This worksheet acts as a simple guideline for people considering admission to a retirement home or to a frail care centre for either themselves or someone they love and care for. Emphasis is on the practical considerations. You are, however, encouraged to look at the emotional implications of your decision and discuss these with someone you trust and can confide in.
It is important to ensure that the home is registered with the Department of Social Development, as registration is required in accordance with the Older Persons Act. The certificate of registration should be visible, displayed in a prominent place.
Of course, no home will meet all these requirements and deciding to enter or admit someone else to such a facility is one of the most difficult decisions one can be called on to make. At our regional offices and on our helpline we have staff and volunteers who can support you as you make this decision and any other important decisions that Alzheimer’s challenges us to make.
ACCESSIBILITY OF THE HOME
- Is it close to family and friends?
- Is it close enough to essential community activities e.g. church, shopping centre, hospital?
- Is it in a familiar environment or a new area?
- Will the resident be able to meet his/her spiritual needs at the home?
- Is it a mixed-sex residence?
- Is the property secure and are there visible security staff?
- Can a resident wander around freely and can the resident leave the grounds undetected?
- Is there a security system at the front door?
- Is the home linked to an armed response company?
- Friendliness of staff on your arrival
- Is the interior clean and attractive, with functional and comfortable furniture and decorations?
- Are there bad odours (especially urine)?
- Do the residents appear clean and appropriately dressed for the weather?
- Do the residents seem to be happy and occupied or are they sitting staring into space?
- Did you see staff and residents sitting talking to each other?
- Does the staff appear to be respectful and caring?
- Are there any birds or animals? Are pets allowed to visit?
- Noise – Are the sounds at a normal level and is there soft music playing?
- Is there a lounge with television and one without?
- Are there demarcated smoking and non-smoking areas?
FUNDING OF THE HOME
- Who are the major funders of the home?
- Is it a profit or non-profit organisation?
- Is there any form of financial assistance if frail care is needed or additional care that the residents may not be able to afford?
- Will you be able to afford the fees, possibly for an indefinite period?
- What is the annual increase in fees?
- If you have medical aid/disability cover/insurance, will it cover any of the costs?
- Are there additional costs that are not part of the monthly rate?
- How is ‘pocket money’ handled?
RULES AND REGULATIONS
- Are the rules and regulations made for the benefit of the residents or are they regimented e.g. fixed bedtimes and strictly enforced visiting hours?
- How much is the family involved in the individual managed care programme of the resident?
- Is there a residents’ committee?
- Are there channels for residents’ complaints?
- What means of communication are available to the residents e.g. telephones, facsimiles, e-mail?
- Is there privacy available for telephone calls?
- Is there transport to a hospital, clinic, shops etc?
- Are residents encouraged to remain physically and mentally active and to see to their own needs where possible and suitable?
- Are residents allowed to assist in the chores/activities of the home?
- Are residents called by name by the staff?
- Do residents have a choice of food and quantity? Are second helpings allowed?
- Are residents allowed to be sexually active?
- Own or shared?
- Bath and/or shower that has been adapted to the needs of the older person?
- Is there easy access to the bathroom, for a wheelchair?
FOOD AND KITCHENS
- Is the food of good quality and varied?
- Is provision made for special diets e.g. diabetic, low fat, halaal, kosher etc?
- Are the services of a dietician available?
- Are desserts and fruit part of the regular menu?
- Are there separate areas for food preparation, dishwashing and garbage disposal?
- Are visitors allowed to have meals in the dining room and at what cost?
- Are there ever any special meals e.g. Christmas, birthdays etc?
- Are there regular teatimes, with tea supplied by the home? Is anything served with the tea?
- At what times are the meals served?
- Is the garden easily accessible and available to residents?
- Are more active residents encouraged to assist in the garden?
- Are there benches outside?
- Is there a suitable safe path to walk on, in the garden?
- Are frail residents helped to gain access to the garden?
- Are residents allowed to go out for days/weekends and/or holidays?
- Can visitors come and visit at any time or strictly only at visiting time?
- Is there a private room for visitors?
- Do visitors have to sign in on arrival?
- Are relatives/friends encouraged to participate in the care of the resident?
- There needs to be good staff-resident interaction
- Are there enough caregivers on duty for every shift?
- Is there a Registered Nurse on each shift?
- Does the staff receive on-going training?
- Is there a resident doctor? Are you required to use him or may you use your own?
- What specialist medical services are available e.g. doctor, podiatrist, occupational therapist, physiotherapist?
- Have senior staff and management been trained in institutional management and care of the elderly and frail?
SAFETY AWARENESS, EMERGENCY PROCEDURES
- Is there adequate lighting in the home?
- Are there safety rails in the corridors?
- Are the floor surfaces non-slip?
- Are there easily accessible panic buttons, especially in the bathrooms?
- Is there a disaster plan for evacuating the home?
- Are there visible and accessible fire hydrants?
- Are there smoke alarms?
- Do they have regular fire drills in the home?
- What emergency medical equipment is available on the premises?
- Are there procedures to deal with elder abuse?
- What part does the family play in these procedures?
- Is there a view from the room?
- Is there adequate lighting?
- Is there a problem with damp in the room?
- What personal furniture and belongings are allowed?
- Is it a single or double room?
- Are the rooms shared? What happens if someone does not like the person with whom s/he is sharing?
- Is there an emergency bell in the room?
- Are there enough cupboards and drawers in the room?
- Is the resident allowed to have a kettle, toaster etc in the room?
- Are there enough plug points for bedside light, kettle, hairdryer, radio, TV etc? If not, are adaptors allowed?
WHAT ADDITIONAL SERVICES ARE PROVIDED BY THE HOME?
- Podiatrists (foot care)?
- Hairdressing facilities?
- Tuck shop or canteen?
- Day clinic/examination room?
- Are there activity rooms?
- Is there a regular activity programme?
- Taking into consideration their capabilities, do frail residents receive physical and social stimulation?
- Are residents encouraged to learn new skills?
- Are outside trips, outings or shows arranged?
- Is there any community involvement?
- Does the home use volunteers?
- Is the laundry done on the premises or contracted out?
- Compiled by Lindy Smit, Loraine Schirlinger and staff of the national office
Your approach to personal care should always take full account of the feelings and dignity of the person you are helping. People with dementia cannot always tell you if they feel embarrassed. Personal care must be given to the individual; it’s not just a matter of tasks that must be completed. Respect his/her feelings at all times.
The routine of dressing can become quite tiring, so try to make it as pleasant as possible. It is much easier to just dress the person and get it done with, than to spend time trying to persuade him to dress. It is important for the person’s physical and mental health, however, to encourage the person to do things for himself for as long as possible. As the disease progresses, he may need more help.
Help keep the person’s sense of identity by giving every opportunity for him to make a choice. Life is about choices. A danger of caring for people with dementia is that it is easier to make the choices for them, or we do so without realising it, thinking we are helping them by telling them what to do.
- Put away clothing that might cause confusion, e.g. put away winter clothes during the summer.
- The day starts with getting out of bed and changing from pyjamas into day clothes. This helps the person to realise that it is now daytime.
- Give him or her a reason for getting up and getting dressed.
- Make sure that dressing takes place in private.
- If needed, give simple instructions e.g. ‘Now put your arm through the sleeve’.
- If the person does not want to get up or get dressed, try to find out the reason and leave it for a while, rather than causing more distress.
- Ensure that there are no distractions in the room.
- Try to warm up the room before getting the person up.
- Try to keep to a dressing routine that the person is used to.
- The person may like to be left alone whilst dressing as it embarrasses him or her to dress or undress in front of someone else.
- Begin the task for the person, if necessary.
- Give people with dementia time. Give help only once they have gone as far as they can go. Avoid taking over.
- Pain may also put them off getting dressed as they might have hurt themselves, be suffering from arthritis or even feel ill.
- Do not make a big deal of behaviour that really is not a problem. It should not matter if the person puts the dress on back to front or wears three dresses at the same time, unless she’s going to be seen in public and you do not want her to be made a fool of. If family or friends are visiting, just explain the situation to them and how it is more important that she made the choice and dressed herself, than how she looks.
A possible simple routine
- Ensure that the way you present yourself is friendly, calm and relaxed, with a smile on your face, even though you might have woken up in a bad mood or are, yourself, under pressure.
- Begin the conversation with orientating information, which means identifying yourself, and calling the person by name.
- Create a relaxed atmosphere by beginning the conversation socially so as to win the person’s trust, which will make the task much easier. Spend time talking before you begin, e.g. ask how s/he slept, discuss the weather or family members, or look at photographs and talk about the people in them.
- Give the person clothes to choose from that are to his or her taste – our clothes are part of our personality. Take two suitable items out of the cupboard and ask which one s/he would like to wear. Show one item at a time. If neither is liked, take out another two. Do not give too much choice at one time as this may cause confusion. Humour or gentle teasing can also be used.
- Put the clothes out in the order that they will be put on and then leave the person to carry on, coming back now and again to see if help or encouragement is needed.
- If the person needs more help, give instructions in short steps, doing one task at a time. If an item is put on incorrectly, have a laugh while you correct it. Once the clothes are selected you can comment on how nice the outfit will look for the daughter who is coming, or for the tea party or any other function that might be looked forward to. It might just be sitting in the lounge or garden.
- Looking good helps us to feel good. Having hair styled and make-up put on, plus a dab of perfume or a piece of jewellery, plays just as important a role in dressing as do the clothes. Women who used nail varnish might enjoy having their nails done. Men may need to be reminded to shave. An electric razor would help maintain the independence of this task for longer. Beards and moustaches will also need trimming.
- Compliment the person on how nice s/he looks, to encourage her or him to be proud of her or his appearance.
Clothing tips for easy dressing
- If the person knows how to use Velcro, it is worth replacing zips with Velcro, especially the fly-zip on men’s trousers and the zips on skirts.
- Buy slip-on shoes or those that do up with Velcro, rather than lace-up shoes.
- Boxer shorts are easier for men than the conventional shorts, as are tracksuit pants rather than trousers. This will only work, however, if the items chosen are according to the person’s taste.
- Buy clothes that are easy to manage such as clothing with front fastening or without any fastening at all.
- For a woman, front-fastening bras are easier to manage. Do not let a woman who is used to wearing a bra, go without one, as she will be uncomfortable and it can also lead to soreness.
- Discourage the use of slippers whilst active during the day as they do not give enough support and the person might slop around in them, increasing the risk of falling.
Most adults like to wash on their own when no-one is around to watch them. When looking after people with dementia, you need to remember this and only help as much as you have to. It is important to respect their need to be on their own and let them wash themselves for as long as they possibly can.
Try to bath or wash people at the same times that they usually did it themselves. If they bathed at 5pm, try to bath them at the same time. Also, find out what they usually put on after bathing, as some people dress in their pyjamas even though it is still early.
As the disease gets worse, some people need to be reminded to bath or wash. At times you might also find that some refuse to bath or wash even though they were once very clean people. When this happens, you will need to try very hard to talk them into bathing/showering, or standing at the basin to wash.
Reasons a person may not want to bath or wash
- Scared of falling
- Scared of being left alone in the bathroom.
- If showering, the spray might be too hard on the person’s skin.
- The person might feel ashamed if s/he was incontinent and does not want you to see the mess.
- Does not want you to bath her/him.
- The room is too cold
- The room is too dark
- Does not like to be seen without clothes on
- Does not like showering
- Does not like bathing
- The water in the bath feels too deep
- Lying in the bath hurts (especially if the person is thin)
- Likes to undress in the bedroom, not in the bathroom.
Preventing accidents in the bathroom
- Make sure that the floor is dry
- Make sure that the room is warm before s/he gets undressed
- Make sure that the temperature of the water is not too hot
- When filling a bath, always run the cold water first in case the person climbs into the bath when you’re out the room
- Make sure that the person cannot lock the bathroom door from the inside. S/he may have an accident, or forget how to unlock the door and you will not be able to get in to help
- Always let the person stand on a rubber mat so that s/he does not slip
- If you do not have a rubber mat, put a coloured towel at the bottom of the bath to stop the person from slipping. It will also help her/him to see the bottom of a white bath
- Putting a stool (not wooden) in the bath or shower for the person to sit on will make that person feel safer
- Never leave a confused person alone in the bathroom
- Rails attached to the wall next to the bath or in the shower that s/he can hold onto will help to stop the person from falling. If a rail is put against the walls next to the toilet, the person can use the rail to pull her/himself up from the toilet seat.
Tips for bathing and washing
- Try to make bath time a nice time to spend together
- Talk to the person and say what you are doing as you bath her/him
- Do not be bossy and order the person to bath. Talk about how nice it will feel to be clean and look nice for visitors or the family, or for going out
- Stay calm and try to get her/him to wash, without fighting. If the person does not want to bath just then, leave it for a while and try again later
- Make sure everything is ready before you start bathing the person and help her/him put out the clothes to wear after the bath
- If s/he is very confused, it might be better to get everything ready for the bath and then say that you will help her/him to start getting undressed
- People who do not like being undressed can be washed in their underwear and then dried and dressed with a towel wrapped around them
- Check the skin for any sores, marks or bruises and report it to the nurse or someone in the family
- Use soap that does not smell too strong or it will make the skin dry. Make sure that all the soap is rinsed off. Never put bath oil in the bath water because it will make the bath slippery and the person will fall
- If you shower the person, start at her/his feet and then go upwards
- Do not wash the person’s hair when s/he is bathing or showering
- Give her/him the facecloth and soap. Let the person do as much as possible, only helping when help is needed
- Make sure that the hands and face are washed, under the arms, between the legs and, for a woman, under the breasts
- Make sure that the person is dried properly, especially under the arms, between the legs and, for a woman, under the breasts, or sores will develop
- If the skin is dry, put on a cream. If the person doesn’t want a particular cream, “Aqueous cream” is the best
When you are caring for people with dementia, you need to encourage them to be independent (do things for themselves) but at the same time you need to make sure that they cannot get hurt or put themselves in danger. A simple fall can result in that person no longer being able to lead an active and independent life. Small accidents can and will happen in the home but there are ways in which we can try to prevent these accidents from happening.
THINGS TO REMEMBER
- Dementia does affect the person’s memory.
- The person with dementia does not always know what is right and wrong.
- As people get older they fall more easily because with age come changes in vision, hearing, muscle strength, co-ordination and reflexes.
- They also move slower than other people. This can be dangerous for them. An example is if they touch a hot plate or pot on the stove, they are slower in taking their hand away and so will get very badly burnt.
- Some people may also have other diseases or disabilities that make it harder for them to do things.
- Also, they may be taking medication that can cause them to feel dizzy.
- If the person with dementia is very nervous or anxious, accidents will also happen more easily.
WAYS TO MAKE THE HOME SAFER
- Ensure that the person has her/his eyes tested. If s/he wears glasses, the eyes need to be tested every two years.
- If the person loses her/his balance easily, ask the doctor if the medication is affecting her/him.
- If the person gets up at night, leave a small light on to show theway, or give the person a torch, if s/he remembers how to use it.
- Also, during the day, make sure that there is enough light so that the person can see where s/he is going.
- Make sure that there are no loose mats or tiles, toys or mess on the floor that someone might fall over.
- Remove all pieces of furniture that someone might fall over when moving about the house.
- Do not move furniture around because the person may become confused.
- Be careful that the people will not slip on the floor and get hurt. Also make sure that, if anything is spilt on the floor, it is wiped up straight away.
- Another problem can be electric cords or wires lying on the floor. The person can very easily fall over them.
- Furniture that is broken or wobbles can cause falls and injuries.
- Older people usually like to wear their slippers in the house. Just make sure that the slippers fit properly and they are not slopping around in them.
- If the person can fall easily, handrails can be put on the walls, to hold onto. It is useful to put one on the wall in the toilet and shower or next to the bath, so that the person can hold onto it to sit down or stand up. Handrails are also useful next to any steps inside or outside the house.
- Encourage the person to use a walking stick or a walker if her/his walking is unsteady
- If the person drinks alcohol, too much of it can also cause a fall.
- Encourage the person to stand up slowly. Getting up too quickly often makes people feel dizzy.
- Being too hot may also make someone feel dizzy.
If someone does fall and looks bad or is in pain, do not move the person and do not give anything to drink in case s/he needs to have an operation. Cover the person with a blanket and put a small pillow under the head, then send for an ambulance or, if there are no ambulances, ask for help from the neighbours to get the person to hospital.
- Lock all medicines and tablets away in case the person swallows them.
- It is very important to lock away everything used for cleaning, as well as paraffin, methylated spirits and drain cleaner, in case the person with dementia drinks one of them, believing it to be cooldrink or medicine.
- If you do think that something poisonous has been swallowed, the person must be taken immediately to the nearest hospital or clinic. Take with you the poison that you think was swallowed, to show the doctor. If you have a phone, you can phone the ‘Poison Control Centre’ on 0800 333 444 and tell them what the person has swallowed. They will tell you what to do.
- The danger of the person getting burnt can be a big problem. Ensure that all matches, candles, lighters, gas heaters and small gas stoves are locked away.
- Candles are a big problem in causing fires as they are easily knocked over, or clothes and blankets touch the flame and start a fire.
- Never dry clothes over a fire or heater as this can cause a fire.
- If using coal for heating, make sure that there are no holes in the stove or chimney that will let the smoke into the room. This smoke is poisonous and the people in the room can die from it.
- If there is an open fire in the room, it should always be covered with a fire screen that cannot fall over.
If the person does get burnt, put the part that is burnt into cold water for at least 10 minutes to stop the burning and help stop the pain. If the person takes the part that is burnt out of the water and if the pain starts again, put it back in the water. The burn will warm the water, so change the water or add cold water. Do not take off any clothes or the skin might come off with them. If the hands have been burnt, take off any rings, watches or bracelets because burnt skin can swell up. Do not put anything on the burn, just cover it with a clean wet cloth and take the person to the nearest clinic or hospital.
IN THE KITCHEN
- If there is electricity, have an electric kettle that switches itself off when the water has boiled. If there is no electricity and gas is used to boil the water and the person is at home alone, make a drink that is not too hot and leave it in a vacuum flask or covered jug.
- Keep the very sharp knives in a safe place, but make sure that anything that the person can safely use is within reach, so that s/he does not have to climb on a chair and perhaps fall.
- People with dementia seem to like turning on taps and unfortunately it might be the hot water tap and so they burn themselves. If possible, remove the handles of the hot water taps and keep a “tap turner” in your pocket. You just put the “tap turner” over the top of the tap where the handle would go and open the tap with it. The “tap turner” is like a small plastic spanner. If you cannot get a “tap turner”, a small spanner that can be bought from a hardware store will also work.
- People with dementia should not use an electric blanket in bed in case they wet themselves. If a hot water bottle is used, it must have its own cover or be wrapped in a towel.
- If people with dementia smoke, make sure that they do not smoke on their own. You will need to keep the cigarettes and lighter or matches for them. It is important that they do not smoke in bed.
- Never take an electric heater into the bathroom as anyone in the bathroom can be electrocuted if it gets wet.
- Always make sure that a window is left open, even just a little bit, if you are using gas, paraffin or coal to cook or to heat the room.
- Keep a torch with spare batteries in the house in case the lights go out.
- Use rubber mats in the bathroom. A coloured rubber mat or wet towel in the shower or placed on the bottom of the bath will stop the person from slipping.
- If there is an electric geyser in the house, set the water temperature to 48.8◦C or lower so that the person does not get burnt.
- Keep a list of telephone numbers that you can phone for help. Keep this list next to the phone if there is one in the house. If not, keep the
- list with the telephone card so you can use it when you phone from a call box or ask someone to phone for you.
- If the person lives alone or is left alone for a while, ask a friend or good neighbour to check on the person and watch out in case something goes wrong.
- If you feel you can trust them, leave a spare set of keys with friends or neighbours and leave a telephone number with them or tell them where you are going.
- Put locks on doors and cupboards so that you can lock away anything that might hurt the person. People with dementia do like to open drawers and cupboards, unpack them or just go through them, so try to leave one cupboard open for them or they might get very anxious if they can’t open anything.
Further reading: http://www.alzinfo.org/alzheimers-treatment-modifying.asp