this disease progresses.
2. Advances at Wildly Different Rates: The duration of the illness may often vary from 3
to 20 years. The areas of the brain that control memory and thinking skills are
impacted first and eventually, the disease will cause a person to forget to swallow,
for instance, because the brain is not functioning properly and sending out the right
signals.
3. Personality Changes: A specific part of this disease is the way that a person's
personality can change causing them to experience anxiety, suspiciousness,
agitation, and delusions and relating to individuals in the opposite way than they ever
have in the past.

Watch Video on the 10 Signs of Alzheimer's from Illinois Alzheimer's Chapter: 5 Minutes, 5

Seconds

As a caregiver, you have a unique perspective and bring a fresh set of eyes and ears. You can be a

valuable asset to the family and help recognize signs of dementia.

Is the change in memory a "Sure Thing" as we age?

Watch Video from Trinity College of Dublin: 4 Minutes, 11 Seconds

Tip Sheet
Alzheimer's Disease symptoms involve forgetting Person, Place and Time, Stages of Alzheimer's

Disease, A Doctor Identified Alzheimer's Disease more than 100 Years Ago, Neurology Lesson:
Nerve Cells Tangle up and Die, Plaques Form, Chemicals that are Lacking in the Brain Don't Process

Information Properly, Alzheimer's Disease Advances at Wildly Different Rates and Is called a

Progressive Disease Because of This

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.

Prevention
Stages, Hoarding, Paranoia, Hallucinations, and Sundown Syndrome
Stages of Alzheimer's Disease
Alzheimer's disease progresses in a way that can be compared to climbing a mountain. Just as a

mountain climb sometimes requires going sideways and back down the mountain, in order to

maneuver to the top of the peak, the way Alzheimer's Disease impacts a person also will zig-zag.

There will be days where the person seems to be completely aware and not impacted by the disease,

mixed in with days where they are displaying signs of the disease.

Even in the later stages of the disease, there can be moments when they share a profound memory.

Researchers and doctors began trying to define the disease in "stages" to assist caregivers to better

know how to care for the person and what to know where they are on the journey of this progressive

disease.

Much of this disease is still a mystery. Stages have been identified and as the disease progresses

differently with each person, it is important to know that the stages are simply a road map for this

journey which will involve some detours up and down the hills of the stages based on each person's

disease progression.

Early Stages

 Loss of short-term memory

 Hard to find a word (Aphasia)

 Seeks familiar people and places

 Challenges with writing and using objects

  Apathy and depression

 Needs reminders with some high-level Activities of Daily Living (ADLs)

Middle Stages

 Greater loss of short-term memory

 More difficulty finding words

 May get lost at times and not know where they are

 Repetitive actions with trouble using objects

 Possible depression and agitation

 Needs reminders to help with most Activities of Daily Living (ADLs)

Late Stages

 Mixes up past and present

 Often unable to understand or use words

 Misidentifies people and places

 Tremors, rigidity (fall risk)

 Increased risk of behavioral disturbances

 Needs reminders of all ADLs

Final Stage

 No apparent link to past or present

 Mute or a few incoherent words

 Seemingly oblivious to surroundings

 Little spontaneous movement

 Seizures

 Swallowing difficulty

 Completely passive

 Requires total care

Over the years, many different assessment scales have been used by physicians in an attempt to

identify the stages of Alzheimer's disease more precisely. Assessment scales are used by some

physicians to be able to better communicate care needs to family members and caregivers.

The Functional Assessment Staging (FAST) scale, developed by Dr. Reisberg and colleagues,

divides the progression of Alzheimer's disease stages into 16 successive functional stages and

assesses the loss of functional abilities within each stage, from Stage 1 (no impairment) to the final

stage, which includes loss of speech, locomotion, and consciousness.

Functional abilities include:

 Dressing

 Toileting

 Eating

 Walking

Alzheimer's stages at which ability is lost

 Hold a Job: Earliest Stage

 Handle Simple Finances: Early to Mild Stage

 Select Proper Clothing: Moderate Stage

 Put on Clothes Unaided: Moderately to Severe

 Shower Unaided: Moderately to Severe

 Toilet Unaided: Moderately to Severe

 Control Urine Unaided: Moderately to Severe

 Speak 5 to 6 words: Severe

 Walking: Severe

 Sit up: Severe

 Smile: Severe

 Hold up Head: Severe

Watch Video on the Stages of Dementia: 9 Minutes, 10 Seconds

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Risks: Wandering
Because this disease can cause confusion with places, time and people, the risk of someone with the

disease doing what is called "wandering" is very high. Wandering means leaving a location to go to

another location that the person thinks exists and is available to reach at the time they are going there,

but in fact, their memory may be in the past and this causes them to wander and become lost. This is

why it is important for someone with the disease to have someone with them at all times.

Memories from a long time ago may be most active for the person with Alzheimer's Disease.

Many times people may try to walk or drive to their former place of employment, for instance, or

take a walk to a friend's house that is not actually in their neighborhood or within walking distance.

Safety Systems for Wandering

Establish a consistent routine and be sure to follow it daily in order for the senior with Alzheimer's

Disease to be better able to progress through the stages with a feeling of comfort. This allows seniors

in the early stages of the disease to more easily remember what will happen as they move through the

day and rely on their muscle memory. Many times the first signs of the disease are displayed when a

senior is traveling and out of their familiar environment and routine. Having a routine will help the
caregiver to also be able to better combat any behavior outbursts by focusing the senior back onto

their current daily activity.

Identify any wandering risk factors and do not allow the senior to go to the bathroom, for instance,

during a doctor's visit or outing where they are out of your view. Always stay with the senior and

have a back-up plan if they may become confused and want to leave the home on their own.

Door and window posters: sometimes posters of a bookcase are used to cover doors and windows so

that a senior who may be a wandering risk will not try to exit the home or become agitated.

Watch Video on Wandering: 4 Minutes, 5 Seconds

Risks: Hoarding

A person with behavioral variant frontotemporal dementia (FTD) may be drawn to hoarding.

This can be frustrating for the family if items are disappearing from their normal locations because

they are being taken by the person with dementia.

Hoarding can be an attempt for a person with dementia to control their situation. What is happening

in their brain is so frustrating, that they want to control something, which could be physical items.

The person may also feel paranoid or have delusions and believe their things will get stolen, so they

may try to hide or protect them.

Suggestions to help with hoarding:

 Suggest a hoarding box or drawer where the person can put objects they want to keep safe.

 Try to work out where the person seems to hide things, then show the person you’re helping
them to find them.

 If the person becomes anxious about lost items, try to reassure them and help them feel
better.

 Don’t leave important documents or items where they can be easily picked up.

 Keep a spare set of things that are often lost, such as keys or glasses.

 If the person hides food or other perishable things, check their ‘hiding places’ regularly, and
throw out things that have gone bad.

 Put child safety locks on cabinets or locking cabinet if food is being taken.

 Video cameras have come down in price and can be used to monitor places where items are
normally taken. There may be a pattern of time of day or other triggers that can be discovered
to help with the hoarding.

Risks: Paranoia and Hallucinations

Hallucinations and Delusions

Hallucinations involve hearing, seeing, smelling, or feeling things that are not really there. Example:

the person may "see" the family dog which died years earlier.
Delusions are false beliefs that the person thinks are real. Example: the person may think you are

their grandchild instead of the caregiver.

Suggestions to help with hallucinations and delusions

 Sometimes an illness or medicine may cause hallucinations or delusions. Suggest on the care
notes that the problem is discussed with their physician.

 Try not to argue with the person. Instead, comfort the person if he or she is afraid.
Remember, this is how the person really feels, regardless if you think they should feel this
way, they DO. Be kind and supportive.

 Distract the person. Sometimes moving to another room or going outside for a walk helps.

 Turn off the TV when violent or upsetting programs are on. Someone with Alzheimer’s may
think these events are happening in the room.

 Safety First—make sure the person can’t reach anything that could be used to hurt anyone or
himself or herself.

Paranoia

Paranoia is a type of delusion. They may believe, falsely, that others are mean, lying, unfair, or “out

to get" them. The person may become suspicious, fearful, or jealous of people.

Paranoia can become worse as memory loss gets worse.

 If the person forgets where he or she put something, they may become upset. The person may
believe that someone is taking his or her things.

 The person may not know you are the person’s caregiver. Someone with Alzheimer’s might
not trust you if he or she thinks you are a stranger.

 He or she may believe that strangers will be harmful.

 The person may think you are trying to trick him or her when you tell them something.

Paranoia may be the person’s way of expressing loss. The person may blame or accuse others

because no other explanation seems to make sense.

Suggestions to help with paranoia

 Try not to react if the person blames you for something.

 Don’t argue with the person.

 Let the person know that he or she is safe.

 Use gentle touching or hugging to show you care.

 Explain to others that the person is acting this way because he or she has Alzheimer’s
disease.

 Search for things to distract the person, then talk about what you found. For example, talk
about a photograph or keepsake.

Also remember: They may not be paranoid. There are people who take advantage of weak and

elderly people.

Find out if someone is trying to abuse or steal from the person with Alzheimer’s.

Watch Video on Delusions: 10 Minutes, 15 Seconds

Tips from Dr. Natali from Careblazers:

Keep it simple.

Respond to the emotion, NOT THE WORDS

Example: The person is afraid someone is breaking into the home. Instead of saying, "no one is

breaking in."

"I'm so sorry you feel scared. I am going to protect you, so nothing happens to you."

Imagine you are in their world and seeing, hearing and feeling the same things. Pretend along with

them and respond the way you would want someone to respond to you. Remember, for them this is

real, it is not made up. You cannot rationalize with them and make them understand.
Remember the saying—if you can't beat 'em, join 'em.

Meet them where they are in that moment.

Risks: Sundowning
Sundowning or LATE DAY CONFUSION

Sundowning is a symptom of Alzheimer's Disease and other dementia and is also commonly called

LATE DAY CONFUSION.

The term "Sundowning" developed as terminology in memory loss because often the confusion

begins to show in the evening or when the sun is setting. This seems to happen as memory loss

symptoms begin and also continues to happen ongoing as the disease progresses.

The term Sundowning now refers to confusion that happens at a specific time of day.

Watch Video explaining Sundowning: 3 Minutes, 29 Seconds

Sundowning can continue into the night. Sometimes people with Alzheimer’s disease have trouble

falling asleep.

Sometimes they get up from bed at night and they may think it is time to go to work or time or time

to eat breakfast.

When Sundowning becomes a regular occurrence, around-the-clock caregivers must be present for

safety.
What Causes Sundowning?

Like other issues with Alzheimer's Disease, the causes are not really known.

We know that the brain changes with Alzheimer's Disease. The thought is the biological clock, or the

ability to know day from night, can be affected.

Have you ever traveled from one time zone to another? Or stayed up all night? If so, you know that it

takes time for your body to change back to your normal sleep and wake schedule. The ability to

maintain a sense of day and night is regulated by sunlight and your body's biological clock.

Imagine if you can't change back to your normal sleep or wake schedule and how tough that would

be. When you miss a good night's sleep, you can become grumpy and unhappy and the same thing

happens for those who experience Sundowning.

Possible causes could be:

1. Pain—sometimes they can't communicate that they are in pain
2. Hunger or thirst
 3. Boredom
4. Depression
5. Being overly tired

Signs of Sundowning in the late afternoon and early evening:

1. Confusion or anxiety
2. Pacing
3. Wandering
4. Yelling

Suggestions to help with sundowning:

 Avoid clutter—a clean uncluttered space is relaxing

 Turn the volume down—or turn it off—turn off the TV and Music and have a quiet
environment

 Provide an activity to the person to distract from pacing or other sundowning behavior

 Create a schedule to maintain a quiet and relaxation time each afternoon

 Go for a walk

 Close the curtains

 Each day at dusk turn down off the ceiling lights and turn on the lamps to create a nighttime
environment
Physical activities and exercise during the day can help make the person tired and improves the

quality of sleep.

Make sure naps are short. If they are too long, they will disrupt night sleep, even for someone who is

healthy.

Spend time outside every day if possible. Schedule a daily walk of outdoor activity. Go sit in the park

or go to a park bench on a street corner.

Exposure to sunlight helps the natural rhythm of sleep and wake.

Things to Avoid:
1. Caffeine late in the day: coffee, tea, cola
2. Alcohol: Can cause confusion and anxiety and not mix well with prescription
medications
3. An unstructured routine: Keep the daily schedule simple

If the problem is severe, make notes in the care plan and discuss it with your Care Manager. Make

sure the client discusses sundowning with their medical team to rule out pain or other medications

that could be causing the confusion at that time of day.

Watch Video on Sundowning: 3 Minutes, 39 Seconds

Tip Sheet
Stages of Alzheimer's Disease, Functional Assessment Staging (FAST), Wandering Risks, Severe

Stage Loses Abilities to Sit Up, Smile, Walk, Familiar Routines Bring Comfort, Structure Activities

for Morning, Afternoon and Evening, Minimize Distractions, Engage in Activities for Connection 

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.

Prevention
Effective Communication Including Communicating w/ Individuals w/
Dementia

How to communicate with older adults to connect with their generation and for seniors who are hard

of hearing, have dementia or have other special needs.

Seniors who require caregiving services often are experiencing an age-related illness or a decline in

their physical abilities. Sometimes this means they will have difficulty with self-care and

communication. Marketers have given labels to generations of people born between certain years as a

way to stereotype their behavior based on the norms that were present when they were developing

into adults.

G.I. Generation (Traditionalists): born between 1900 and 1924

Silent Generation: born between 1925 and 1945
Baby Boomers: born between 1946 and 1964
Generation X: born between 1965 and 1979
Generation Y or Millennials: born between 1980 and 2000
New Silent Generation or Generation Z: born between 2001 and the
present

As a caregiver, you are caring for the G.I. Generation or Traditionalists, and the Silent

Generation, primarily, with some Baby Boomers also beginning to need senior care. By

understanding the age of the person you are caring for you can communicate about topics they are

familiar with and learn how the events in their life impacted them. Every generation has a "Defining

Moment" that impacts their outlook on life. For instance, today's elderly (80+) were young children

when World War 2 began and will have strong memories of relatives or neighbors who may have

died in the war.

The DEFINING MOMENT for each of these generations may be used as a conversation starter

with your senior residents.

The G.I. Generation

(Also called the “Greatest Generation”) lived through the Great Depression and fought in World War

II and the Korean War, went to college in record numbers as part of the G.I. Bill and experienced the

Cold War. They are known to be patriotic, loyal and fiscally conservative. G.I. stands for

"Government Issue" and a popular nickname for soldiers was "G.I. Joe.”

G.I. Generation Defining Moments

 Great Depression

 World War II

 Faster Communication with Radio Ownership

 Singers: Frank Sinatra, Bing Crosby

The Silent Generation

Members of the Silent Generation were born as wars were being fought and the economy was weak.

This generation was born during and after the Great Depression between 1929 and 1939 and World

War II (fought between 1939 and 1945). They were simply happy to be alive and to be able to have

jobs as they joined the workforce. They were not activists and felt it was dangerous to speak out as

young adults during the McCarthy Era. They were the first generation to be smaller in size than the

one before them. They may have lost a parent in the war or knew first-hand of loved ones their

parent's lost, and of the financial difficulties their parents suffered during the Great Depression. Some

call them "The Lucky Few" as they became young adults during the prosperous economy of the

1950s and 1960s when modern life became more "convenient" with appliances and automobiles and

televisions available for everyone.

Silent Generation Defining Moments

 Birth of Rock 'n' Roll

 Born during or after the Great Depression and World War II

 Rise of the "Housewife" enjoying Modern Appliances: Dishwashers, Washing Machines, Air
Conditioning, Jello-Salads

 Builders of High-rises and Factories after the War

 Saw Televisions come into the Home

The Baby Boomer Generation

(The babies born to those who came back from fighting World War II). The Baby Boomers

experienced the Vietnam War, Watergate, the Civil Rights Movement, the Kennedy and MLK

Assassinations, the Moon Landing and the Cold War. Boomers are known to question authority and

crusade for causes.

Baby Boomer Generation Defining Moments

 Vietnam War

 Civil Rights Movement

 Moon Landing with Neil Armstrong Planting the Flag

 Assassinations of Martin Luther King, Jr., John F. Kennedy, Robert Kennedy

 Women Began Careers Equal to Men (Equal Rights Amendment)

Boomers have continued to make headlines as a generation that is living longer while being more

active during their senior years than their parent's generation. They are innovating to choose to age in

new ways with second careers after retirement and actually choosing to move to Active Assisted

Living Communities. As our lifespans increase and technology advances, this will be the generation

paving the way for innovations in caregiving.

By understanding the generation of the senior, you may start conversations around the events that

occurred in their lifetime.

Realize that just as you have certain ways of communicating with your friends, seniors also learned a

certain communication style for the era when they were coming of age.

Remember that the older generations did not learn to communicate on smartphones or through text

messaging. Caregivers need to effectively communicate in the style a senior prefers while being

respectful of hearing and memory loss challenges. Even vocabulary words may have different

meanings between generations.

Effective Communication with the Elderly

 Establish a daily routine that includes discussing the day’s schedule

 Speak clearly and face the senior when talking

 Use proper vocabulary

 Be mindful of memory loss and how this may impact communication skills

 Be aware of hearing loss signs: television and radio volume is too loud or speaking volume
becomes louder

 If hearing aids are used, be aware that battery changes may be needed and communicate with
your supervisor if you notice a resident needs this assistance
Tips for Communicating With Someone with Hearing Loss

Watch Video on Hearing Loss: 2 Minutes

 Gain Attention: touch their hand or shoulder if necessary

 Avoid Covering Lips and Mouth

 Speak Naturally: speak at a normal rate—not too fast, not too slow

 Pause: give them time to process your words

 Rephrase Rather than Repeat

 Engage in Conversations Without Background Noise (turn off the TV or radio)

 Converse in Areas with Good Lighting

Communicating with People — Active Listening

Active listening, where you repeat back what the person has said and then answer the question or

continue the conversation, can help when communicating with someone. Maintaining a consistent

routine will help the person better know what to expect each day. When speaking to the person, say

their name and speak clearly and give them time to answer. Remember that often body language will

be part of the communication process, look for visual clues as well as verbal ones. Meet them where

they are each day with a wink, a smile, and a pat on the back as you keep their routine on track.

Use the Senior’s Name: for example, "Louise, how did you enjoy lunch today?"
Example of Active Listening

Resident says, “My son always arrives 15 minutes late, never on time.”

Associate says, "Since your son always arrives about 15 minutes late, why don’t we plan to wait

until he arrives to put in the roast?"

Speech problems may be temporary, for instance, if a senior is recovering from a stroke. Use pen and

paper to communicate more easily.

Communicating with Someone with Dementia Tips:

1. R-E-S-P-E-C-T
2. Use Non-Verbals: Nod, Smile
3. Choices: Give them a Two-Choice option rather than asking "Yes" or "No" Questions
4. Maximize Hearing: Face Them when You Speak
5. Do Not Force Conversations

Watch Video on Tips for Talking with People with Alzheimer's Disease and Dementia by Dr.

Natali: 10 Minutes, 22 Seconds

Avoid Frustration, Remain Calm

People may become demanding and express frustration when they cannot communicate effectively.

Always remain calm and try to connect with them by showing them you understand their frustration

and challenges and will be patient with them.

Develop a communication system that will work between you and your client. Maintain a calm and

pleasant demeanor and keep an established routine for them to follow each day.
There may be good days and bad days and you must learn to never take it personally when someone

is frustrated. Keep the lines of communication open.

Effective Ways to Communicate with Individuals with Dementia

Alzheimer's disease and other types of dementia affect areas of the brain responsible for

communication. There are techniques you may use to adapt your behavior to communicate better

with your clients who are experiencing memory loss.

Communication Changes
Early Stage
1. Vocabulary shrinks
2. The person may use wrong or similar words
3. The person may become quiet and withdrawn

Middle Stage
1. More vocabulary loss
2. Difficulty finding words for common items
3. The person may not understand what is spoken
4. The person may be aware of their language mistakes but unable to correct them
Late Stage
1. Limited vocabulary
2. Extreme difficulty speaking and cannot correct speech
3. May appear like they cannot speak at all
4. Probably cannot understand written words
5. Unclear how much-spoken words are understood

At any stage, do not assume the person can't understand. Never speak as if the person is not

there.

Someone told a story about a woman who appeared as if she could not understand. A friend spoke

about her to her husband as she stood next to him. Tears began to stream down her cheeks. She

clearly understood and her feelings were hurt.

Watch Video on the Bookcase Analogy: 5 Minutes, 13 Seconds

VIDEO NOTES: This video clearly explains what is happening as Alzheimer's progresses and why

our non-verbal communication is so important. It also helps you to know how to better explain

Alzheimer's disease to other people.

The old saying, "It's not what you say, but how you say it" becomes so very important.

Non-verbal communication can be the majority of what is communicated, even when you are

speaking. Think about how the same words, said in a different tone of voice and with or without a

smile will have a very different meaning. Studies show that only 7% of communication comes

through words for healthy adults.

Remember this when you are caring for someone with memory loss.
Meet them Where They Are Each Day
It might be that the person with Alzheimer's disease wakes up one day and thinks it is their birthday

or your birthday. Or, they may think they need to get ready to go to work. "Meet them where they

are" means to acknowledge what they are talking about and feeling. Then change the subject and

discuss a task at hand, such as if they are ready to have breakfast. Staying focused on daily tasks and

a consistent routine helps.

Speech and vocabulary gradually lessen over time in Alzheimer's disease, but feelings and non-

verbal cues can still be conveyed.

Alzheimer's and Dementia Best Practices for Communication:

 Approach the person from the front, make eye contact: Address the person by name "Good
morning, Mary, it's Susan, your caregiver. I'm here to help you today."
 Use simple, easy sentences, giving direction. "Mary, sit in this chair," NOT, "Would you
like to sit down?"
 Give choices if they are able to make a choice, but don't give suggestions. For example,
instead of saying, "Wouldn't it be nice to get a shower and be clean before bed?" say, "Mary,
would you like to take a shower to be clean before bedtime now, or after your meal?"
 Avoid inappropriate questions or asking a person if they remember. For example, don't say,
"You raised four children so you should remember how to brush hair." Instead say, "Mary,
you raised four children, I bet you brushed a lot of hair in your day.
  If the person says they are hungry and have not eaten, explain to them when they will be
eating, such as: "It has been a while since you ate breakfast, I bet you are getting
hungry. We will have lunch soon."
 Divide tasks into small steps. Instead of saying, "Get ready for lunch," say, "Mary, it's
almost lunchtime. Let's wash your hands before we eat." Then add the next step, "Please
place a napkin at each plate."

 Touch is important. Use nonverbal cues. Do not patronize. Be kind in words and tone of
voice.

 Speak slowly and repeat phrases using the exact same words.

 NEVER argue or correct. If Mary asks when her mother is coming. Don't say, "You know
your mother is dead." Instead say, "Your mother was a kind person, tell me about her."

 Acknowledge the person's feelings. We all want to be understood. This is how the person
truly feels, honor their feelings, play along and comfort them.

 Once a client is noncommunicative, be alert to facial and body motions, which can signal
pain, anxiety, or distress.

We are told from the time we are young children to always tell the truth. As a caregiver for

Alzheimer's clients, it is important that you remember their reality may be very different. In order to

comfort them, you need to join their world. This may often mean that you pretend along to provide

for their best interests.

"Meet them Where They are Each Day"

Non-Verbal Communication

Pay attention to non-verbal communication, it will often be more important than verbal. This goes for

both you and the client. In later stages, when the person loses the ability to speak, being attuned to

their non-verbal clues will help you communicate more effectively.

Always use professional and ethical standards while considering the person's religious, cultural and

individual preferences. As a caregiver, you will learn about the cultural and religious preferences in

the Plan of Care. If you are caring for someone from a different cultural background or religion from

your own, be sure to confirm with your Care Manager that you understand their preferences for care

approaches, including non-verbal communication.

Watch Video on Communication: 5 Minutes, 13 Seconds

Don't Take Anything Personally

Don’t expect the person to recognize you or recall your relationship each shift

Walking and Talking to Improve Communication

A recent study at the University of Miami discovered walking and talking helped to improve

communication skills with those with Alzheimer's disease.

Nursing home residents diagnosed with probable Alzheimer’s disease were divided into 2 different

groups. One group participated in planned walking while communicating for 30 minutes, three times

each week. The comparison group did not walk or perform any other type of physical activity, but

rather, they engaged in conversation only.

The study authors discovered that when group participants walked as they conversed,

communication improved significantly.

As compared to the study group that just conversed without engaging in any type of physical activity,

after 10 weeks, those who "walked and talked" showed significant improvements in communication

ability.

The study data suggests you should plan consistently scheduled walking, at least 30 minutes, 3

times per week while talking.

Schedule 30 Minute Walks, 3x's Weekly
This structured exercise activity of walking and talking can be an effective tool for improving

communication performance as the disease progresses.

Remember to:

 Make eye contact

 Use simple sentences

 Ask Yes or No questions, not vague open-ended questions

 Be aware of your tone and body language.

 Don't pretend the person is not there or does not understand

 Use touch

 Try distracting the person or changing the subject if communication creates problems
Validation Therapy

Validation therapy was developed in the 1960s and '70s by Naomi Feil to help treat Alzheimer's

disease. It is a holistic therapy which focuses on empathy and helps people communicate to promote

peace and wellbeing.

How the Validation Method Began

Naomi Feil, a social worker for the elderly, was unhappy with the common practices at the time and

developed her own methods. She published two books on her validation methods.

 Validation therapy emphasizes empathy and listening

 Offer individuals a means for expression, verbally or nonverbally, so at the end of life they
can pass in peace

Example:

A woman is convinced someone is throwing away her most precious belongings, including photo

albums and scrapbooks. The woman is actually hiding these things.

Instead of arguing with the woman, you could rephrase the situation, helping her reminisce about her

youth in a positive light: “Your wedding ring is gone. Do you think I’ve stolen it? It was a beautiful

ring. How did you and your husband meet?”

Watch Video on Validation Therapy: 5 Minutes, 46 Seconds

Tip Sheet
Understand the Generation the Senior is from to Better Connect, Speak Clearly and Face the Senior,

Gain the Resident’s Attention by Touching their Shoulder, Hearing Loss of High Frequencies Often

Accompanies Aging, Use Active Listening to Better Communicate with Seniors with Alzheimer's or

Dementia, Maintain an Established Routine

Communication Abilities Change According to Alzheimer's Stages, Never Speak as Though the

Senior Doesn't Understand, You Can Still Communicate Non-Verbally, Never Argue or Correct,

Exercise May Improve Communication, Validate Your Client's Feelings

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.

Prevention
Problem Solving when Challenging Behavior Exhibited in Dementia
Care
Alzheimer’s Disease and Dementias
Memory loss diseases can cause people to act in unpredictable ways. As the changes can progress

over time, it can be difficult for family members and caregivers to know what each day will bring.

Some people with Alzheimer's say they have noises playing in their heads.

Can you imagine listening to a constant stream of loud noise in your head and trying to accomplish

tasks? Even simple tasks become very difficult.

Behaviors
Watch Video on Challenging Behaviors: 3 Minutes, 6 Seconds

They often misunderstand what they hear. Remember—the person is NOT trying to be difficult and it

can be their way of trying to communicate.

Aggressive Behavior

This can be shouting, name-calling, mean remarks or physical like hitting, shoving, or smacking.

PINPOINT BEHAVIORS

 Was it harmful?

 Can you figure out a trigger?

 What happened next?

 Could the person be in pain?

 Could it be related to a medication?

  Are their needs being met?

 Are they comfortable?

 Can you change your reaction?

CALM RESPONSE

 Focus on feelings

 Be positive

 Speak slowly and in a soft tone

 Be “all in” — avoid distractions and focus attention

 Create a relaxing environment with music, massage or exercise

 Take a break if the person is safe

IF THE PERSON IS UNABLE TO CALM DOWN, seek help.

If you do need to call 911, it is important to tell the first responder the person has dementia and

can become agitated and aggressive.

Remember, aggressive behavior can be a response to:

1. Pain or discomfort
2. Medication
3. Hunger or thirst
4. Loud or busy environment
Confusion and Forgetfulness
Remember, patients can forget the purpose of common items like a pen, glasses, fork, spoon.

They can forget a person, even their most beloved, which can be difficult for everyone.

Stay Calm

 Don’t overwhelm with a long answer—clarify with the most simple and short explanation.

 Instead of correcting, suggest “I think it is used to eat your food” instead of “You use this
every day to eat your food, it is a fork.”

 Show photos of the person with the loved one to "jog" their memory

Watch Video on Communication Best Practices: 2 Minutes, 47 Seconds

Repetitive Questions

Many times someone with Alzheimer's disease will repeat the same question over and over again.

Sometimes there will be a recurring theme that they are concerned about such as worrying about if

they paid a bill or if their daughter or son will be visiting on Sunday.

Tips for repetitive questions include guiding them to focus on what they are able to understand and

giving them the tools to easily see reminders for their daily schedule.

Watch Video on how to Respond to Repetitive Questions: 3 Minutes, 44 Seconds

Repetitive Actions
It can be difficult and slightly annoying when a person repeats something over and over again.

 This can be verbally or physically

 Repeating a phrase or repeating an action

 They may pace back and forth endlessly

 They may undo something you just did

This can cause stress for you as the caregiver.

As long as the action is not harmful, keep calm and look for the reason why the person is doing the

behavior—the trigger. Most times repetitive behaviors are a calming response to something.

Watch Video on Repetitive Behaviors: 3 Minutes, 45 Seconds

Turn the action into positive behavior. For example, if they are rubbing a surface, provide a cloth for

dusting.

If they are wringing their hands provide a wet cloth for them to wring out.

If they are pacing, take them on a walk.

Suspicions and Accusations

No one likes to be accused of something, especially when you didn’t do anything to deserve it. Even

if you are accused of something you find horrible or offensive—DON’T take offense.

Be reassuring—still, respond to the person and acknowledge their feelings.

Do not argue or be defensive.

Offer a very simple answer, then quickly focus their attention on something else, a new activity for

example.

Aggressive behavior can also be due to:

 Lack of a consistent daily, evening, and nightly routine

 Communication issues with loved ones who don’t accept or understand the disease

Steps for Caregiving when Aggressive Behavior Occurs

 Approach them in a friendly manner

 Meet them where they are (where they think they are)

 Talk at eye level

 Use their name

 Gently touch (on the shoulder, for instance)

 Talk about a non-threatening topic for a couple of minutes

  Once comfortable, suggest they take a walk with you or suggest another activity

Use REMISSION to get them to focus on a subject that makes them feel good.

For instance, if they are still able to communicate, they may enjoy talking about their spouse or their

first car or a child.

Once they are talking, the caregiver can begin assisting with the care needs.

Break tasks down into manageable steps.

Never say “no” or argue with a person with dementia.

It is much better to divert their attention elsewhere.

Learn about what they like or a person they love and talk about that when they are being aggressive.

Remember that their aggression is something that is not caused by you. Do not take it personally.

Watch Video on Dementia and Aggression: 4 Minutes, 43 Seconds

Catastrophic Behaviors

Catastrophic reactions are an overreaction to a seemingly normal, non-threatening situation. The

word catastrophic implies that there is a catastrophe or some terrible event that occurred.

Catastrophic Reactions are more likely to occur in the middle stages of Alzheimer's.

Examples of Catastrophic Reactions

 Physical Aggression such as hitting, kicking, or pulling hair

 Emotional outbursts such as shouting, yelling, or crying uncontrollably

Why Do Catastrophic Reactions Occur in Dementia? What Causes Them?

Dementia can distort the way a person interprets reality.

The University of Rochester study found that the most common trigger for a catastrophic
reaction is assistance with personal hygiene tasks, and the evening dinner time is the most
frequent time of day that catastrophic reactions are experienced.

Can Catastrophic Reactions Be Prevented?

Often, the way you interact with others can affect their reaction to you.

 Approach the person from the front, rather than the back or side which may startle them.

 Don’t appear rushed or frustrated or upset.

 Know the person’s preferences. For example, some people respond very positively to touch
and others bristle even if someone is near them.

 Explain clearly what you would like to have the person do before attempting to do it. (“It's
bath time. Let’s walk together to the bathroom.”)

 Don't argue, criticize or disagree with a person who has dementia.

 Avoid over-fatigue if possible.

 Avoid sudden changes in routine.

How Should You Respond to Catastrophic Reactions?
 Give the person physical space.

 Don’t attempt to continue whatever it was that triggered the reaction unless it is absolutely
necessary to accomplish that particular task at that specific time.

 Don’t use force.

 Be respectful, not patronizing.

  Use the person's name.

 Allow him extra time to calm down.

 Reassure her. Perhaps she has a favorite stuffed animal. Let her hold the item and be
comforted by it.

 Divert him as he’s calming down. Catastrophic reactions are traumatic for those experiencing
them, so encouraging him to focus on something else can help.

 If the person has experienced a catastrophic reaction previously, you should always take note
of what appeared to trigger the reaction before and avoid that behavior if at all possible. Note
this in their care plan.

 If a catastrophic reaction is unusual for this person, you will also want to consider if she has
any health changes that might be causing her to have pain, such as a fall or other injury, or
delirium. Delirium is usually caused by an infection or other illness. It can cause a sudden
change in cognition and/or behavior, and it can show up as increased confusion or aggressive
behavior.

Modesty Garments

Seniors from the Silent Generation who are age 60 and above, were raised in a time when nudity was

considered more shocking than it is today. Remember that even public schools had dress codes

requiring skirts below the knee and colleges had curfews for women. These earlier generations

considered public nudity more unacceptable and this may be escalated when a senior has memory

loss. This is why bathing and personal care can become a battle. The senior associates this as

behaving badly. This strong resistance to bathing and toileting often is because of their modesty.

Modesty garments are available to allow the caregiver to cover the senior's private areas while still

allowing the caregiver easy access for bathing and toileting. They will often help solve the senior's

resistance.
Watch Video on How to Respond to Dementia Behaviors: 5 Minutes, 44 seconds

Tip Sheet
Be Calm and Reassuring, Alzheimer's and Dementia Cause Unpredictable Behavior, Confusion and

Forgetfulness Can Be Frustrating, Break Down Tasks into Manageable Steps

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.

Prevention
Fundamentals of Dementia Care

Remember: Alzheimer's Disease is a progressive disease—meaning it gets worse over time.

Currently, there is NO cure.

Actively Empathize
Care starts with compassion and empathy. This holds true in all human relationships but is especially

important for dementia caregivers.

How would you feel and want to be treated if you suddenly found yourself disoriented in an

unfamiliar place, not even sure of the year or even who you are?

Don't be too hard on yourself.

The person you care for will have good days and bad days. Try your best to foster the good days and

even the good moments for the person with dementia, don’t try to force them.

Dementia is More than Memory Loss

Memory loss is a classic dementia symptom. But some types of dementia, particularly frontotemporal

dementia and Pick’s disease, show up as personality changes rather than memory loss. The

symptoms depend on the areas of the brain that is affected by the disease. Even when memory loss is

the most obvious symptom, the person with dementia is experiencing a neurological decline that can

lead to many other issues. In the latest stages of most types of dementia, patients become unable to

attend to activities of daily living (such as dressing and toileting) independently. They may become

non-communicative, unable to recognize loved ones and even unable to move about.
Watch Video There is More to a Person than Dementia: 2 Minutes, 25 Seconds

Plan for the Future

The only sure thing is change when you are caring for someone with dementia. Be mindful to

continually reassess the care needs and update the daily Care Plan notes of any changes. Remember

that care needs will increase over time. Help the family so they can be ready for the next stage.

What do people with Dementia Need?

Fundamentals of Dementia Care
1. COMFORT: Be supportive, warm, and tender
2. ATTACHMENT: Important to promote personal relationships, maybe even more than
the general population
3. INCLUSION: Important to feel part of things, to feel belonging
4. OCCUPATION: Important to find activities where the person can work, play, and be
involved and connected.
 5. SENSE OF IDENTITY: Important to hold their memories, life histories, and their
pasts, and to respond to them as an individual.

Watch Video on What it is Like to Experience Dementia: 6 Minutes

Coping with Alzheimer's Diagnosis

Coping with this diagnosis and its symptoms can be stressful, so give a newly diagnosed person time

and grace to process the information and adjust to the new challenge.

Acknowledge and identify emotions, and understand that a range of feelings can be a normal reaction

to this new diagnosis.

Emotions and thoughts may include:

 Shock and Disbelief: "I can't believe this is happening. I just want to wake up and find out
that this was a bad dream. It doesn't even seem real."
 Denial: "There's no way that this is correct. The doctor didn't even ask very many questions.
I don't think anybody could have passed that test he gave me."
 Anger: "I can't believe this is happening! Why me? It's so unfair."
 Grief and Depression: "I'm so sad. Is life as I know it forever changed? I don't know how to
live with this knowledge."
 Fear: "Will I forget my loved ones? Will they forget me? What if I can't live at home
anymore? Who will help me? I'm afraid—both of not knowing and knowing the future with
this disease."
  Relief: "I knew something was wrong. I wanted to believe it wasn't a problem, but in a way,
I'm glad to be able to name it. At least now, I know what's happening and why it is."

As this is a progressive disease impacting the brain, it will progress, or advance, at different stages

for each person. This adds to the challenge of knowing 100% of how a medication will work for each

person.

Medications
Right now there is NOT a medication available to prevent or cure Alzheimer's disease. There are

suggested lifestyle habits that may assist in helping to prevent the onset of the disease and the

severity of the disease. However, the research in this area remains new and the studies are continuing

to find a cure and confirmed ways to prevent Alzheimer's disease.

Resistance to taking medications naturally begins to happen as the disease progresses. There are

medications that will slow the progression of the disease.

Alzheimer's Disease Medications

Class 1: Cholinesterase Inhibitors Medications

 Donepezil branded as Aricept

 Galantamine branded as Razadyne or Reminyl

 Rivastigmine branded as Exelon

How Cholinesterase Inhibitors Alzheimer's Drugs work:

Cholinesterase Inhibitors work by slowing down the process that breaks down a key

neurotransmitter.

There is a shortage of acetylcholine in the brain and these drugs help to build it back up.

The medications are shown to assist in slowing down the rate of decline of memory loss by helping

to improve cognitive memory.

Side Effects

Side effects will vary for each person.

Nausea, vomiting, and diarrhea can be experienced as side effects but they usually do not last more

than 6 weeks. Duration has been documented from 1 to 6 weeks.

Changes in vision and skin rashes can also be experienced.

Monitor any and all changes you may notice when someone is taking medication for memory loss.

Class 2: N-Methyl D-Aspartate (NMDA) Antagonists

 Namenda is the only drug in this class, and it is approved for moderate to severe Alzheimer's

 Namenda appears to work by regulating glutamate (an amino acid) levels in the brain.
Normal levels of glutamate facilitate learning, but too much glutamate can cause brain cells
to die

 Namenda has been somewhat effective in delaying the progression of symptoms in later
Alzheimer's disease

Combined Drugs
In 2014, the FDA approved Namzaric, which is a combination of donepezil and memantine
—one drug from each class above. It is designated for moderate to severe Alzheimer's
disease.

Drug Therapy for Behavioral, Psychological & Emotional Symptoms

Psychotropic medications are used at times to treat the behavioral, psychological, and emotional

symptoms of Alzheimer's disease.

The class of psychotropic medications consists of antidepressants, anti-anxiety

medications, antipsychotics, mood stabilizers, and medications for insomnia (sometimes
called sleeping pills or hypnotics). These medications can be effective but can also cause
significant side effects.

Monitor All Medications

Remember that the impact of medication may be modified if the medication is not taken at the proper

time and in the proper format.

Check Medication Instructions

 Time of day

 Taken with or without food

 Possible side effects

 Drink a full glass of water, juice, or other liquid

When Seniors are Resistant to Taking a Medication

Watch Video on Refusing to Take Medication: 4 minutes and 3 Seconds

Remember that as seniors begin to lose their capabilities and lose loved ones, it is natural to respond

by showing control over tasks that they can control. Seniors with memory loss can have days where

they may decide they do not want to take a medication.

 Explore other formats for the medication. Many times a pharmacy can offer a liquid version

of the medication.

 Take with a Favorite Food? Using applesauce or other food (with medical doctor approval)

may assist the senior to be more accepting of the medication.

 Routine for Taking Medications? Create a fun format for taking medications, based on the
senior's personality. Set a place setting and play music and customize this time to tell a joke,
share a memory or play a favorite song.

Tip Sheet
Alzheimer's Medications do NOT cure the disease, only slow down the progression. Review

medication instructions and maintain the medication schedule. Monitor for side effects or any

changes in the senior's behavior when a new medication has been prescribed to monitor a positive or

negative impact.
IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.
Prevention
The Aging Process and Maintaining Safe Environments

People do not become old or elderly at any specific age. Traditionally, age 65 has been designated as

the beginning of old age. But the reason was based on history, not biology.

What defines "old" can be answered in different ways:

  Chronological age: Chronological age is based solely on the passage of time. It is a person’s
age in years. The likelihood of developing a health problem increases as people age, and
health problems, rather than normal aging, are the primary cause of functional loss during old
age.
 Biological age: Biological age refers to changes in the body that commonly occur as people
age. Because these changes affect some people sooner than others, some people are
biologically old at 40, and others at later ages. Differences in apparent age among people of
similar chronological age are caused by lifestyle, habits, and effects of disease rather than by
differences in actual aging.
 Psychological age: Psychological age is based on how people act and feel. For example, an
80-year-old who works, plans, looks forward to future events, and participates in many
activities is considered psychologically young.

Most people do not need the expertise of a geriatrician until they are 70 to 75 years old.

Geriatrician: a doctor who specializes in the care of the elderly.

Gerontology is the study of the aging process, including physical, mental, and social changes. The

information is used to improve the lives of older people. Some gerontologists have a medical degree

and are also geriatricians.

Geriatrics is the branch of medicine that specializes in the care of older people, which often involves

managing many disorders and problems at the same time. Geriatricians have studied the aging
process so that they can better decide which changes result from aging itself and which indicate a

disorder.

Normal Aging

People often wonder whether what they are experiencing as they age is normal or abnormal.

Changes are to be expected to be generally unavoidable.

For example, as people age, the lens of the eye thickens, stiffens, and becomes less able to focus on

close objects, such as reading materials.

The condition is called presbyopia. This change occurs in virtually all older people. Presbyopia is

considered normal aging. Other terms used to describe these changes are usual aging.

Exactly what constitutes normal aging is not always clear. Changes that occur with normal aging

make people more likely to develop certain disorders. People can sometimes take action to make-up

for these changes.

For example, older people are more likely to lose teeth.

But seeing a dentist regularly, eating fewer sweets, and brushing and flossing regularly may reduce

the chances of tooth loss.

Therefore, tooth loss can be avoidable.

Healthy (Successful) Aging

Healthy aging refers to a delay in the unwanted effects of aging.

The goals of healthy aging are maintaining physical and mental health, avoiding disorders, and
remaining active and independent. For most people, maintaining good health requires more effort as

we age. Developing certain healthy habits can help:

 Following a nutritious diet

 Exercising regularly

 Staying mentally active

It is never too late to begin. We can have some control over what happens to us as we age.

The average life expectancy of Americans has been increasing dramatically over the past

century.

Life Expectancy

A male child born in 1900 could expect to live only 46 years, and a female child, 48 years.

Overall, women live about 5 years longer than men.

Although the maximum life span—the oldest age to which people can live—has changed little since

records have been kept.

The chance of living to be 120 is minuscule.

Madame Jeanne Calment from France had the longest documented lifespan: 122 years (1875 to

1997).

Several factors influence life expectancy:

 Heredity: Heredity influences whether a person is likely to develop a disorder.
For example, a person who inherits genes that increase the risk of developing high cholesterol levels

is likely to have a shorter life.

A person who inherits genes that protect against cancer is likely to have a longer life.

There is good evidence that living to very old age—to 100 or older—runs in families.

 Lifestyle: Avoiding smoking, not abusing drugs and alcohol, maintaining a healthy weight
and diet, and exercising help people function well and avoid disorders.
 Exposure to toxins in the environment: Toxins can shorten life expectancy even among
people with the best genetic makeup.
 Health care: Preventing disorders or treating disorders after they are contracted, especially
when the disorder can be cured (as with infections and sometimes cancer), helps increase life
expectancy.

Most people reach their peak functioning at around age 30.

Is Aging Actually Good for You?

How soon you notice age-related changes in stamina, strength, or sensory perception will vary based

on:

 Your personal health choices

 Your medical history

 Your genetics

Some age-related complaints are common, and some symptoms aren’t caused by aging at all.

Eye Trouble
By around age 40, almost everyone will be reaching for reading glasses.

Presbyopia occurs when the lens becomes stiff and won’t adjust to refocus from distance to near

vision.

Cataracts, or a clouding of the lens, may begin to affect your vision when you reach your 60s.

Long-term exposure to sunlight increases the risk of cataracts, which can be corrected through

surgery to replace the lens.

About a third of people who are 60 or older have some hearing loss.
Hearing Loss

This condition, known as presbycusis, may be due to the loss of sensory receptors in the inner ear.

At first, some sounds may seem muffled, and high-pitched voices may be harder to understand.

Men tend to have more hearing loss than women.

A Decrease in Strength or Stamina

With age, we lose muscle tissue and our muscles become more rigid and less toned.

 Weight training and stretching improve strength and flexibility, although we can’t completely
counteract this natural course of aging.

 Our organs lose their extra reserve, too.

 The walls of the heart become thicker

 The arteries are stiffer

 The heart rate slows as we age

Aging of the heart is a major reason it may be harder to exercise when we are older as we could when

we were 20.

Maintaining regular aerobic activity—even just walking—can improve stamina.

High Blood Pressure

Aging is not a disease, but our body’s changes make us at risk for some medical conditions.

One example is essential hypertension or high blood pressure. The exact cause of essential

hypertension is not known.

There are several factors that can cause high blood pressure including:

 Genetic factors
  Obesity

 Salt intake

 Aging

Blood vessels tend to become less elastic with age, and this stiffness may lead to high blood pressure.

More than half of people 60 and older have high blood pressure—a reading of 130 (systolic)

over 80 (diastolic) or higher.

A low-sodium diet, exercise, and maintaining a healthy weight can help prevent high blood pressure.

Memory Loss

Can’t remember where you put your keys? Forgot the name of an acquaintance you haven’t seen in a

while?

Those momentary lapses are normal.

No need to worry, unless the forgetfulness is impairing your daily life.

Generally, information processing slows as we grow older, and older people have more trouble

multitasking.

Older adults typically outperform young adults in their knowledge of the world.

 The red flag for dementia related to Alzheimer’s disease is the inability to learn and retain
new information.

 Experiencing short episodes of memory loss may be a sign of early Alzheimer’s.

 People with Alzheimer’s have other cognitive problems as well, such as trouble with
language or recognizing objects.

 Alzheimer’s disease rarely occurs among people who are younger than 65.

 About one in eight people aged 65-74 have Alzheimer’s and 43% of people who are
older than 85 have Alzheimer’s.

Apps to Help with Aging

 Lumosity—Split into sessions of three games tailored to your goals: memory, attention,
problem-solving, processing speed, or flexibility of thinking. The games are played against
the clock and change every time.
  Personal Zen—Players follow two animated characters, one of which looks calm and
friendly while the other looks angry, as they burrow through a field of rustling grass. A single
session of play can build resilience over several hours. Use the app right before a stressful
event, but 10 minutes a day will help build more enduring positive effects.
 Happify—Train your brain to be happier? Research shows that some activities help build
your ability to conquer negative thoughts, show gratitude, cope with stress and empathize.
The app’s quizzes, polls and gratitude journal — combined with a positive community,
gradually teach life-changing habits.
 Eidetic—Uses a technique called spaced repetition to help you memorize anything from
important phone numbers to interesting words or facts. It works differently from typical brain
training apps by using items that have meaning and context.

Safety in and Around the Home

 Help them to be as happy and independent as possible by creating a safe and familiar
environment

 Routines are important for a person with dementia

 The home environment should help them know where they are and help them find where they
want to go

 Any changes in the environment may add to confusion and disorientation

The disease can cause brain changes to:

Judgment: Forgetting how to use household appliances

Sense of time and place: Getting lost on one's own street

Behavior: Becoming easily confused, suspicious or fearful

Physical ability: Having trouble with balance

Senses: Experiencing changes in vision, hearing, sensitivity to temperatures or depth perception

Home Safety Checklist

o Evaluate your environment.

1. Pay special attention to garages, workrooms, basements and outside areas

where there are more likely to be tools, chemicals, cleaning supplies and
other items that may require supervision.

2. Keep poisonous chemicals such as gasoline, spray paint and paint thinner out
of reach.

3. Install a garage door safety sensor.

o Avoid safety hazards in the kitchen.

1. Consider removing the knobs.

2. Use appliances that have an auto shut-off feature.

3. Keep them away from water sources such as sinks.

4. Remove decorative fruits, sugar substitutes and seasonings from the table and
counters.
 5. Keep knives and sharp items in a locked drawer or cabinet

o Be prepared for emergencies. Keep a list of emergency phone numbers and

addresses for local police and fire departments, hospitals and poison control

helplines.
o Install locks out of sight. Place deadbolts either high or low on exterior doors to

make it difficult for the person to wander out of the house. Keep an extra set of keys
hidden near the door for easy access. Remove locks in bathrooms or bedrooms so the
person cannot get locked inside.
o Keep walkways well-lit.

1. Add extra lights to entries, doorways, stairways, areas between rooms, and
bathrooms.

2. Use night lights in hallways, bedrooms, and bathrooms to prevent accidents

and reduce disorientation.

3. Inexpensive, peel and stick, motion-activated lights are now available

o Remove and disable guns or other weapons. The presence of a weapon in the home

of a person with dementia may lead to unexpected danger. Dementia can cause a
person to mistakenly believe that a familiar caregiver is an intruder.

Watch Video on Guns in the Home: 5 Minutes, 40 Seconds

o Place medications in a locked drawer or cabinet. To help ensure that medications

are taken safely, use a pillbox organizer or keep a daily list and check off each
medication as it is taken.

Example of lockable electronic pill dispenser: Alarm beeps and pills are
dispensed at scheduled times
 Remove tripping hazards. Keep floors and other surfaces clutter-free. Remove objects such
as magazine racks, coffee tables, and floor lamps.
 Watch the temperature of water and food. It may be difficult for a person with dementia to
tell the difference between hot and cold. Consider turning down the hot water heater, so the
water is not as hot.
 Avoid injury in the bathroom.

1. Install walk-in showers.

2. Add grab bars to the shower or tub and at the edge of the vanity to allow for
independent, safe movement.

3. Add textured stickers to slippery surfaces.

4. Apply adhesives to keep throw rugs and carpeting in place, or remove rugs
completely.

 Improve laundry room safety. Secure and lock all cleaning products such as detergent,
liquid laundry “pacs” and bleach. If possible, keep the door to this room locked.
Support the person's needs. Try not to create a home that feels too restrictive.

The home should encourage independence and social interaction. Clear areas for activities.
Creating a Safe Environment

This also means making sure you as the caregiver are safe.

It is not uncommon for people with dementia or Alzheimer's to be sexually inappropriate. It can be

stressful for you as the caregiver.

Watch Video on Handling Advances: 6 Minutes, 8 Seconds

Altering the Environment can Change Behavior

Maybe you need to hide or lock things to prevent access to an area, like cleaning supplies in a closet

or candy in the pantry.

Maybe you need to accentuate an area to help the person find what they need, like putting the picture

of a toilet on the bathroom door or removing doors so the person knows what room it is.
You can put bright colored tape around a light switch cover to help the person find the switch or put

labels or photos on cabinet doors to show what is inside.

Use night-lights at night so they know it is night time instead of leaving bright overhead lights on.

Keep the Environment Simple, Clean, and Clutter-Free.

Tip Sheet
A geriatric doctor specializes in the care of elderly patients. Eating a healthy diet, regular exercise

and staying mentally active can help a person age healthier. Presbyopia is part of the aging process.

Life expectancy is influenced by heredity, exposure to toxins, healthcare, and lifestyle. Psychological

age is based on how you think and feel. 

A Safe Environment is Important for Both the Senior and the Caregiver, Alzheimer's can Cause

Changes to the Brain and Affect Both Physical and Mental Capacities, Create a Home Safety

Checklist, Altering Environment can Change Behavior

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.

Prevention
Managing the Activities of Individuals with Dementia
Activities for Seniors with Alzheimer's Disease
For the person with Alzheimer’s Disease, activities and routines can mean the difference

between feeling loved and needed and feeling unloved and unnecessary.

When planning activities and daily tasks to help the person with Alzheimer’s organize their day,

think about where they are in the stages of the disease and remember that creating a routine creates

comfort for them. As they may be forgetting people, engagement in activities helps to keep them

connected and comforted.

Watch Video Clip from the movie "Still Alice": 1 Minute, 46 Seconds

For the person with Alzheimer’s Disease

 What skills and abilities does the person have?

 What does the person enjoy doing?

 Does the person begin activities without direction?

 Does the person have physical problems?

Planning
Your Approach to Developing a Daily Plan for Engaged Activities

 Make the activities part of your daily routine

 Focus on enjoyment, not achievement

 Determine what time of day is best for the activity

  Offer support and supervision

 Be flexible and patient

 Stress involvement by them — even if you are asking them which cup to use or which color
to pick

 Help the person remain as independent as possible

 Simplify instructions

 Establish a familiar routine

Activities for Seniors with Alzheimer's Disease and Memory Loss

Rule #1: Relax and have fun!

Rule #2: Be in the moment!

Rule #3: Smile when they smile!

Meet Them Where They Are Each Day

Match and Mirror Their Behavior (as long as they aren't harming themselves or others).

It will be common that a senior with memory loss will go back to a habit formed a long time ago. For

example, if they worked as a bank teller, they might be very comfortable sorting out money or paper.

Think about ways you can assist them to have the comfort of doing the motions of the activity, even

if actually doing the activity the exact same way is not appropriate. For example, this is why some

seniors with Alzheimer's disease take comfort in holding a doll as if it is actually a real baby. If you

can creatively think about how to safely give them some physical activity, you can often bring them

great satisfaction.

Activity Ideas

 Reminisce
  Read aloud

 Sing to the music they remember

 Go to a park to sit and people-watch

 Go to a lake or river to watch boaters and sun-seekers

 Make a scrapbook using magazines and photos

 Bake cookies or an easy recipe

 Watch old movies together

Watch Video on Activities: 6 Minutes, 41 Seconds

Memory Loss for Recent Events

During the early stages of the disease, individuals often will have a difficult time remembering more

recent events and newly learned information. They will ask the same question over and over again,

for example. They may misplace items by placing them somewhere the item clearly does not belong,

such as placing a piece of jewelry in the silverware drawer. They may wear an outfit that is not

appropriate for where they are going or what they are doing. They may forget their address.

This is why developing a routine for each day and keeping a simplified and organized home are both

very important tasks to implement as early as possible.

Simplify the daily events and connect with the senior based on where they are each day to keep them

feeling as comfortable and secure as possible.

Activities should be designed to follow familiar activities, understanding how very basic daily tasks

are being forgotten. Avoid making the senior think more. Instead, make any activity extremely easy

for them to follow.

Keep it Simple
Reminiscing Exercises

Play favorite music from their high school and childhood days to spark pleasant memories to

reminisce about. View photo albums or movies or television shows from their childhood or young

adult days. Many times seniors will remember an old sitcom or television series that was one of their

favorites and watching an episode daily can be built into their daily activities. Discuss with their

children or loved ones to learn about their former favorite pastimes. Very often by introducing a

positive entertainment option from the past, you will spark feel-good memories.

Baby Doll Comfort for Middle and Late Stages

Dolls can deliver a calming effect for both men and women with Alzheimer's disease as the disease

progresses. Baby dolls that are close to the actual size of a baby bring them back to a time when they

felt loved and had a sense of purpose in caring for a child. A baby doll can bring pleasure and

security to a senior with Alzheimer's disease. Try to introduce a doll with the same hair, skin and eye

color of one of their children or another loved one to make it easy for them to connect with their

memories and to connect the doll as their own. Or, simply let them choose a doll they like.
Watch Video about Doll Therapy: 5 Minutes, 18 Seconds

Activity Pillows and Aprons

Sometimes seniors with Alzheimer's disease will begin to constantly seek to engage their hands.

Their busy hands may add to agitation for them. Introducing an activity pillow or apron will allow

them to safely have stimulation which may include:

 Buttons to button

 Zippers to zip

 Ties to tie

Find ways to safely engage their hands in repetitive activities, such as a magazine with pages to turn

or a jar of coins to sort. Anything which they may be familiar with can bring comfort and help them

feel included.

Photos as Conversation Starters

Our brains are wired to remember events that had an emotional impact on us. Both very happy and

very sad events will more easily be remembered by all of us as we age. Seniors experiencing memory

loss will sometimes dwell on one of these happy or sad memories.

Happy Memory Conversation Starter: Vacation photos and family photos can be used to spark a

happy memory. Ask your Care Manager or one of the senior's family members about a happy

memory you could spark by using a photo. You can also create a new photo album with pictures of

people who are currently important in the senior's life, including photos of you with the senior. Then

you can refer to the photo album to discuss your day.

Music and Memories

The Alive Inside documentary explains how music memory remains for a person with memory loss

and by finding the right song playlist, caregivers can connect a person with memory loss to

themselves and others. The emotion that music evokes remains and allows them to be "alive" even

when other forms of communication no longer work.

Engagement with music does require cognition.

Music ties us to events and memories which evoke emotions. Emotions are even more important

when a senior experiences memory loss because they are losing connections with their loved ones.

Playing a song as senior loved, you can allow them to tap into the present moment.

Our favorite songs transport us by conjuring surrogate emotions through our brain channels which

are hard-wired into our experience of music.

Music Triggers Memories

Watch this video from the "Alive Inside" documentary to see how music allows seniors with memory

loss to gain their ability to remember and communicate.

Watch Video on Music and Memories: 2 Minutes, 18 Seconds

See this video showing how music allows a senior with memory loss to reconnect with his

caregivers.

Watch Video of Man in Nursing Home Reacting to Music: 6 Minutes, 30 Seconds

How to Develop a Playlist for a Senior

1) Watch the documentary "Alive Inside"

2) Talk with a senior's loved ones to learn about their favorite songs from different decades in their

life

3) Research songs that were popular during a senior's teenage and young adult years. This is when

we turn to music as we cope with growing pains and first loves

4) Make a Playlist: Youtube allows searching for music by decade and other services such as Spotify,

Apple Music, and Pandora allow for playlists

5) Find comfortable headphones

6) Introduce the senior to the music. Plan for consistently scheduled music time each day. Take notes

on songs that connect with them to share with family members and your senior care team.

Senior Music by Decade

Why the Songs We Hear as Teenagers Hold Eternal Power of Emotions
Memories are Meaningless WITHOUT EMOTION

Brain imaging studies show that our favorite songs stimulate the brain's pleasure circuit, which

releases an influx of dopamine, serotonin, oxytocin and other neurochemicals that make us feel good.

The more we like a song, the more we are treated to neurochemical bliss, flooding our brains with

neurotransmitters.

When we are TEENAGERS, the neural activity sparks even more because our brains are sparking

with growth hormones. These hormones tell our brains that everything is incredibly important.

These songs that are the soundtrack to our teenage dreams and mishaps stay with us

throughout our lifetime. Think of this as a fireworks show of neurons in our mind, imprinting the

songs into our memories permanently.

Kick up a song you loved as a teenager and you will also kick up those memories. Scientists say

that the years between age 12 and age 22 are when you "become you". These years are when you

mature into an adult both physically and emotionally.

Singing

Sing along to a song in your head and you will activate your "premotor cortex" which helps plan and

coordinate movements.

Dancing

Dance and your neurons will synchronize with the beat of the music.

When you pay attention to the lyrics and the beats of the instruments, you activate your "parietal

cortex" which helps your brain maintain attention to different stimuli.

Listen to a song that triggers personal memories and your "prefrontal cortex" which maintains

information relevant to your personal life and relationships will begin to pull in all of the connections

you make to the music.

Music connects with emotionally and we will most remember events that sparked strong emotions.

Weddings, graduations, and all those "firsts" that happen when we are teenagers. As a caregiver,

remember the first movie you attended as a teenager, the first dance you attended and perhaps even

your first kiss. What were the songs that you can remember playing or listening to when you were in

high school? Do you remember who the top singers and musicians were at the top? Who was the

"Elvis Presley" of your teenage years? Part of the reason there are teenage heart-throb singers is

because this is when we are maturing into adults and feeling all of the hormones for the first time and

for reasons that scientists are still researching, these songs become imprinted within our brains

permanently, with the ability to bring back the memory even when we are experiencing a memory

loss condition.

Playlists to Connect with your Senior Client — By Decade

Here is a guideline to begin a discussion with the senior or their family members to find the songs

they liked when they were teenagers and young adults. Remember, just like you may like a certain

artist but may not like all of their songs, the same is true for a senior. Talk to their family members to

learn that singers and songs they really liked, or, you can always experiment by playing songs to see

what sparks a response if they are already experiencing memory loss.

AGE OF SENIOR + PLAYLIST GUIDE

The senior who is age 90s+ will like music from the 1940s

 Ella Fitzgerald

 Billie Holiday

 Hank Williams

 Louis Armstrong

 Benny Goodman

 The Mills Brothers

 The King Cole Trio

 Charlie Parker

 Dean Martin

 Glenn Miller Orchestra

The senior who is age 80s+ will like music from the 1950s

 Elvis Presley

 Nat King Cole

 Chuck Berry

 Buddy Holly

 Perry Como

 Carl Perkins

 Fats Domino

 Bing Crosby

The senior who is age 70s+ will like music from the 1960s

 The Beatles

 The Rolling Stones

 Bob Dylan
  The Beach Boys

 Ray Charles

 The Temptations

 Simon & Garfunkel

 Tammy Wynette

 George Jones

 Buck Owens

The senior who is age 60s+ will like music from the 1970s

 Alabama

 Olivia Newton-John

 Kenny Rogers

 ABBA ("Mamma Mia", both movie and songs)

 Pink Floyd

 Eagles

 Aerosmith

 Ramones

 Bruce Springsteen

 David Bowie

The senior who is age 50s+ will like music from the 1980s

 Madonna
  Celine Dion

 Michael Jackson

 Prince

 George Michael

 Elton John

 Diana Ross

 Duran Duran

 George Strait

 Marie Osmond

 Willie Nelson

 George Strait

Remember, all of us have our own tastes in music. We may like more than one style of music. Try to

discuss with your senior what type of music they have liked throughout their life to best find the

playlist that will be a fit for them.

You can add playing certain songs or music to your daily routine with the senior. Scheduling a time

to listen to music or sing-a-long could be a daily or weekly activity.

Songs of Faith
Songs that connect with a person's religion or with special life milestones can also spark strong

emotions and memories. If a senior attended a certain church as a child or an adult, they may connect

songs to their religion. They may also have a strong memory of some of the songs from their

religion's hymnal book.

Find out if the person you are caring for has any special songs that bring them comfort or joy that

may be from their religious service.

WOODSONG MUSIC RESOURCE

If the senior you are caring for has a connection with religious songs from their church services, you

can find out which songs are sung at different church denominations from Woodsong Music. They

have organized church hymns by religion. This can be a way to find songs that connect with a senior

who follows a certain religious faith.

Laugh Daily

Think of a daily activity that will spark laughter for your senior client. Perhaps they would enjoy

watching a television show, such an "I Love Lucy" or another show they enjoyed when they were

younger. Maybe there is a joke of the day in the daily newspaper or you can find a joke book or a

website with jokes. Maybe they will like 'knock-knock' jokes. Or maybe there is something funny

that you can do each day to make a laugh such as standing on one leg to balance or doing another

personal funny "move". Maybe there is something you can always find to laugh about when serving

the meal or cleaning up after a meal. If you can find a way to laugh each day, this can be your

grounding moment to share with the senior.

At the restaurant the other night...
An elderly looking gentleman, (mid-nineties) very well dressed, hair well-groomed, great looking

suit, flower in his lapel, smelling slightly of a good aftershave, presenting a well-looked-after image,

walks into an upscale cocktail lounge.

Seated at the bar is an elderly looking lady.

The gentleman walks over, sits alongside her, orders a drink, takes a sip, turns to her and says, “So

tell me, do I come here often?”

Tip Sheet
Develop Activities Customized for the Senior Based on their Past Favorite Activities, Develop

Activities Similar to Physical Tasks that Will Remind Them of Performing Activities They Did in the
Past, Smile When They Smile, Be in the Moment, Reminisce About the Past, Read Aloud, Sing,

Dance

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.

Prevention
Sexual Harassment in the Workplace
What is Harassment?
Illegal harassment:

Severe or pervasive verbal or physical conduct that denigrates, shows hostility or aversion toward an

individual because of his/her/their:

(Meaning ongoing spoken or physical behavior that attacks, shows unfriendliness, or avoidance

toward a person because of the following)

 Race

 Color

 Religion
  Gender

 National origin

 Age

 Disability

 Reprisal for reporting an incident

The EEOC or Equal Employment Opportunity Commission defines sexual harassment as

unwelcome verbal or physical conduct of a sexual nature:

 When submission to such conduct is made a term or condition of employment—in other
words, if you are told you have to do something of a sexual nature to keep your job.

 When submission to or rejection of such conduct is used as a basis for employment decisions.

 When such conduct unreasonably interferes with job performance or creates an intimidating,
hostile, or offensive work environment.

Sexual Harassment
 Unwelcome

 Can be physical, verbal, or nonverbal, including visual

 Severe and pervasive

 Unreasonably interferes with an individual’s work performance

 Creates a hostile work environment

 Focus is on the impact of the behavior, not the intent

 Genders of both the harasser and the victim are irrelevant

Watch this Public Service Announcement created by the new non-profit Times Up: 2 Minutes

and 50 Seconds
2 Types of Harassment

Sexual Harassment falls into 2 categories in the court of law.

1. Quid Pro Quo
2. Hostile Work Environment

Quid Pro Quo

This is the type of harassment that occurs when some type of employment benefit is made contingent

on sexual favors in some capacity. For example, this might be a supervisor offering a promotion if an

employee will meet their sexual demands. Quid pro quo literally means "something for something".

Usually, this type of sexual harassment, by its nature, occurs between someone in a position of

power and a subordinate. This is because the person in a position of power has the ability to give

employment benefits. Employment benefits in this context might include:

 Favorable performance reviews or recommendations

 Promotions

 Raises

 Sought-after work assignments or work shifts

This type of sexual harassment can also occur when there is a threat of negative work

consequences for refusing sexual favors. For example, this might mean someone is threatened with

 Job loss

 Demotion

 Bad performance reviews

 Unfavorable shifts

 Less desirable project assignments

**A single incidence of quid pro quo sexual harassment is illegal and can be the
grounds for a lawsuit.**
With quid pro quo harassment, the employer can also be found legally liable for the actions of the

supervisor who commits this act because supervisors are thought to be acting on behalf of the

employer.

Hostile Work Environment

This is the type of sexual harassment that occurs when there is frequent or pervasive unwanted sexual

comments, advances, requests, or other similar conduct. It can also occur when there is other verbal

or physical conduct that is not necessarily sexual in nature. This could include:

 Displays of inappropriate or offensive materials

 Sexual jokes

 Interference with someone’s ability to move freely

 Persistent, unwanted interactions, such as asking for dates continually

 In general, this type of conduct must be unwelcome and either frequent or pervasive (or both)
to be considered a hostile environment.

 It is not usually deemed a hostile environment if the activity in question was an isolated
occurrence or a simple attempt at initiating a sexual relationship that was not
reciprocated nor repeated. Whether or not this criterion (unwelcome, frequent, pervasive)
has been met is determined on a case-by-case basis.

 Sexual favoritism

*Unlike quid pro quo harassment, a hostile work environment does not require any

employment benefit to be at risk. Since it is not tied to the promise or threat of particular

employment actions, this type of sexual harassment is found across all levels of employees.
  Meaning that a co-worker not in a position of power can create a hostile work environment
for another employee

Also, the victim does not have to be the person harassed but can be anyone affected by the

offensive conduct.

It must meet the criteria of:

 Unwelcome

 Frequent

 Pervasive

Work to Create a Positive Work Environment

If your attitudes and decisions are shaped by facts based on performance and behavior, you will

create a work environment free of discrimination where people are treated with respect based on

what they do—not on what they were born into. You will have created the kind of place where

everyone would like to work.

 For sexual harassment to be actionable, it must be unwelcome and sufficiently severe or

pervasive to alter the conditions of the victim’s employment and create an abusive working
environment.

When sexual harassment by a supervisor results in a tangible employment action against an

employee, the employer is automatically liable.

 This means that if a supervisor sexually harasses an employee and it has an impact on the
employee's job—it can be title, position, promotion, raise, overtime work shift, or other
details affecting an employee’s work—the employer is responsible.

If no tangible action is taken, an affirmative defense is available, if the employer exercised

reasonable care to prevent and correct the sexually harassing behavior promptly (has an anti-

harassment policy and complaint avenues).

The employee unreasonably failed to take preventive or corrective opportunities provided by the

employer (failed to take advantage of the complaint process).

 This means that an employee was told what to do in this situation and the employee did not
notify the employer or take any steps to report the problem, then the employee failed and not
the employer. It is your responsibility to report the incident, otherwise, the employer is
not at fault.

 If the employer quickly takes action when they learn of the problem, they will not be held
responsible.

Conduct or comments that have the purpose or effect of unreasonably interfering with an

individual’s work performance or create an intimidating or offensive working environment.

 This category of harassment is often more subtle than harassment that results in a tangible
employment action and is often more difficult to determine where the line falls between
lawful and unlawful.

The key issues here are frequency and severity, so how often and how bad.

“Reasonable person” standard governs.

Anyone can commit this type of harassment—a management official, coworker, or non-employee.

 Pressure for dates

 Making offensive remarks about looks, clothing, body parts

  Touches in a way that may make an individual feel uncomfortable

 Telling sexual jokes, hanging sexual posters

 Using racially derogatory words, phrases, epithet

 Demonstrations of a racial or ethnic nature such as the use of gestures, pictures or drawing
which would offend a particular racial or ethnic group

 Hostile environment

 Comments about an individual’s skin color or other racial/ethnic characteristics

 Negative comments about an employee’s religious beliefs

 Negative stereotypes regarding an employee’s birthplace or ancestry

 Negative comments about an employee’s age when referring to employees 40 and over

 Derogatory or intimidating references to an employee’s mental or physical impairment

Key elements

 The conduct must affect a term, condition, or privilege of employment

 Must be unwelcome

 Can be based on race, color, religion, national origin, sex, sexual orientation, age or disability

 Is severe or pervasive under a reasonable person standard

Co-worker Harassment:

The agency is liable if it knew or should have known of the harassment and failed to take fast and

proper action to fix the problem.

Non-employees:

The liability standard for non-employees is the same as for employees—it is understood that a

company may not have total control over a non-employee. An agency may not be able to control the

actions of a one-time visitor to its workplace, but it would be able to correct harassment by an

independent contractor with whom it has a regular relationship. If a caregiver is with a client who

continually harasses the caregiver, the caregiver notifies the employer, and steps should be taken to

correct the situation immediately. The key is: the caregiver must report the situation. The caregiver

can't assume the employer knows and then decide to take legal action.

EXAMPLE

Mary dreads each time her office color photocopier breaks down because the repair person assigned

to her office always leers at her and makes sexually suggestive comments.

She has fears that if she complains nothing will be done about it because the agency does not have

control over the repair person because he is an employee of the photocopier service company.

The supervisor does relay Mary’s complaints to the service company, but no action is taken.

In this case, the employer has the same duty to create a safe work environment for Mary, the

company not doing so, even though they know there is a problem is supporting a hostile work

environment.

Examples of Harassing Behavior

Verbal: Derogatory comments, racial or sexual epithets, requests for sexual favors, sexual

innuendos, offensive jokes or stories, repeated propositioning.

Non-Verbal: Staring, derogatory or suggestive gestures, winking, throwing kisses, shunning, and

ostracizing.

Visual: Offensive pictures, photos, cartoons, posters calendars, magazines or objects.

Physical: Unwelcome touching, hugging, kissing, patting, stroking, standing too close.

Written: Unwelcome personal letters, notes or emails.

The conduct must be unwelcome to the target of the harassment. “Unwelcome” means that the

employee did not invite or encourage the conduct and does not like it.

The harasser can be the victim’s supervisor, an agent of the employer, a supervisor in another area, a

co-worker, or a non-employee.

Watch Video on Unwelcome Harassing Behavior: 1 Minute, 3 Seconds

1. Harassment can be verbal, physical, or pictorial.
2. The harasser, as well as the target, can be a man or a woman.
3. The claimant does not have to be the person at whom the offense conduct is directed but
can be anyone affected by the conduct.

If a co-worker repeatedly sends inappropriate messages, regardless if it happens during work hours, it

can still be considered harassment.

A supervisor who touches an employee in a sexual way, even if only one time, may be guilty of

sexual harassment.

Illegal harassment: Severe or repeated verbal or physical conduct that attacks or shows hostility or

aversion toward an individual because of his/her:

 Race

 Color

 Religion

 Gender
  National origin

 Age

 Disability

 Reprisal for reporting an incident

The EEOC or Equal Employment Opportunity Commission defines sexual harassment as

unwelcome verbal or physical conduct of a sexual nature.

Tip Sheet
Harassment is a severe or pervasive verbal or physical behavior that attacks, shows unfriendliness, or

avoidance toward a person because of race, color, religion, gender, national region, age, disability,

reprisal for reporting an incident. Sexual harassment can be verbal, nonverbal, and visual as well.

Quid Pro Quo means "something for something". Hostile Work Environment is when sexual

harassment happens frequently.

If a co-worker repeatedly sends inappropriate messages, regardless if it happens during work hours, it

can still be considered harassment. A supervisor who touches an employee in a sexual way, even if

only one time, may be guilty of sexual harassment.

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.
Prevention
Sexual Harassment Prevention Positive Behaviors and Responses
Understanding Sexual Harassment
You know the saying: "You say to-mah-to, I say toe-may-to". Everyone has their own unique

personality which makes the world go around, but there are still cultural norms that must be taken a

bit deeper to understand what may be offensive to someone else, and what can cross the line into

being considered harassment. Managers and employees must learn how to prevent inappropriate

behavior and educate all staff members.

Just because you don't consider something offensive or wrong DOES NOT mean that everyone

else will feel the same way.

Visual Harassment

Verbal Harassment

Physical Harassment

Sexual Favors

TAKEAWAYS:
 Employees and employers are expected to maintain a working environment that is free from
harassing or disruptive activity.

 Sexually harassing conduct need not be motivated by sexual desire.

 No form of harassment will be tolerated included harassment for the following reasons: race,
color, national origin, religion, sex, sexual orientation, disability, or age.

 Any employee who believes that they are a victim of unwelcome harassment has the
responsibility to report or file a complaint about the situation as soon as possible.

 The report or complaint should be made to the employee’s supervisor, or senior management
if the complaint involves the supervisor or manager.
Prevention
Employees should:

 Avoid behavior that may be misread as possible sexual harassment

 Avoid sexual jokes, comments, and e-mails

 Respect a person’s indication that your conduct or attention is not welcome

 Not invade another individual’s personal space

 Not touch anyone without their permission

 Clearly inform those engaging in inappropriate sexual oriented behavior that they find it
objectionable

 Seek assistance promptly if they are the target of, or observe severe or repeated instances of,
behavior that they believe qualify as sexual harassment

What to Expect from Supervisors & Management

Your employer is obligated to ensure a workplace free of sexual harassment and should:

 Take all reasonable steps to prevent discrimination and harassment

 Monitor workplace behavior, enforce respect

 Post/disseminate EEO Policy

 Provide training to educate its workforce on sexual harassment and abusive conduct

 Provide the company policy on sexual harassment and discrimination in the workplace,
including the complaint process
If you are the victim of harassment:

 A victim of harassment should clearly communicate to the harasser  verbally, in writing,

through a third party, or in some other way that the conduct is unwelcome.

o Participation by the victim does not necessarily mean the conduct is welcome.

o In particular, acquiescence or submission to sexual demands does not necessarily

mean that the conduct was welcome

 If the conduct continues after the perpetrator becomes aware it is unwelcome, further action
is necessary

Internal and External Complaint Process

If you decide to move forward:

 Check your company's sexual harassment policy and take the appropriate action. Keep
records of each incident, with the date and time and any people involved.

 The victim or person affected by the conduct should promptly report it or file a complaint per
company policy.
 o If you do not report the conduct, you may not be able to hold your employer

responsible. However, supervisors and coworkers remain personally liable for their
own acts of harassment.

or

 File a complaint with the Federal Equal Employment Opportunity Commission (EEOC).
(Complaints filed with DFEH or EEOC are automatically cross-filed with the other agency.
You only need to submit one complaint.)

Once you've filed your complaint, your employer should:

 Treat all complaints seriously and confidentially

 Collect relevant documentation/evidence

 Conduct a workplace investigation of a harassment complaint

 Conduct a thorough interview with you or the complaining person

 Give the accused a chance to share their side of the story

 Interview parties and relevant witnesses

o Ask opened-questions. This means questions that will not be a “yes” or “no” answer.

Can use a phrase like “There have been complaints of…”

 Protect you or the complaining party against retaliation

Once a harassment claim has been made, the employer must move forward, even if the victim

does not want to pursue the complaint

If you are a victim of sexual assault:

 Call 911 if you are in immediate danger

 Report the incident to the local police

 See a healthcare provider as soon as possible to receive a health exam and appropriate care

 Call the National Sexual Assault Hotline: 800-656-HOPE (4673).

 Seek confidential support from your employer or community

  Rely on friends and family

 Utilize other resources

Tip Sheet
Just because you don't consider something offensive or wrong DOES NOT mean that everyone else

will feel the same way.

If a manager or supervisor learns of sexual harassment and the victim tells them not to do anything,

the supervisor is still obligated to take action, regardless of the request to ignore it.

If you believe you are enduring sexual harassment in the workplace, it is important to:

 Speak up to the Harasser and your Employer

 Document the Abuse

 File a Complaint with the EEOC Quickly

IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.
Prevention
Sexual Harassment and Discrimination Scenarios
Sexual Harassment and Discrimination Scenarios

Case Study 1

Bill sometimes makes comments to his administrative assistant Ann Smith about how attractive she

is. She never says anything when he makes these comments.

One day, Ann requests a raise. Bill says that he will consider her requests and suggest that the two of

them go for drinks and dinner after work. Ann makes it clear that she wants to keep their relationship

purely professional and would, therefore, prefer not to go out with him. Bill says that he understands.

Two weeks later, Bill informs Ann that he has denied her request for a raise.

She asks Bill for an explanation, and he says that if she would be more “cooperative” with him, then

her chance for a raise would improve. Ann asks what Bill means by "cooperative". Bill smiles and

says “You figure it out.”

 In this case, it is quid pro quo. Because she did not comply with his request, she was denied
a raise.
TIP: QUID PRO QUO is Latin for "Something for Something"—if Mary would give in to Bill's

request (this), he would give her a raise (that).

Case Study 2

William keeps a large bible on his desk at work and always wears a large silver cross around his

neck. Sometimes William will use biblical quotations to support his comments and statements in

conversations with his co-workers. Additionally, he usually tells people to have a “Blessed Day”.

Joe, one of William’s co-workers, has started referring to him as “Saint Willy.” This has received a

lot of laughs around the office. William has confronted Joe about this and asked him to stop. Joe's

response was “Can’t you take a joke?” Joe not only has continued to refer to William as “Saint

Willy”, but he has encouraged others to do so.

 In this case, William is experiencing a Hostile Work Environment. He has asked his co-
workers to stop; he feels that his beliefs are being targeted, which is protected under Title
VII.

Case Study 3

Joe asks Mary out on a date. Mary has no desire to go out on a date with Joe, so she declines. He

never asks her out again.

  This is a one-time incident, and although it was perhaps unwelcome, it was not frequent or
pervasive and did not create a hostile workplace.

Case Study 4

Lily and Angela are laughing at something on Lilly's computer screen. Sheila approaches them,

curious about what they find so funny. On the screen, she sees a nude photograph of a certain very

well-endowed popular actor. "What do you think, Sheila?" asks Lily. "I'll bet you wouldn't kick him

out of bed," adds Angela. Sheila laughs uncomfortably. "I'd have to see what my husband would

think." Blushing, she leaves.

 This is a valid Hostile Work Environment complaint. Even though Sheila participated, the

exchange was of an uncomfortable sexual nature.

Jim, who sits across from Lily, is also privy to the exchange. Everything about this makes him

uncomfortable—from the nude photo that he can clearly see, to how they put his friend Sheila on the

spot.

 Another important distinction here is that inappropriate behavior between employees may
also create a hostile work environment for other employees who were not actually the target
of the behavior. Jim has a valid complaint.
Case Study 5

James (he/him) is undergoing a gender transition and is now Jamie (she/her). Almost everyone in the

office is respectful and accepting except for Tim, an older accountant at the company. Tim constantly

calls Jamie by her previous name and insists on using incorrect pronouns. When Jamie uses the

female restroom, Tim yells out, "Watch out ladies, there's a rooster in the henhouse." Tim insists that

he is joking and that "Jimmy" is going to have to get a thicker skin if "he" wants to keep working

here.

Tim is creating a Hostile Work Environment for Jamie by harassing her for her Gender Identity.

What is a joke to Tim is certainly not one for Jamie.