This is from John Hopkins :Habilitation: A Better Caregiving Approach
A quiet revolution is taking place in Alzheimer's care. The approach is called habilitation, and it has been credited with easing caregiver and patient stress, improving communication, and helping to maintain emotional bonds between individuals with Alzheimer's and their family members.
Habilitation focuses on respecting the feelings of people with Alzheimer’s and making the most of their remaining capacities, rather than trying to restore lost abilities (rehabilitation) -- often in vain -- or impose rigid standards for thoughts and behavior. Although the tenets of habilitation may seem intuitive, they run counter to the ways in which many Alzheimer’s patients are treated in nursing homes and family caregiving settings.
Accepting Their Reality In the past, Alzheimer's caregivers were encouraged to practice "reality orientation" with their patients or loved ones. This meant constantly reminding the Alzheimer’s patient of the date and correcting the demented person's faulty beliefs and inaccurate perceptions in order to pull them "back to reality."
For example, if a person with Alzheimer's insisted that she had talked with her deceased husband on the phone that morning, a caregiver would remind her that he had died many years earlier. Oftentimes an argument would ensue, with the caregiver insisting that the person accept the reality of her husband's death. These attempts at reality orientation are not only frustrating and fruitless, but they often trigger agitation and angry outbursts from the patient.
Habilitation takes the opposite approach. The caregiver interacts with the Alzheimer’s patient on his or her own terms. The concept involves entering the person's world, offering patience and acceptance of their reality. In the situation described above, a caregiver practicing habilitation would say something soothing and reassuring, such as, "You and Harry love each other very much, don't you?" or "Tell me about Harry." The practice of habilitation acknowledges that while a person with Alzheimer’s may not have the ability to reason or remember, he or she still feels emotion. As a result, caregivers do not attempt to reason with or correct the Alzheimer’s patient. Instead, they try to connect with the individual on an emotional level. Communication involves identifying the emotion behind the person's words and finding a way to address and validate those feelings.
Streamlining Their Space A major part of habilitation is accommodating your loved one's physical reality as well, which means simplifying the living environment and keeping it as free of distractions as possible. This can help the person to continue to perform self-care tasks and simple household chores that promote independence and feelings of competence. Keep clutter to a minimum, reduce noise, and adjust lighting to minimize shadows, which can confuse or frighten a person who has Alzheimer’s. Dimmer switches on lights can be used to control light intensity. This can be helpful in reducing late afternoon and early evening agitation known as sundowning by increasing light intensity at these times of day.
Remember to break chores into simple steps and to provide only a small amount of information at a time. A caregiver following the tenets of habilitation tries to remain positive, calm, and encouraging and to refrain from criticizing and pointing out mistakes.
Enriching Their World Most individuals with Alzheimer's disease get pleasure from doing things that they have always enjoyed, so it's important to pursue leisure activities that they find pleasing. Create opportunities for success by considering what they liked doing in the past and determine if there are activities that the person can still accomplish without becoming frustrated or agitated. Depending on the stage of Alzheimer’s disease the person is in, these might include crafts and hobbies, making or looking at scrapbooks and photo albums, stringing beads, baking cookies, going for walks, listening to music, or any other enriching activity that can keep the person occupied and engaged.
Social contact and physical activity are also important. Taking walks together in the neighborhood or mall, window-shopping, gardening, and planned activities at a senior center are just a few of the possibilities.
Mary, thank you for posting the article....funny thing....that is what we have been saying on this website for two years!!! Don't argue with them - the reason button is broken; don't tell them someone died years ago, because to them, they will experience the news of the death all over again; try to make the home environment as pleasant as possible for them, and you will be accomplishing the same thing for yourself; let them eat desert first if they want - it really doesn't matter any more; just keep them safe, well loved, and content, and your life and your caring for them will be smoother. Let them do what they can (as long as they can) so that they can feel like they are contributing. If they are social people, try to continue social meetings as long as possible.
The habilitation method was introduced in a book that many of us have read: Learning to Speak Alzheimer's by Joanne Koenig Coste. I'm surprised that the above article (which is a partial summary) does not give her credit.
Jeanette--You expressed my thoughts exactly! After reading her book, I thought it was a method that she herself had developed. Regardless, for anyone who hasn't read it, it is a must. I was fortunate enough to hear her do a presentation and meet her shortly after my husband's dx. Her husband had EOAD, died young (maybe in his 50's?) and she was left with about 5 children to raise on her own, if I remember correctly. She has made education about AD her life's work and her book is probably the best one I've read for caregivers.
The principles are wonderful. It is not always easy for me to follow. For example, if he asks "where is everybody" and nobody is here, do I say "nobody is here" (True) or something like "who are you thinking of" ? OR change the subject? What response would be the least stressful for him? In the late afternoon/early evening he is very likely to ask "where is everybody" - mornings and afternoons he is pretty "normal", sometimes I almost forget that he has ALZ. I can only wish........
I would probably say something like "it's just you and me for now!" and smile at him. Then ask if he wanted something to drink or ask him if he wanted me to put in a movie for him to watch. Redirection is the name of the game......and flexibility is my new motto.....
My DH ALWAYS eats his dessert first..and it just makes me smile. Who made the rule that we were supposed to eat it last? More on the order of food servings... In France, the salad is eaten after the entree'..because they are concerned that the vinegar in the salad dressing affects the taste of good wines they enjoy with the entree. Hey! works for me!!! -Same for eating dessert first!!
I have heard for years to eat dessert first because it will trigger the 'full' signal sooner. Eating salads last will clean you pallet and aid in digestion. I still like to eat salad first - if I save it I may be too full for salad. Dessert I really to not care about.
I bet that you and I don't have to worry about the salad dressing affecting the taste of our fine dinner wine either. (grin) I'm an iced tea drinker with dinner.... Rarely have wine with a meal, although we used to when we'd go out to a nice restaurant for dinner.
I don't drink but so many of you do makes me wonder what I am missing!! I usually have diet cola, water with lemon when going out, or crystal light at home. So no, wine would not affect it. The dressing I am currently in love with is Newman's Light Balsamic Vinegrette.
I've had to become very flexible about mealtimes, to keep dh happy. For instance this morning was my weekly swim, so to keep him happy while I was gone I fixed him a nice breakfast before I left at 7;15, and had a quick bowl of muesli myself. But by the time I got home, he was angry about being left alone and wanting to go to IKEA for breakfast. OK, so there we were around 10:30, having a second breakfast at IKEA. I stuffed most of mine in my purse (I've got to remember to take baggies). We had just got home when I saw I had almost forgotten a concert I wanted to go to, so we were back on the bikes. When we got to the church where the concert was I could only get him to come along inside by promising we'd go to his favorite restaurant in town right afterwards. So shortly after 1 pm we were having our third meal of the day!
(The flute and violin concert was great, and if dh is not very hungry for supper we'll just have some eggs). It's really been a good day!
My DH has food compulsions, for sure. First it was breakfast for dinner, which was fine - eggs, bacon, hash browns, toast. Then it was Hungry Man frozen dinners (actually dinner not dinners, because he wants the same one every day). He went through a red pepper flakes stage. Bought a huge container of them one day at Sam's Club and put them on every single thing he ate for weeks. Now that's over. The latest is peanut butter and jelly sandwiches. Yesterday, he ate a Hungry Man dinner about 4 p.m. An hour later, he ate 4 (count 'em, 4) peanut butter and jelly sandwiches. He even puts jelly on top of his peanut butter crackers. When I don't ask him and just go make something else for dinner, he eats all his vegetables first, then all his potatoes, then all his meat.
My husband also has foods he eats daily. Right now he is on peanut butter and jelly sandwiches and he also likes peanut butter and jelly on crackers. Every night at 8:00 on the dot, he has to have his little bag of m&ms. For a while he had to have corn everyday whether it went with the meal or not (that has stopped). He is also very fixated on his next meal. He could just finish breakfast and ask what's for lunch, then it will be what's for dinner.
He also sometimes forgets he has eaten and when I try to tell him he ate he doesn't believe me. Usually then I'll try to just have him eat a small snack. Then he looks at his belly, which has grown a bit, and say why is it so big. :o
Mine likes to cut slices of bread. If I buy sliced bread, then he gets them out of their baggie, carefully. Then he puts mustard on them. OCCASIONALLY he'll eat one. Sometimes at dinner time I collect 3-4 slices and throw them out for the birds. I confess I don't give him free rein of the bread bag until it's getting a bit long in the tooth, but stale's okay with him.
First, for over a year he must have his pecan pie and icecream at lunch. Thank goodness Mrs. Edwards makes a great pecan pie you can buy in the frozen food section. For about 6 months he wanted Campbell's Bean and Bacon soup everyday. For the last 4 months it has been chunky peanut butter and raisins on toasted breads. I buy the Smart Balance natural with flax oil. It does not have to be refrigerated like most natural brands. Once in a while I will have one with dried cranberries instead of raisins. All you peanut butter people out there, try toasting your bread for a crunchy taste. You'll never go back to doing it any other way.
I ate mustard and mayo sandwiches, lettuce and mayo, now that the tomatoes are ripening it is thick slice tomatoes with lots of Best Foods mayo on bread!!
I use Adams Old Fashioned crunchy PB. IF you mix it up, refrigerate, then it can sit out without separating again. At least it always works for me.
I am a peanut butter junky!!! All your recipies are great but my latest favorite is toasted English Muffin, with lots of butter and then add some peanut butter while it is still warm. If you have a sweet tooth, add a little marmalade to this favorite.
I like peanut butter and mayonaise sandwichs but lettuce really makes it the best. I even have lettuce sandwhiches (no bread) with peanut butter and mayo.
Speaking of mayo, have you tried the olive oil mayo. muy bueno!!!!
Has anyone ever made baked chicken with Peanut Butter. Wash and pat dry the chicken, spread generously with peanut butter over each piece, sprinkle sesame seed on top and bake in the oven. Tastes much like Chicken Satay... (I like spicy food and always sprinkle some red pepper flakes on my piece.)
bluedaze - oh there's nothing wrong with putting jelly on peanut butter crackers - he just never did it before. I love peanut butter (but not jelly) and I eat it every single day, but he never did till Alz. We use Jif peanut butter and he likes strawberry or grape jelly.
My husband loves english muffins with butter, peanut butter and raisins. I like peanut butter and I like jelly--just not together on the same sandwich.
I agree - PB by itself or jelly by itself, just not mixed. Art use to eat PB and saltines every night because there is a chemical in PB that relaxes leg muscles. When the kids were little and waking up with muscle cramps due to growth the doctor said to give them a spoon of PB before bed. It worked. When my 11 & 8 year old grandkids were visiting, they would wake up screaming in the 2-4 age range, so when they visited before bed they would have toast and PB. The grandmother raising them wouldn't do it so they had to suffer at home. :-(