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Keep discussions with patients friendly vs. clinical
Although every patient with dementia has different symptoms and behaviors, and each is at a different stage of the disease, there are some techniques that home health clinicians and aides can use to make the home care visit go more smoothly, says Peter Notarstefano, director of home and community-based services for the American Association of Homes and Services for the Aging in Washington, D.C.
Engage the patient in friendly conversation.
Talk about the patient's hobbies, interests, or favorite memories as a way to develop trust and establish yourself as a friend who is there to help.
Don't overwhelm patient with information.
"We want to tell patients what we'll be doing during the visit, but take little steps," suggests Notarstefano. "Talk about what you will do just before you do it; don't list all 15 things at once," he says. Be conversational, and keep the language simple, he adds.
Send same staff members whenever possible.
Although scheduling visits and staff can be a challenge, consistency in staff assignments for dementia patients is important, says Notarstefano. "The most important part of caring for a dementia patient is establishing trust, and that is hard to do when a different clinician comes to the home each visit."
Pay attention to the time of day.
"Some patients are less confused and more energetic earlier in the morning, while others might be better to see in the early afternoon," points out Notarstefano. Find out which time of day is best, and schedule visits for those times, he suggests.
Be aware of non-verbal cues.
"A patient with dementia might not be able to verbalize pain or discomfort," says Notarstefano. For this reason, home health staff should look for non-verbal cues, he adds. "One patient could not tell the aide that he had to go to the bathroom, but he would play with his belt buckle when he felt the urge," says Notarstefano. "The aide knew him well enough to notice the behavior and recognize the need," he adds.
Also, most dementia patients cannot use the standard pain charts to indicate level of pain, so a nurse or aide might notice that a normally active patient doesn't want to get out of bed, says Notarstefano. Any time a patient's behavior changes suddenly, consider pain, infection, or reaction to a medication change as a cause, he suggests.
Although you want patients to participate in their care as much as possible, make that participation easy, suggests Notarstefano. "Organize clothing so that the patient can easily choose what to wear, or lay out one or two choices on the bed," he recommends.