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1 1 For the slides from this presentation, visit: Slides will be available for 2 weeks 2 Handouts are intended for personal use only.any copyrighted materials or DVD content from Positive Approach, LLC (Teepa Snow) may be used for personal educational purposes only. This material may not be copied, sold or commercially exploited, and shall be used solely by the requesting individual. Copyright 2017, All Rights Reserved Teepa Snow and Positive Approach to Care Any redistribution or duplication, in whole or in part, is strictly prohibited, without the expressed written consent of Teepa Snow and Positive Approach, LLC 3 1

2 How Lifelong Personalities Traits and Preferences Affect Dementia Care 4 Why Is Life So Difficult for Those Involved in Dementia? Many abilities are affected: Thoughts Words Actions Feelings It is variable: Moment to moment Morning to night Day to day Person to person Place to place Some changes are predictable but complicated: Specific brain parts Typical spread Some parts preserved If it is progressive: More brain dies over time Different parts get hit Constant changing 5 Understanding Brain Changes When the Unexpected Happens or There is an Unmet Need: - Learning to respond, not react! 6 2

3 Understanding and Responding to Challenges and Unexpected Behaviors: - What is happening? - Why is it happening? - What helps and what makes it worse/better? - What can we do about it to make it better? - How can we not have it happen in the first place? 7 I m Still Me But I m Different! - Help me to be who and how I am - Don t ask me to do or be what I can t - Let go, but don t give up! 8 What Makes You Click? What Makes You Tick? Learn about how you are and what you like, so you can help yourself and the person you are caring for 9 3

4 Lifelong Personality Traits and Preferences Make a Difference - We are more of who we have always been Unless - We have always been covering up who we really are and we decide to let go Or - Dementia robs us of our ability to be the way we want to be Or - Dementia causes us forget how we are supposed to be and lets us be free 10 Personal Preferences Matter - We like what we like! - With dementia, the likes can change - Old preferences will need to be revisited - The challenge is to honor what is important but change what is needed - Our willingness to meet the person s changing needs is essential - Changes are made harder by our sense of loss and grief 11 Some Personal Preferences: - Appearance - Behaviors - Language - Daily routines - Foods and drinks - Music - Touch, textures, noise, space - Worship and spiritual practices 12 4

5 How Does Dementia Affect This? - Memory - Language: understanding and production - Self-care skills - Sensation - Emotional control - Reasoning and thinking - Vision 13 How Might This Work with You? 14 Personality Traits: Who are you? - Introvert - Extrovert - Lots of Details - Big Picture Only - Logical - Emotional - Planning Ahead - Being in the Moment Who is the person you are trying to help? 15 5

6 First, How You Do You: - Come to decisions? - Get re-energized? - Feel about boundaries and space? 16 Introvert - Extrovert Introvert Likes to be alone Likes to think it out Likes personal space Needs alone time Private Shares little Decides on own after thinking it through Extrovert Thinks out loud Talks it out Seeks out people Shares a lot Not good with boundaries Gets opinions before deciding 17 Second, How Do You: - Like to get information? - Like to do things? - Decide whether to do something? - Approach an unfamiliar task? 18 6

7 Details Big Picture Details Needs to know how Specifics of what to do Wants detailed info: to do it right Likes doing the familiar and routine Likes a check list and follows it Likes to do it Big Picture Needs to know why Likes to fly by the seat of their pants Likes to hear the big plan Likes to try out new and different ways of doing things Likes to experiment Likes to talk it out first 19 Third: What makes sense? - How do you judge things? - How do you decide if things are okay? - What matters most to you? - What drives your behavior and actions? 20 Logical - Emotional Logical: Head First Fair Reasonable Rational Likes to discuss differences of opinion How other people behave Emotional: Heart First Nice Kind Empathetic Prefers to avoid disagreements How other people feel 21 7

8 Fourth: How You: - Use time - Feel about time: the future versus now - Plan ahead versus like surprises - Feel about knowing what is expected - Feel about deadlines - Feel about making decisions 22 Planning Ahead In the Moment Planning Ahead Aware of the future Sets priorities - plans Likes routines Likes a schedule Likes to do things as planned Decide and move on! Needs to be in control In the Moment Being flexible Go with now issues Not forward thinking Running late Putting other things off Considers options Go with the flow 23 Some stuff we think/feel people do on purpose is really just who they are 24 8

9 Which is Best? There is no best or better Just different Just ranges 25 What if You Don t Get What You Need at Work? - You still need it! - You will feel drained and empty if you don t get your needs met! - It s not about what is better, it s about recognizing what you prefer and what you need! 26 What About People Living with Dementia? - They are at home - They have needs how will we help? - How can we change the environment to help? - Who needs to know this? 27 9

10 What About People Living with Dementia? Lifelong Patterns: - Introvert versus Extrovert - Detail versus Big Picture - Thinker versus Feeler -Plan versus Go With The Flow 28 How Can We Become Better Care Partners? - Be willing to try something new - Be willing to learn something different - Be willing to see it through another s eyes - Be willing to fail and try again 29 We think we are: Logical They may perceive us as: Uncaring Honest Deceitful Clear Confusing Concerned Insulting 30 10

11 Think whose brain is working better? We can understand another s perspective They may understand things from only one side We can change our behaviors and actions We can decide to do things differently We can ask for help They may react, not respond They may be at the mercy of old relationships They may ask for help through actions, not words 31 How Do We Measure Progression? - Screening/Assessment - Observed Behavior and Demonstrated Skills - Three Scales Used -1-3 Alzheimers (Early, Middle, Late) -GDS: 7 point scale (1-7) - Cognitive Disability Theory: ACL (6-1) 32 GEMS Levels: - Not numbers: each is precious and unique - Each requires a special setting - Each requires the just right care with visual, verbal, touch cues - Each can shine - Dynamic and fluid: accounts for in the moment behavior - Accounts for chemistry as well as structure - Takes two concepts and connects familiar and new in a better use and application 33 11

12 The GEMS Sapphires Diamonds Emeralds Ambers Rubies Pearls 34 - Us on a good day Sapphires: - Clear and true to ourselves - May feel blue over changes - Can typically choose our behavior - Can make contracts - May have other health issues that affect behaviors - Recognize life experiences, achievements and values - Can follow written info and hold onto it 35 Diamonds: -Sharp, hard, rigid, inflexible, can cut -Many facets, still often clear, can really shine -Are usually either Joiners or Loners -Can complete personal care in familiar place -Usually can follow simple prompted schedules -Misplaces things and can t find them -Resents takeover or bossiness -Notices other people s misbehavior and mistakes -Vary in lack of self-awareness -Use old routines and habits -Control important roles and territories, use refusals 36 12

13 -Changing color Emeralds -Not as clear or sharp, more vague -On the go, need to do -Flaws may be hidden -Time traveling is common -Are usually Doers or Supervisors -Do what is seen, but miss what is not seen -Must be in control, but not able to do it correctly -Do tasks over and over, or not at all 37 -Amber Alert- Caution! -Caught in a moment Ambers -All about sensation and sensory tolerance, easily over or under-stimulated -May be private and quiet or public and noisy -No safety awareness -Ego-centric -Lots of touching, handling, tasting, mouthing, manipulating -Explorers, get into things, invade others space -Do what they like and avoid what they do not! 38 -Hidden depths Rubies: -Major loss of fine motor finger and mouth skills, but can do gross motor skills like walking, rolling, rocking -Comprehension and speech halted -Wake-sleep patterns very disturbed -Balance, coordination, and movement losses -Eating and drinking patterns may change -Tends toward movement unless asleep -Follows gross demonstration and big gestures for actions -Limited visual awareness -Major sensory changes 39 13

14 40 Pearls: -Hidden in a shell: still, quiet, easily lost -Beautiful and layered -Spends much time asleep or unaware -Unable to move, bed or chair bound, fall forward or to side -May cry out or mumble often, increases vocalizations with distress -Can be difficult to calm, hard to connect -Knows familiar from unfamiliar -Primitive reflexes -The end of the journey is near, multiple systems are failing -Connections between the physical and sensory world are less strong but we are often the bridge With Dementia All Senses Are Affected: - Miss information - Misunderstand information - Over-react to information - Under-react to information - Get stuck on a sensation - Can t stand a sensation - Variable abilities - Can t adjust or adapt to sensation 41 GEMS Sensory Changes: - Sapphires: you and me, as is - Diamonds: more vocal and rigid - Emerald: visual and auditory most - Amber: all senses critical - Ruby: touch, movement, personal and intimate space awareness - Pearl: touch, movement, intimate space are key! 42 14

15 Consider Sensory Preferences: - Visual likes: stimulating and calming - Auditory likes: stimulating and calming - Touch likes: stimulating and calming - Movement likes: stimulating and calming - Smell likes: stimulating and calming - Taste likes: stimulating and calming 43 Consider Sensory Intolerances: - Visual Irritants - Auditory Irritants - Touch Irritants - Movement Irritants - Smell Irritants - Taste Irritants 44 Realize: It Takes Two to Tango or Two to Tangle! 45 15

16 Being right doesn t necessarily translate into a good outcome for both of you 46 It s the relationship that is most critical Not the outcome of any one encounter 47 DISCLAIMER The content contained in this presentation is strictly for informational purposes. Therefore, if you wish to apply concepts o r ideas contained from this presentation you are taking full responsibility for your actions. Neither the creators, nor the copyright holder shall in any event be held liable to any party for any direct, indirect, implied, punitive, special, incidental or other consequential damages arising directly or indirectly from any use of this material, which is provided as is, and without warranties. Any links are for information purposes only and are not warranted for content, accuracy or any other implied or explicit purpose. This presentation is copyrighted by Positive Approach to Care and is protected under the US Copyright Act of 1976 and all other applicable international, federal, state and local laws, with ALL rights reserved. No part of this may be copied, or changed in any format, sold, or used in any way other than what is outlined within this under any circumstances without express permission from Positive Approach to Care. Copyright 2017, All Rights Reserved Teepa Snow and Positive Approach to Care 48 16

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