Home Instead Senior Care of Sonoma County, CA, sponsored an event with guest speaker Teepa Snow. Teepa is a dementia and Alzheimer's expert, particularly teaching caregivers how to understand the disease and the symptoms and how to best care for the elderly with the disease. This event was held on March 22, 2010, at the Scottish Rite Masonic Center in Santa Rosa, CA. An all day workshop that included CEU credits for certain health care professionals. Home Instead Senior Care of Sonoma County (Rohnert Park home care) and Brighton Gardens Assisted Living of Santa Rosa were the sponsors. This presentation was one part of the workshop in which Teepa Snow explained the various stages of dementia as GEMS. (c) 2010 TeepaSnow.com. All rights reserved. Use only with permission.

1. Caregiving Gems Teepa Snow, MS, OTR/L, FAOTA 1 © 2010 Teepa Snow. All rights reserved. Use only with permission. Presentation at Home Instead Senior Care of Sonoma County sponsored Dementia and Alzheimer’s event, March 22, 2010, at the Scottish Rite Masonic Center in Santa Rosa, CA.

2. Beliefs People with Dementia are Doing the BEST they can We must learn to DANCE with our partner We are a KEY to make life WORTH living What we choose to do MATTERS We can change the WORLD with help We must be willing to CHANGE ourselves We must be willing to STOP & BACK OFF 2 © 2010 Teepa Snow. All rights reserved. Use only with permission. Handout at Home Instead Senior Care of Sonoma County sponsored Dementia and Alzheimer’s event, March 22, 2010, at the Scottish Rite Masonic Center in Santa Rosa, CA.

3. How Can We Become Better Care Partners? Let go of the past to be in the MOMENT Go with their FLOW 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 & try again 3

4. Caring for Someone with Dementia… What Works BEST? 4

5. The Basics for Success… Be a Detective NOT a Judge Look, Listen, Offer, Think… Use Your Approach as a Screening Tool Always use this sequence for CUES Visual - Show Verbal - Tell Physical – Touch Match your help to remaining abilities 5

6. Positron Emission Tomography (PET) Alzheimer’s Disease vs. Normal Brains Early Alzheimer’sAlzheimer’s Late Alzheimer’s Normal Child G. Small, UCLA School of Medicine. 6

7. Normal Brain Alzheimers Brain 7

8. Learning & Memory Center Hippocampus BIG CHANGE 8

9. Understanding Language – BIG CHANGE 9

10. Hearing Sound – Not Changed 10

11. Sensory Strip Motor Strip White Matter Connections BIG CHANGES Automatic Speech Rhythm – Music Expletives PRESERVED Formal Speech & Language Center HUGE CHANGES 11

12. Executive Control Center Emotions Behavior Judgment Reasoning 12

13. Vision Center – BIG CHANGES 13

14. Some Basic Skills Positive Physical Approach Supportive Communication Consistent & Skill Sensitive Cues Visual, verbal, physical Hand Under Hand for connection for assistance Open and Willing Heart, Head & Hands 14

15. First Connect – Then Do 1st – Visually 2nd – Verbally 3rd – Physically 4th – Emotionally 5th – Spiritually - Individually 15

16. To Connect Start with the Positive Physical Approach 16

17. Your Approach Use a consistent positive physical approach pause at edge of public space gesture & greet by name offer your hand & make eye contact approach slowly within visual range shake hands & maintain hand-under-hand move to the side get to eye level & respect personal space wait for acknowledgement 17

18. A Positive Approach(To the Tune of Amazing Grace)Come from the frontGo slowGet to the side,Get lowOffer your handCall out the name then WAIT…If you will try, then you will seeHow different life can be.For those you’re caring for! 18

19. Supportive Communication Make a connection Offer your name – ”I’m (NAME) ”… “and you are…” Offer a shared background – “I’m from (place) …and you’re from…” Offer a positive personal comment – “You look great in that ….” or “I love that color on you…” 19

20. Support to ‘Get it GOING!’ Give SIMPLE & Short Info Offer concrete CHOICES Ask for HELP Ask the person to TRY Break the TASK DOWN to single steps at a time 20

22. “It’s about time for… “

23. “Let’s go this way…”

24. “Here are your socks…”

25. DON’T ask questions you DON’T want to hear the answer to…

26. Acknowledge the response/reaction to your info…

27. LIMIT your words – Keep it SIMPLE

28. WAIT!!!!21

29. Now for the GEMS… Diamonds Emeralds Ambers Rubies Pearls 22

30. Diamonds Still Clear Sharp - Can Cut Hard - Rigid - Inflexible Many Facets Can Really Shine 23

31. Diamonds Know Who’s in Charge – Respect Authority Can do OLD habits & routines Become more territorial OR less aware of boundaries Like the familiar – FIGHT CHANGE Can pull it together to make you look bad Know how to push your buttons Want to keep roles the same Tell the same stories ask the same ?s 24

32. Emeralds Changing color Not as Clear or Sharp - Vague Good to Go – Need to ‘DO’ Flaws are Hidden Time Traveling 25

33. Emeralds Think they are FINE Get emotional quickly Make mistakes – don’t realize it Do over and over OR Skip completely Ask – “What? Where? When?” Like choices Get lost in past life, past places, past roles Need help, DON’T know it or like it! 26

34. Ambers Amber Alert Caution! Caught in a moment All about Sensation Explorers 27

35. Ambers Get into stuff Fiddle, mess, touch, taste, dig, tear, fold….. Move toward action and noise OR away Sensory tolerance Sensory need Mouth, fingers, feet, genitalia Can’t figure it out… react physically 28

36. Rubies Hidden Depths Red Light on Fine Motor Comprehension & Speech Halt Coordination Falters Wake-Sleep Patterns are Gone 29

37. Rubies Fine motor stops Hard to stop and hard to get going Limited visual awareness One direction – forward only Can’t figure out details – but do copy us SLOW to change On the go or full stop Use music and rhythm 30

38. Pearls Hidden in a Shell Still & Quiet Easily Lost Beautiful - Layered Unable to Move – Hard to Connect Primitive Reflexes on the Outside 31

39. Pearls Can’t move Not aware of the world around – most of the time Problems swallowing Hard to get connected How we touch and help matters SLOW!!!! Varies a LOT 32 © 2010 Teepa Snow. All rights reserved. Use only with permission. Presentation at Home Instead Senior Care of Sonoma County sponsored Dementia and Alzheimer’s event, March 22, 2010, at the Scottish Rite Masonic Center in Santa Rosa, CA.