OccupationalTherapy.com Phone: 866-782-9924


Occupational Therapists Effectively Training Caregivers: Effective Communication And Care For Persons Living With Dementia

Occupational Therapists Effectively Training Caregivers: Effective Communication And Care For Persons Living With Dementia
Tammy Jurkins, OTR/L, CDP, CADDCT, CMDCP
October 20, 2022

To earn CEUs for this article, become a member.

unlimited ceu access $99/year

Join Now
Share:

Editor's Note: This text-based course is a transcript of the webinar, Occupational Therapists Effectively Training Caregivers: Effective Communication And Care For Persons Living With Dementia, presented by Tammy Jurkins, OTR/L, CDP, CADDCT, CMDCP.

Learning Outcomes

  • After this course, participants will be able to identify 3 dementia awareness interventions for caregiver education.
  • After this course, participants will be able to identify 5 interventions for effective communication.
  • After this course, participants will be able to identify 3 examples of how to modify activities to promote success.

Introduction

  • For our patient interventions to be carried over successfully, therapists must provide appropriate caregiver training, which at times can be a challenge.
  • We need to understand the caregivers' challenges in order to provide successful caregiver training.
  • We need to look at the "big picture" of the caregiver's specific and complete interactions with the patient.

Hello. We want to ensure that we understand the caregivers' needs and put ourselves in their place as much as possible. We cannot provide appropriate interventions if we do not know what interventions will be helpful for them. 

  • What are the challenges as an occupational therapist when providing effective caregiver training so that the caregiver is compliant?
    • People do not know what they do not know.
    • Caregivers may think that they understand how to communicate with and physically assist the patient, but that is not always the case.
    • Caregiver burnout
    • High caregiver turnover/lack of caregiver carryover

There can be many challenges when providing effective caregiver training. People do not know what they do not know. As such, caregivers are not always open to the interventions we are trying to provide because they think they understand the client and are not receptive to learning new things. We have to ensure we have a good relationship with the caregivers. They need to understand we are respectful of their knowledge and rely on them for their input as they spend the most time with the patients.

Caregivers may think they understand how to communicate with and physically assist the patient. We want to ensure that we provide interventions where they can physically help the patients. We want both the patient and caregiver to be safe. For cognition, we want them to understand how to approach the patient to make a connection to increase patient trust. Patients are more willing to work with someone if they trust them and feel safe, so we want to ensure that we are setting the caregivers up for success.

Caregiver burnout can be another challenge for therapists. If the caregivers are frustrated and/or have not had appropriate training from the beginning, they may not be taking in our interventions. They are just there for their job. We want to ensure they enjoy their job and there is a good carryover of our interventions.

High caregiver turnover and a lack of caregiver carryover are issues. If the caregiver leaves, we must train somebody new and promote connection and trust with the client again.

Lack of carryover by the caregiver is also a challenge. Caregivers have many people helping to get up, take them to breakfast, et cetera. They are not always able to provide appropriate interventions as they are in a rush. We want to encourage them to slow down to succeed when working with the patient. If the caregiver feels rushed and frustrated, that does not always happen. However, if we train the caregiver appropriately, they will understand concepts like using good eye contact and giving the patient time to participate. By doing so, the individual is more likely to trust that caregiver and work with them rather than resisting or being combative.

Understanding the caregivers' challenges, as well as our own, helps us to work together successfully for optimal patient care. Working together is crucial as the number of people living with Alzheimer's is increasing.

  • According to the Alzheimer's Association:
    • More than 6 million Americans are living with Alzheimer's Disease
    • 12.7 million people aged 65 and older are projected to have Alzheimer's dementia by 2050
    • In 2022, Alzheimer's and other dementias will cost the nation $321 billion. By 2050, these costs could reach nearly $1 trillion dollars.
    • Many of the costs are paid out of pocket by families.

Family members often think that Medicare or their private insurance pays for things and do not realize how much is out of pocket. We must be proactive and educate caregivers and family members, so they understand what resources are available in their community. We need to help people as a community as the numbers are growing. If somebody falls and goes to the hospital, they have professionals to help them. However, if someone is "aging in place" in their private residence, they or their family may not know what is available in the community.

Caregiver Challenges

  1. Limited understanding of the challenges of the people for which they are caring
  2. Lack of training to assist people with the following challenges: physical, cognitive, behavioral, emotional, etc.
  3. Lack of continued/updated training
  4. Short staffed (co-workers), high turnover (co-workers)

Limited Understanding

What are the caregiver challenges? We have access to all this information before intervening, but caregivers are not always privy to this information. They might know the person's name or how many people are needed to transfer the individual. They do not necessarily know a lot about that person as an individual, and we want to make sure that they do. When new residents move into a community setting, they are initially at a higher risk for falling, exit-seeking, and elopement. Caregivers need to know this crucial information for safety as well as to be able to interact and connect with them. 

Lack of Training

We want to ensure we provide that for the caregivers right from the beginning so they can help those individuals with physical, cognitive, behavioral, and emotional issues. While we want to educate caregivers on how to help with transfers and ADLs, we also want to ensure that they understand the person's abilities. If they are focused on what the person can do for themselves, they can jump in and assist when needed but step back and let that person do as much as they can for themselves. Caregivers have to have the proper training to understand that. Perhaps, they have never worked with a person with dementia or other challenges, so we want to ensure that we educate them.

Again, we want to set them up for success because we work as a team and want carryover of our interventions. This can be a challenge. Sometimes, we have behavioral patients or do not understand how to communicate with them. First, we want caregivers to realize that the behavior is not against them. If they approach the person correctly, connect, communicate with them, and give that person time to participate. If the person is still displaying behaviors, we do not want the caregivers to take it personally. We also do not want them to feed into a behavior, causing it to exacerbate. We also want to ensure that the caregivers know how to protect themselves and not injure the client if a client acts out. We want to provide education right from the beginning.

Many of our patients have emotional challenges. Perhaps they have had depression for years and were never properly treated. Think about everything this person has given up by coming to the facility. They now have caregivers coming in and helping them with activities they have done their whole life, such as bathing and dressing. They may have given up the ability to drive, had a recent death of a spouse, or have given up their private residence. We need to be caring and empathetic and educate other caregivers so they can address these areas positively rather than being apathetic. 

Lack of Updated Training

We want to ensure the caregivers are getting the proper training. For example, assisted living communities are bringing in residents that are much lower level, physically and cognitively, than they did years ago. The staff has to be trained appropriately to properly care for the residents living there so that everybody is safe.

There should also be continued training for staff, not just an orientation. We need to work as a team, so the patient gets proper carryover. They may have therapy for two to three hours a week, but they should also have these skills carried over to other times, especially when discharged from therapy. Otherwise, it becomes a revolving therapy door.

Short Staffed/High Turnover

Caregivers being short-staffed can be frustrating. Caregivers already have many people on their schedule; if someone calls off, that list becomes even longer. Clients may not be able to receive adequate care or are allowed to participate in their care if the caregiver is rushed.  

High turnover can also be stressful for team members. Many caregivers work together, and now, they must learn a new person's routine and skills. Currently, there is a lot of turnover, so continuing education is essential.

Person-Centered Care

  • Three Elements of Person-Centered Care
  1. Organizational Structure/Supportive Managers
    • necessary supplies, training, support in general
  2. Process: Caregivers need to understand the challenges and needs of the patient
  3. Outcome: Individualized care; a connection between patient and caregiver; patient participation and well-being; lack of caregiver burnout/turnover

There are three elements of person-centered care.

Organizational Structure/Supportive Managers

First, an organizational structure must have supportive managers, necessary supplies, training, and support. We have to start there. The people in charge need to provide the proper training for the caregivers. We might be contracted into a building and do not necessarily have control over this. However, we can educate people in the building, even the people who are not directly working as direct caregivers. For instance, we can inform administrators how the residents (and caregivers) are struggling. Caregivers want to provide proper interventions so that the residents can be safe, functional, and stay at the highest level of cognition for as long as possible. To do this, caregivers need support from the top. We have to work as a huge team. Otherwise, it does not work. The people in charge determine caregiver training and the needed supplies. We must find a way to connect in that aspect, so there is a continuation of care. 

Process

The second element of person-centered care is process. Caregivers need to understand the challenges and needs of the patient. Again, this is our responsibility. We get to know the patient during our evaluation and as we talk to the patient and family. We want to ensure that we provide as much information about the person's abilities as possible. We also want to focus on the positive and the client's strengths and where the person needs assistance. We also want them to understand the person's background and what that person's occupations were. What kind of music did they enjoy, or what hobbies did they have? With this knowledge, the caregiver can communicate with the person and form trust. The patients have to feel confident with the caregivers to carry over and succeed. Provide this information even if they are not asking, as caregivers may not know what to ask.

Outcome

The outcome is providing person-centered, individualized care. Especially when someone has cognitive deficits, we must know their history and cultural and spiritual backgrounds to forge that relationship. Individualized care forms a positive connection between the patient and the caregiver. We often become close with patients during self-care activities, but we also want that connection to happen with the caregivers. We do not want them to feel overwhelmed or frustrated. We want them to connect with the patient to promote participation and well-being.

If the person receives the proper interventions and is treated with dignity, including given time to participate, we will see better outcomes and less caregiver burnout and turnover. If the caregivers feel like they are appreciated and we (care partners and clients) need them, it is more likely to be a positive experience for them. We want them to know that their input is valuable.

Dementia Awareness

  • We do not know what we do not know.
    • It is imperative that, as therapists, we are proactive in providing caregiver training right from the beginning of care.
    • The caregiver must know the person as an individual (culture, occupation, spiritual/religion, hobbies, etc.).
    • Make sure caregivers understand how important their role is for the patient's success.

We cannot expect people to ask questions because they may not know what to ask. We may need to provide information to direct caregivers and other family members proactively.

The caregiver must know the person and their cultural, spiritual, religious, and leisure interests. Anyone that connects with the client, including maintenance and dietary, should know something about them. If they are entering that person's room (their home), we want them to acknowledge and be a comfort for that person. We do not want them to be afraid of those entering their room.

Ensure caregivers understand how vital their role is for the patient's success. I do not think caregivers get enough appreciation or compliments. They are busy with a lot on their plate. On top of that, somebody may have quit or called in sick. We must let them know how appreciative we are and respect their input. They spend the most time with the patients, so if there is a change in someone's behavior, caregivers will often notice it first. For example, a person may stop wanting to eat in the dining room or attend activities. Caregivers are going to see those behavior changes. Their input is crucial, and they must let the medical team know.  

People with dementia can have multiple diagnoses, sensory loss, and many medications. Sometimes, their medication changes a client, and caregivers must report any differences they note. Just because somebody lives in the memory care community and they do not want to go to an activity, it is solely because of their dementia. That is not always the case. A lot is going on, and we want to know if they are progressing and where they are in that disease process. Do we need to update the care plan? Another example is if maybe there was a patient that was continent, and now they are incontinent. The caregivers telling us that they gave this person adult briefs is important, but we still want them to understand it has to be reported to nursing so they can figure out why there is a change.

  • How can we put the caregiver in the place of the patient to promote understanding and empathy?
  • The Virtual Dementia Tour: Attempting to complete activities with visual, hearing, fine motor, neuropathy, and possible cognitive deficits.
  • Having the caregiver observe the patient successfully participating in activities
  • The Train Journey

How can we put the caregiver in place of the patient to promote understanding and empathy? The caregivers must understand what this person is going through so there is consistent care for people across the board, from direct caregivers, administrators, and even building maintenance.

The Virtual Dementia Tour® shows caregivers what it is like to attempt activities with deficits in vision, hearing, fine motor control, sensation, or cognition. This tool can be used as part of caregiver training because it helps them understand what a person is going through and their challenges. It is also suitable for family members. The other important thing about The Dementia Tour is that it may help administrators set up the environment, like decorations or wayfinding techniques. The environment set-up helps clients be oriented and find their rooms and other living areas. 

Having the caregiver observe the patient successfully participating in activities is crucial. If we verbally give instructions, it may or may not sink in, but if they see the person engaging with us in an activity, this may be more beneficial. They might not understand that that person has those abilities because they have only observed the person sitting in front of the TV. If we give clients an intervention that is meaningful to them, caregivers can see the client's potential during this positive interaction.

The Train Journey is another way of explaining what somebody living with dementia is going through. There is a person that gets on a train that they have gone on before. They recognize all the scenery, and eventually, they fall asleep. However, when they wake up, they do not recognize anything. Everything seems foreign to them. So they get up, but as they do so, other people on the train guide them back to their seat. They do not want to sit down because they are scared. They try to explain, "I do not recognize anything. I do not belong on this train. I'm going in the wrong direction. I need to get off." But nobody is listening or paying attention. In the meantime, this person starts looking through their purse for their train ticket. They cannot find it and feel like someone stole from them. They sit there for a moment, and then they get back up again. And then again, they are redirected back to their seat. Finally, the person realizes, "No one's listening to me. I cannot get off this train until it stops." They start feeling sad and wish they never got on the train. They did not get to say goodbye to their loved ones.

No one is taking the time to let them express themselves. No matter what level they are in the disease process of dementia, we still need to listen to what they are trying to get across to us so we can provide care with dignity, respect, and success.

Naomi Feil

  • Validation Training
  • Just because someone is not acting out or crying does not mean that they are not scared and do not need a connection
  • Make eye contact and connect with the patient
  • Provide a meaningful intervention (For example: singing a familiar song) and give them time to respond

Naomi Feil talks about the validation training. Validation training is working more with the inner person and what they are experiencing. It is not focused on reality orientation or getting someone to remember things. Via appropriate interventions, we can work on helping them be functional in their daily life. Validation training is working on emotion and connecting. Again, we need to know that person as an individual to understand what interventions we can provide for them.

Even though somebody is sitting very quietly and not acting out, this does not mean they are not terrified. Everyone needs to try to connect with them. We do not want them to feel like they are a bother to us, are being rushed, or that we are not paying attention. We have to slow down and take our time. When listening to somebody, we want to pay attention to what they are saying and ask questions. Are we listening to what they are trying to convey, or are we focused on how we will respond when they have finished? We must listen and learn to let them express themselves, and then we can intervene. For the validation training to be successful, we want to ensure we provide interventions familiar to them.

It is vital to make eye contact during interactions and activities and be mindful of our body language and facial expressions.

One example of a meaningful intervention is singing a familiar song and giving them time to respond. We want them to participate with us as much as they can. A positive interaction can help decrease people's anxiety, elevate their mood, and help them to be less withdrawn.

Communication Training

  • What do caregivers need to understand?

1) The person as an individual prior to approaching them (caregivers do not do chart reviews or patient/family interviews, so they rely on us to provide information so they can connect)

2) How to approach the patient and connect with them

3) Give them time to express their needs and give them time to understand what we are asking them to do

What do caregivers need to understand? We gather much information via chart reviews, interviews with the patient and family, and discussions with other team members before starting treatment with the client. We want to set the caregiver up for success with that as well. Remember, caregivers are often not privy to this information. They rely on us to provide the information, so we should do this right in the beginning.

We want to instruct them on approaching the patient and connecting with them (eye contact, interests, etc.). Often, there are changes in caregivers, so we should have a consistent caregiver training program.

Many caregivers want to do for the client as they are in a "helping" profession. They need to step back and let them express their needs and concerns. It is a dignity issue. Even if the person does not understand all the instructions the caregiver gives them, the person can sense if someone is being kind to them. It is essential always to include the client. For example, you might be talking about how you will complete a transfer. Please have them in that conversation so that they feel comfortable and in control.

4) Listen and observe

5) Allow the patient to participate to their maximum potential

6) Compliment the patient

7) Be aware of how we are presenting to the patient

Here are some other vital things to remember. It is essential to listen and observe. We want to ensure that we get the correct information they are trying to convey. Allow the patient to participate to their maximum potential. We want caregivers to focus on the person's abilities. Of course, we will help when they need it, but focus on what they can do. We all feel good when someone compliments us. Make sure that our clients feel appreciated and respected. We also want to make sure that we understand their reality. If we are constantly correcting them all the time, they are not going to trust us necessarily. 

Lastly, always be aware of how we are presenting, especially in a group situation. For example, if we are intervening with a patient sitting at the dining room table, other patients may be paying attention to this interaction. They can take on that calm demeanor if it is a positive intervention. Educate the caregivers on how their mood gets carried over to the person and those around them.

Modify ADLs

  • What do caregivers need to understand?
  1. Proper positioning
  2. Patients' abilities/caregivers' interventions
  3. How long a patient can attend to a task/how many steps of instruction a patient can follow
  4. Safety concerns (i.e., lack of safety awareness, cognitive deficits, behaviors, fall risk, etc.)
  5. Adapting care as the disease progresses

Positioning

Before a person can participate in any activity, they must be positioned appropriately. For instance, for meals, if they are too far away from the table and need to stretch to fill that utensil with food, they may get tired and not as eat as much as they usually would. This is similar to transfers. The client needs to be appropriately positioned for safe and effective transfer. If they are sitting too far at the back on the bed or leaning over to one side, it will take more effort for that caregiver to get that person to go from sitting to standing, which can cause injuries. We must educate caregivers about proper positioning and ergonomics so that the client can participate to their maximum potential and the caregivers are safe.

Patients' Abilities- Attention and Instructions

Caregivers should be focused on what the person can do and let them do as much as they can for themselves. They need to know, for instance, how long they can attend to a task and how many steps they can follow. Remember, we want to set people up for success. If they are assembling and decorating bird feeders in activities, for someone with limited attention, we can give them a bird feeder that is already assembled, and they can decorate it. They still can enjoy that activity without feeling frustrated or over-challenged. Even when that activity is over, they might not remember that specific activity later in the day, but they may carry that positive feeling. We want to ensure that we provide interventions for them to succeed. This can be a challenge when we first get to know them, and another reason why we need to get to know them. 

Safety Risks

Caregivers should also know about any safety risks. Someone with a mild cognitive decline may appear to have good safety awareness. However, they could be frequent fallers and do not remember to pull the cord to call for help before transferring. This person may benefit from a bowel and bladder program for scheduled toileting and assistance.

We also want to ensure that the clients' rooms are functional and not overdecorated. Clients are at increased risk for falls if they have to maneuver around too much furniture or clutter. Caregivers should be proactive in setting them up for success. 

Behaviors can be a challenge. Often the patient is not getting proper instructions or the right communication. We need to explain to the person what is going to happen. They might not understand everything you are explaining, but let them feel included. We are not just doing something for them, but we want them to participate as much as possible. 

We cannot assume they will not try and do things, like transfer on their own. Their safety awareness is often poor, so it puts them at risk of falling. We can educate caregivers to be proactive.

We also need to ensure that caregivers are trained to effectively get someone off the floor, as accidents will happen. They need to use proper body mechanics to be as safe as possible.

We want people to have as much power and control over their day as possible. By minimizing clutter and choices, they will feel like they are in control, and it is less overwhelming for both parties. 

Adapting Care Over Time

Of course, we want to adapt the care as a disease progresses, as it is progressive. 

Modify Leisure Activities

  • What do caregivers need to understand?
  1. Background and individual interests
  2. Activity times based on the patient's routine
  3. Break activities into components to set the patient up for success
  4. Chores/roles for the patient provide purpose
  5. Environment should not be overstimulating to the patient

The easiest way to intervene is to know the person as an individual, and activity times should be based on the patient's routine. Not everybody wants to go to an activity directly after breakfast.

We also want to give them breaks as people often are in their wheelchairs all day. That might not necessarily be comfortable. Can we help them transfer out of the wheelchair into a different chair when they engage in a leisure activity or watch TV? We want to ensure that they are comfortable throughout the day and that the activities are scheduled at different times of the day so that they can engage in their schedule. The environment should also be set up appropriately. Are there different activity stations? There could be a folding laundry station or an art station so they can engage on their own.

Break activities into components to set the patient up for success. For example, if they are going to help us make dinner, they may be able to peel the carrots. They will not complete the whole activity, but we have them help with part of the task to be successful. 

The other thing to remember is that just because they used to enjoy doing something, they may not enjoy it anymore. We do not want to assume that it is something that they want to continue to do. Chores or roles for the patient provide purpose, like watering plants or whatever it might be. If it is a living community, higher-level people could be "ambassadors." For example, when a new resident comes in, they may make a card for that person, introduce themselves, or give them a tour of the building to help the person acclimate. Being an ambassador provides residents with a purpose, which we all crave. This is why it is so crucial that we assess what purpose would be meaningful for them.

The environment should not be overstimulating to the patient. We can block out irritating noises, but our patients do not have that ability. Listen when you walk into a room and see if there are any noises that you can eliminate. We want them to be able to communicate successfully with each other, with the staff, and with their families. If a door periodically slams, this may scare them. We want them to be successful in the environment.

Community Integration

  • What do caregivers need to know?
  • Is the patient at risk for wandering/elopement?
  • Interventions for possible wandering/elopement
  • Is the person comfortable/safe out in the general community, OR are they overwhelmed/afraid?
  • Therapists can educate caregivers of appropriate activities in THEIR specific community
  • Examples: Memory Cafes, Intergenerational Activities, etc.

It is essential to understand what is available within the community. We also need to know if a patient is at risk for wandering or elopement during community events. One intervention for possible wandering or elopement is the group wearing the same color shirt or something to make them stand out.

We also should contact local police departments. Some police departments have programs for people at risk of elopement, and we can give caregivers and families information so that they can be prepared if something happens.

We also want to ensure that we know where the person is. We do not want them to assume that they know where someone is. A bell, chime, or alarm can be put on the doors for those aging in place. We do not want the noise to scare them or make them fall. We need the caregiver to be aware that the person is trying to open the front door because even if the person has 24/7 care, the person is not always in the same room.

If someone has left the building and we cannot find them, how long does the staff look before they call the authorities? There needs to be a policy in place whether they are leaving the environment because we took them out on a community outing or they are leaving on their own. We also want to ensure that the community outing is something they are interested in and where they feel safe. What feels comfortable for them, and what does not? Is the person comfortable and safe out in the general community, or are they overwhelmed and afraid?

Therapists can educate caregivers about appropriate activities in their specific communities. Some communities have memory cafes where people can do activities together. Cafes can be in an actual restaurant, in a community building, or a museum. The cafes can have different themes like art, crafts, music, or reminiscence. It is excellent for the caregiver and the patient to get them out into the community to socialize with those with the same challenges. It can be a great support system.

You can search online for activities in the community. In addition to memory cafes, there are also activities in senior centers and libraries. Intergenerational activities are also very positive for both elderly and youth. Adult and child daycare centers are also sometimes offered within nursing homes.

One example of a great intervention is gardening, as it stimulates the senses and gives them enjoyment. They may have done this activity their whole life, remember how to do it, and can be successful. They can help with the plants whether they live in their private residence or a memory care community. Remember, it is their home, and we want them to have the ability to engage.

Montessori Approach

  • Based on person-centered care
  • Adapt activities to fit the patient's abilities
  • Provide roles for the patient within their private residence/community: watering plants, washing/drying dishes, leading an activity, delivering newspapers, welcoming new residents to the community, etc.
  • Community Interventions: joining community groups, intergenerational activities, etc.

The Montessori approach focuses on getting to know the person that someone was before they developed dementia. Who was that person, and how can we connect with them? It relies on the input from interdisciplinary team members because we get to know people differently. One person might get one piece of information, while someone else might learn something else.

We want to adapt the activities to fit the patient's abilities. For instance, if a person has a physical limitation, can we break down the activity and give them one component to set them up for success? We do not want anyone to be left out. We want to focus on what people can do, not what they cannot do. How can we set them up for what they enjoy?

We also want to provide roles for the patient within their private residence or community, such as watering plants, washing and drying dishes, leading an activity, delivering newspapers, or welcoming new residents to the community. It is their home, and they need a purpose. They might not remember the activity later in the day, but their positive feeling can stay with them.

Again, community interventions, groups, and intergenerational activities can be impactful. Be aware of what is available in your community. The Dreams Program offers different options for people. The program operated on donations. An example may be someone turning 100 and wanting to have a big birthday party or celebration for an anniversary. This program gives a person a meaningful experience. It also gives caregivers a positive feeling as they see a person enjoying an activity. People in the community also play a part in this as they are helping this person to have their dream come true.

There are many resources on dementia care-friendly environments in communities, and the numbers are growing. We need to have things available in the general community as well. Examples are a walking program or a garden club.

We also want to provide intervention options to family members. For instance, if somebody is aging in place at home, a home evaluation and caregiver training are crucial. We want them to be able to stay in their environment for as long as they can. We also do not want family members to go online and buy equipment that is not necessary or safe. If the person is going to age in place with them, the family members should have specific training based on their environment. If the loved one is no longer safe, we can help caregivers with this transition. We can educate them on what they need to ask with they go on tours, for example. Many people do not understand all services offered in these communities. Do they feel that their loved one needs a nurse on the premises 24/7? What training is provided to caregivers who care for their loved ones? Knowing what is available is helpful as it is an emotional decision to move someone from a private residence into a community setting.

We also want to ensure that that decision is based on the safest community for their loved ones. We do not want them to be in assisted living when they should have been in a memory care center. For example, they can be an elopement risk. Things have changed over the years, and many assisted living facilities are taking people at a lower level, both cognitively and physically. The question is, are they providing effective care for the people and educating the caregivers?

We also want to look at the environment. How is that unit decorated? Are there different activity stations? Are the hallways decorated in different colors so people can find their way around? Is the bathroom safe? Is there a cutout underneath the sink if they are in a wheelchair? Again, we want to make sure that family members know what questions to ask so that they are picking out the appropriate environment for their loved ones.

There are different apps for phones and video monitoring systems that can detect where a client is if they get too far away from their house. We want to set up people for success so they can stay in the least restrictive environment and be safe and functional for as long as possible.

Summary

  • As therapists, we need to support caregivers in their success by providing individualized patient-centered care by:
    • Understanding the caregivers' challenges
    • Education to promote caregivers' understanding of the patients' abilities and challenges
    • Effective communication training
    • Education and training to successfully modify activities to fit the individual's abilities

As therapists, we must support caregivers and their success by providing individualized patient-centered care and understanding the caregivers' challenges. We have to understand their challenges just like we do with our patients. Once we know what people's challenges are, we can intervene.

Education can promote caregivers' understanding of the patient's abilities and challenges. Training in effective communication and modifying activities to fit an individual's abilities are also critical. We want the clients to be successful and safe for as long as possible. Therapists must be proactive in understanding the caregivers' and clients' challenges and their own to succeed.

References

Gan, D., Chaudhury, H., Mann, J., & Wister, A. V. (2022). Dementia-friendly neighborhood and the built environment: A scoping review. The Gerontologist, 62(6), e340–e356. https://doi.org/10.1093/geront/gnab019

Manee, F. S., Nadar, M. S., Alotaibi, N. M., & Rassafiani, M. (2020). Cognitive assessments used in occupational therapy Practice: A global perspective. Occupational therapy international, 8914372. https://doi.org/10.1155/2020/8914372

Queluz, F., Kervin, E., Wozney, L., Fancey, P., McGrath, P. J., & Keefe, J. (2020). Understanding the needs of caregivers of persons with dementia: A scoping review. International psychogeriatrics, 32(1), 35–52. https://doi.org/10.1017/S1041610219000243

Wu, Q., Qian, S., Deng, C., & Yu, P. (2020). Understanding interactions between caregivers and care recipients in person-centered dementia care: A rapid review. Clinical interventions in aging, 15, 1637–1647. https://doi.org/10.2147/CIA.S255454

Zhao, Y., Feng, H., Hu, M., Hu, H., Li, H., Ning, H., Chen, H., Liao, L., & Peng, L. (2019). Web-based interventions to improve mental health in home caregivers of people with dementia: Meta-analysis. Journal of medical Internet research, 21(5), e13415. https://doi.org/10.2196/13415

Citation

Jurkins, T. (2022)Occupational therapists effectively training caregivers: Effective communication and care for persons living with dementia. OccupationalTherapy.com, Article 5548. Available at http://OccupationalTherapy.com

To earn CEUs for this article, become a member.

unlimited ceu access $99/year

Join Now

tammy jurkins

Tammy Jurkins, OTR/L, CDP, CADDCT, CMDCP

Tammy Jurkins is an Occupational Therapist (OTR/L) and a graduate of Wayne State University in Detroit, Michigan. She has worked clinically in geriatrics for 20 years with the first 15 years were in the rehabilitation department in a skilled nursing facility and the five years in an outpatient clinic in an assisted living facility. She has provided consulting services to family members and caregivers who are caring for their loved ones living with dementia. She is also an instructor for the National Council of Certified Dementia Practitioners (NCCDP) Alzheimer’s Disease and Dementia Care Seminar.



Related Courses

Occupational Therapists Effectively Training Caregivers: Effective Communication And Care For Persons Living With Dementia
Presented by Tammy Jurkins, OTR/L, CDP, CADDCT, CMDCP
Video
Course: #5712Level: Introductory1 Hour
Education to effectively train families and caregivers to communicate with and care for people challenged with dementia will be provided in this course. The focus is on understanding the abilities and challenges of the dementia patient as well as the challenges of the family and caregivers.

The Spaced Retrieval Technique: A How To For OTs
Presented by Megan L. Malone, MA, CCC-SLP
Video
Course: #4695Level: Introductory1 Hour
This course will provide an overview of the spaced retrieval technique, which is a cognitive intervention that can improve recall of functional information. Participants will learn the evidence behind this technique as well as how to implement it in therapy sessions.

Lewy Body Dementia: The Role Of The PT, OT, And SLP In Person-Centered Care
Presented by Julia Wood, MOT, OTR/L, Heather J. Cianci, PT, MS, GCS, Heather Hodges, MA, CCC-SLP
Video
Course: #5719Level: Advanced4.5 Hours
Master skills to implement in your practice immediately with continued Master Class. The complexity of Lewy body dementias (Parkinson’s disease dementia and dementia with Lewy bodies) and evaluation and intervention approaches for PTs, OTs, and SLPs will be examined in this class. Case studies emphasize opportunities and approaches for interprofessional collaboration to provide comprehensive, person-centered care.

Cognition and Cancer, Part 1
Presented by Theresa Marie Smith, OTR, PhD, CLVT
Video
Course: #5222Level: Intermediate1 Hour
The content in this course includes the executive functions adversely affected for many breast cancer survivors and effects to their occupational performance. Other factors shown to contribute to cognitive impairment for breast cancer survivors will be examined. This is Part 1 of a 2-part series.

Cognition and Cancer: Part 2
Presented by Theresa Marie Smith, OTR, PhD, CLVT
Video
Course: #5223Level: Intermediate1 Hour
The content in this course focuses on assessments used to measure the executive function of breast cancer survivors and measurement issues. Outcomes of interventions used to improve cognition of breast cancer survivors and how to apply study findings in the clinic will be presented. This is Part 2 of a 2-part series.

Our site uses cookies to improve your experience. By using our site, you agree to our Privacy Policy.