IL Caregiver 10
IL Caregiver 10
IL Caregiver 10
Prevention
Job Descriptions, Protocol and Care Plan Notes for Documentation
Your Professional Caregiver Responsibilities
On-Time Arrival: Always arrive on time or a few minutes early for your caregiver job. Call the
Always Call the Senior Client by Their Last Name: Use the more formal, such as "Mrs. Smith,"
unless the client tells you it is acceptable to call them by their first name.
Get Acquainted: This is your first task. Make the senior feel comfortable and relaxed. Thank them
for allowing you to work with them and let them know you are glad to have the opportunity to be
their caregiver. Ask them to tell you about themselves and their preferences. Share some of your own
interests.
Review the Care Plan: This is your reference tool and where you will document the care in a Care
Plan documentation log. Make sure you discuss with the senior client where to keep it. Be sure to
Discuss the Senior’s Meals and Favorite Foods: Begin to understand the dietary requirements of
emergency or needs to reach you at work, have them call the senior care company office and they
Cell Phone: Do not receive or make calls from your cell phone while at work. Your cellular mobile
phone should be turned off and out of sight unless told differently by your agency.
Do not Solicit Money at Any Time for Any Reason: Do not ask senior clients or family members
for money. Any senior shopping needs will be managed by a Care Manager or Supervisor.
Never Come to Work Under the Influence of Alcohol or Drugs: Random drug tests can be
As a professional caregiver, you will want to conduct yourself with good manners and take
responsibility for delivering quality care, no matter if you are experiencing a good or bad day in your
personal life. You will set a tone of integrity by always showing up on time, dressing appropriately,
Self-Confidence
client. As each client's care schedule, medical conditions, and needs may vary, you will be provided
Your daily care plan for each senior care client will be customized.
Assist with walking and light exercise
Companionship
Report any significant client changes to the Senior Care Company office
Hourly Caregivers: Report to work at the client's home, assisted living community, or senior care
center and work for the scheduled hours of service. Receive hourly pay for the number of hours
worked.
24-Hour Caregivers: Term used for caregivers who may report to work at senior client’s home and
stay over-night with the senior for one or more nights, taking a break for down-time in the evening
and sleeping at night. Meals are usually provided by the client along with the costs of any shared
activities with the senior. Sometimes seniors receiving end-of-life care will progress to needing
active caregiving around-the-clock which will require a rotation of a day and night caregiver.
Medication Monitoring: Senior caregivers must take extra care to monitor the senior’s medications
according to the Care Plan. Medication reminders are an important part of senior care. When a
variety of medications are prescribed, taking the medications at the scheduled time and in the proper
manner is very important in order for the medication to have the proper results. Example:
medications may be prescribed to be taken with food or on an empty stomach or before bedtime.
administer medications as only a medical doctor may prescribe medications and authorize a
registered nurse to administer doses in some cases. Caregivers will document in the Care Plan the
medications taken and the time the medications were taken and also record any side effects they
their medicine as prescribed. Call your Care Manager for advice and guidance on how to handle the
situation. An experienced Care Manager can provide coaching on how to best convince the senior to
take their medication as prescribed. Sometimes doctors will prescribe medication in a liquid form or
Observing, reporting, and documenting client status and the service furnished, including changes in
functional ability and mental status demonstrated by the client are presented in this section.
Historically care plans were in paper formats, however more and more care plans are digital.
The HITECH Act of 2009 incentivized adoption of electronic health records and paved the way for
This means care plan notes will often be available to the clients’ care teams and families.
In January 2015, CMS transitioned Medicare to a more quality-based practice of reimbursing for care
Why?
Medicare and all medical plans want to reduce hospital readmissions. Electronic linking of medical
records makes sure “everyone is on the same page” so to speak. Clear communication can mean
The care team is everyone who manages or provides care, including caregivers. It can also
Currently, Care Plan content is not the same across every company or health care provider. You will
learn your company’s care plan procedures and their requirements for the digital care plan or written
care plan.
Care Plans are expected to evolve and contain more evidence-based content, in other words,
information about the disease(s) the person has and activities that should be done to help the person.
Topic Segmentation
Typically you will see topics arranged in separate sections, like this:
Nutrition
A nutrition plan must recognize the current problems in eating habits and consider chronic
Physical Activity
Regular physical activity is especially important for those with conditions like diabetes, high blood
pressure, or high cholesterol. Exercising regularly can lower blood glucose, blood pressure, and
Patient Summary
Summarized history includes basic information such as demographics (name, age, contact info,
ethnic or religious beliefs), health metrics (weight, blood pressure, etc), allergies, or medications and
therapies. It can also contain past health history such as past hospitalizations.
Goals
Goals are used to measure progress. They give a care plan direction and are the first indicator of what
path a patient is taking to manage their health concerns. Care plans are typically made up of a few
Health Concerns
These are the current problems in health. Identification of these concerns can involve reviewing
symptoms, general health behaviors, and any social or environmental factors on health. Collection of
caregivers to stay current with the client’s status and enables higher quality care.
Senior caregivers working as companion caregivers, certified nursing aides, certified home health
aides, and personal care assistants are responsible for reporting and documenting information about
Care Plan Daily Note Sheet or Chart for Recording Daily Activities
Confidentiality of Information
Clinical Record
Patient Chart
Medical Record
Quality care plan notes for each client care shift assist with the following legal protections:
Use EXACT quotes from the client when they are communicating pain or discomfort
Be specific
Do Not:
Most Senior Care Companies will have a Daily Care Notes form which you can fill out each day and
Bathroom Visit
Shower/Bed Bath
Dressing Assistance
Haircare
Skin Care/Lotion
Dental Care
Medication Reminder
Exercise Routine
Nutrition
Meal Preparation
Set-Up Meal
Breakfast
Lunch
Dinner
Snack
Activities
Physical Therapy AM/Walk
Other Activities:______
Client Routine/Vitals
Wake-up Time:_____
Nap A.M.____
Nap P.M.____
Bed Time:_____
Bathroom Visits:_____
Weighed Client____lbs.
Doctor Appointments:___
Household Cleaning
Laundry
Sorted Mail
Cleaned Kitchen
Cleaned Bathroom
Swept Floors
Mopped Floors
Dusted Rooms:_______
Vacuumed Rooms:____
Errands:____________
Other:______________
Watch Video on Ideas for Activities with Seniors with Alzheimer's Disease and Memory Loss:
5 Minutes, 32 Seconds
Legal Issues
Poor Care Plan documentation could make it look like a caregiver is giving poor care or indicate
neglect. Caregivers must be sure to provide solid care notes each day.
Long-term Care Insurance Companies: Care Plan Notes may be required in order for the
insurance to pay the claim. This is why it is very important to maintain professional notes
daily and correctly document daily care activities.
Medication Reminder Charts: Medication monitoring is not the same as medication
administration. Caregivers only “monitor” the medications to be sure the person receiving
care took the medications as authorized in their medication chart.
Incident Reports: If a work injury occurs, such as a fall or damage of property (you dropped
a vase and it breaks,) this is separate from the Plan of Care. Call your supervisor and follow
your company system for incident reports.
Care Plan Safety: Protect both yourself as the Caregiver and the Care Client by
IMMEDIATELY REPORTING any significant changes in health conditions, safety
concerns, or new developments. If Elder Abuse by a family member or friend seems apparent
when you arrive for a care shift, act immediately by calling your Senior Care Company
Manager and documenting what you observe.
Observe: We have two ears and one mouth so we can listen twice as much as we talk.
Observe with all of your senses—listen, smell, and touch to observe changes in condition.
Quality of Care Plan Information: Remember that a long-term care insurance company,
family members, doctors, nurses, and in some cases, an attorney acting as a legal guardian
may be reading the Care Plan Notes. Keep them professional and be sure to proof them at the
end of your work shift.
Tip Sheet
Arrive 5 Minutes Early, Never Touch Pills, Never Solicit Money, Get Acquainted, Turn Cell Phone
Off, Never Come To Work Hungover, Job Description Duties, Hourly Caregivers Receive Hourly
Pay, Live-in Caregivers Receive Daily Stipend, Live-in Caregivers Do NOT Move-in Permanently
Care Services Daily, Understand Objective vs. Subjective Notes, Medication Monitoring is Just That
—a Reminder to Take a Medicine as Scheduled, Protect Yourself and Your Care Company and
Insurance
Portability and
Accountability
Act
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) sets guidelines for
health care organizations to maintain client confidentiality and privacy of medical records.
HIPAA provides many details for medical doctor offices and hospitals to follow, even mandating that
a computer screen cannot be in a high-traffic area where someone might walk by and see patient
information.
Watch Video on Security and Accessing Public Wifi: 4 Minutes and 20 Seconds
These rules provide federal protections for patient health information and give patients rights for who
Confidentiality means: the state of keeping a secret or maintaining trust and confidence of secrets
Clients receiving senior care services may have medical records and medical instructions from their
doctor, including medications. This information remains private to the caregiver—meaning you are
not allowed to share this information with people other than those involved in the care of your client.
As senior care involves staying with a senior in their home, it will be natural to hear personal
information about the senior’s family and friends. Maintain confidentiality of any information you
Just as when you work for any company, the company information remains confidential, so does
Example: You find out that your client has a terminal illness. The client's niece comes to visit: you
Money matters of a client should remain confidential. Remember that seniors can become especially
sensitive about money issues. This is because most seniors are no longer earning income but rather
living on a fixed income. Be mindful that they may have many emotional issues surrounding money.
Do not discuss your financial issues with a client and simply change the subject if a senior you are
Verify the identity of doctors, pharmacists, or any other providers who may call and refer
them to the Care Manager
Never exchange money with a senior client in order to protect both yourself and the client
MANAGER
Information that Identifies the person or Could Possibly Identify the Person
Examples of such information include your client or care recipient's name, address, social security
PHI (Protected Health Information) is all individually identifiable health information in any
form:
1. Paper
2. Verbal
3. Electronic
Exceptions:
You are allowed access to the minimum amount of Protected Health Information necessary for you
You may only disclose the minimum amount of Protected Health Information necessary to satisfy
a request and only request the minimum amount you need to perform your job duties.
authority for access. Document the request which means write down the person's name, phone
number, and the time of the call or visit to show you verified the information.
Rules for Permission to Use or Disclose Protected Health Information and TPO:
Generally, however, you do need specific, written authorization from your client or care recipient
before you can use or disclose his or her Protected Health Information for anything other than
If you hear someone who is in violation of HIPAA requirements and procedures, tell your manager
or supervisor about the situation, as it is your duty to make sure the law is being upheld. Employers
are bound by law to protect a workforce member from harassment or retaliatory actions if they report
Law Enforcement Officers: You are allowed to disclose PHI to law enforcement without the
ASK YOUR SUPERVISOR: if you are ever unsure of how to proceed in a situation involving
NEVER DISCUSS PHI you see or hear while performing your job with anyone unless
necessary!
Watch Video from the U.S. Dept of Health and Human Services on HIPAA: 1 Minute, 55
Seconds
Example 1: As a caregiver, you go with your client "Mary" to the doctor. You learn that Mary's
diabetes is out of control, her circulation has worsened and she needs to see a specialist about
possible amputation. You return to her home and her daughter stops by, her daughter does not have a
healthcare power of attorney. Mary does not mention the diagnosis and tells her daughter that the
visit went well and her health is good. Even though you would like to tell her daughter about the
diagnosis, you cannot. Mary has decided not to tell her daughter and it is not your right to pass on the
information. You may be familiar with an attorney and client confidentiality when a lawyer cannot
speak to others about your case. This is similar, you are not allowed to speak to others about Mary's
diagnosis.
1. As you learned in the previous section, this information is called Protected Health
Information or PHI
2. Other things you can't share: information about the individual’s past, present, or
future physical or mental health or condition, and past, present, or future payment for
the provision of health care to the individual
Example 2: You learn that Mary, from Example 1, has Stage 1 Alzheimer's Disease, and you know
the condition will not get better. Mary decides to tell no one. Her neighbor stops by and tells Mary "I
told you we were having bridge today, I don't understand why you aren't ready, you are always
ready." You cannot tell the neighbor that Mary has Stage 1 Alzheimer's disease and that is why she
The Health Information Technology for Economic and Clinical Health Act (HITECH Act or "The
Act") is part of the American Recovery and Reinvestment Act of 2009 (ARRA) and increases the
Speeding up the electronic health record (EHR) systems among providers was the motivation for
You know what happens when you park in a no-parking area- your car can be towed or you can
receive parking tickets. The same situation happens if a company does not properly safeguard a
patient's information.
A major provider of Home Health was fined $239,000 for not properly safeguarding client
In each section, you will be given multiple scenarios. Write down what you think the answer is and
You are at the grocery store and see Vivian. Vivian is a good friend of Rose. Rose is your client and
Vivian knows this, as she often comes over while you are caring for Rose. Vivian asks how Rose's
1. You respond that it didn't go very well, Rose's blood pressure was high and her
blood sugar was not controlled. You also mention for her not to tell Rose you gave
her any information.
2. You politely tell Vivian you really appreciate her concern. Then politely tell Vivian that
HIPAA rules require you to keep all information private.
3. Ignore her comment and walk away.
You meet a coworker for coffee in a busy coffee shop and both begin talking about your clients. You
use the person's first name only, but also talk about the drive to the client's home, the neighborhood
and then tell your friend about the client's heavy use of alcohol and failure to pay medical bills. The
conversation continues and at the next table, one person has been sitting within earshot for the entire
conversation.
Reporting to your agency-client information and changes in health is not considered a HIPAA
violation, as anyone that requires access to the information to perform care is bound by the same
HIPAA standards.
----------------------------------
Talking to your co-worker who does not work with your client is a violation of HIPAA.
Talking to your family or friends about a client in a way they can figure out who the client is—
or if you only have one client and they automatically know who it is, also violates HIPAA.
Did you know it's even a HIPAA violation for a person in a hospital to "look someone up" in the
Example: If you have a friend who works as an ER nurse and she tells you that she saw 25
cases of people with the flu during her last shift, that would not be a violation of HIPAA. She
Likewise, if you say it's common to see depression in your senior clients, then you aren't giving
any specifics on a client and you are not discussing any personal identifiable protected health
information.
Failure to Physically Secure Information:
Did you know some of the biggest healthcare data breaches were caused by a lost or stolen device?
If your agency still uses paper for Care Notes you should remember that even lost care notes are also
a HIPAA breach.
Real-Life Case:
A Home Health Aide had copies of patient records in her home. When she moved out after a divorce
she did not take the documents with her. Her ex-husband had full access to the records. She also
sometimes stored paper documents in her car. The agency claimed the documents were taken from
their office without their knowledge. It did not matter because the agency was fined $250,000
When your company follows strict security procedures for client information, know they are required
to under HIPAA.
You go to see your client in the morning for a half-day shift, then go to the gym. Your company
1. You figure it is fine to leave the tablet in the car and lock your door
2. You take it with you to your yoga class and leave it in the corner of the room with
your shoes, unattended
3. You take it into the gym and lock it in your locker with your other belongings
In this case, the best option is probably 3, as it is safely locked in your locker with your other
belongings and not in a car which can be hot and damage devices, but also can be broken into.
the way information is stored and transmitted is very strict. Not only are there specific encryption
rules and rules for storage, but even require companies performing EHR (electronic health record)
Using your home computer to send emails about your client to your agency—NOT SECURE
You are with the client and have a specific question for your manager about their care. You decide to
send a quick text, remind your manager who your client is by name and then ask a care question.
That is a violation of HIPAA. Do NOT TEXT information about your senior care client.
You've been with your client for 3 years and you had a very special day. Your client has late-stage
Alzheimer's, but you were able to enjoy a lovely day at the park. You decide to post a selfie of you
The answer is 3
Posting to Facebook is a violation of HIPAA, in this case, the situation is made worse as the person
HIPAA? HIPAA authorization forms expire. When your agency takes on a new client, the client or
the person legally able to act on their behalf gives your agency consent to know their health
Say Rose was supposed to be a client for 6 months but is now on her 2nd year of care.
Your agency must have signed forms that are current or not expired.
They cannot be denied access to care and the agency/provider must still adhere to HIPAA standards.
You know he has not been given access to medical information and does not have the medical power
of attorney.
However difficult the situation may be, you have an obligation to your client and your agency to
Jake, I understand you have questions about your father's health, as that is normal for a child.
Please understand I cannot share the information, as I am bound by HIPAA and it is against
If you know the client is in good mental health and is able to communicate, encourage Jake to talk to
his father or mention to your client that Jake is requesting information. The client can make the
decision to share the information. If the client is not sharing the information, there is probably a
being paid to be a caregiver and keeping your client's best interests at heart will always help you be a
better caregiver.
Tip Sheet
HIPAA means Privacy of Information Between Healthcare Providers and Clients, Senior Caregivers
Must Keep Client Financial and Personal Info Private, Keep it to Yourself, a BA is defined as a
Business Associate, a CE is defined as a Covered Entity, Privacy Rule protects Any and All Health
Information, Security Rule, Breach Notification Rule, Privacy Rule, HITECH Act Widens Scope of
HIPAA Privacy and Security Protections, Increases Potential Legal Liability for Non-Compliance,
Caregiving is Your Career, Rules of HIPAA Must be Followed, HIPAA Rules are Legal
Requirement for You, Your Agency and Your Client, HIPAA Privacy Protects You and Your
Behaviors that would constitute abuse or neglect and the legal prohibitions against such behaviors, as
well as knowledge and understanding of abuse and neglect prevention and reporting requirements.
Elder abuse and neglect are serious problems that occur in our communities and in our senior care
institutions. People are most at risk for abuse and neglect when they are unable to take care of
themselves mentally and physically. This makes children and elders targets for abuse and neglect.
Senior Caregivers need to understand abuse and neglect to protect themselves and the seniors in their
care.
Learn about examples of Elder Abuse and how to report in each state through a phone line for elder
Abuse is any action by a trusted individual that causes physical or emotional harm to the victim.
Physical Abuse
Sexual Abuse
Emotional Abuse
Financial Abuse
Neglect Defined
When someone fails to do tasks that are necessary to meet the needs of an elderly person this is
considered neglect. Neglect can happen by a family member or a caregiver who does not provide the
Abuse and neglect can happen anywhere, both in the home or in an institutional caregiving setting. In
order to regulate the industry to prevent abuse, nursing home violation reporting systems were
created. Because even in facilities, abuse and neglect can occur. Unfortunately, sexual abuse also
occurs in institutional settings as predators can target these types of communities. All caregivers need
Sometimes neglect happens because caregiving staff is overworked, stressed, or poorly trained. It is
important to understand that even if you are having a difficult day, you must remain professional and
not become verbally abusive to a senior nor neglect a necessary task. Sometimes family members are
exhausted by the rigors of senior care or may be battling their own drug or alcohol challenges which
may expand into elder abuse. Know the signs and take action to protect both the senior and yourself.
If you feel yourself getting stressed, take a breather—step away, take deep breaths, and return when
Elder abuse is harm done to people over the age of 65 by someone in a position of being trusted to
Adult children and spouses are often abusers, as they are the people who are most trusted. Many
times the senior will not report the abuse because of shame. Sometimes caregiver stress leads to
abuse.
Signs of Abuse:
You hear two different stories about how the senior got a bruise or other injury
Hitting
Slapping
Shoving
Shaking
Kicking
Pinching
Burning
Physical restraints
Physical punishment
Inappropriate sexual contact
Sexual Abuse
Inappropriate Touching
Emotional Abuse
Causing pain and anguish by the use of words and actions (what you say and what you do).
Insults
Threats
Intimidation
Humiliation
Harassment
Silent treatment
Controlling activities
Financial Abuse
Forging checks
Committing fraud
Watch Video on Signs of Elder Abuse and the Importance of Reporting: 1 Minute, 49 Seconds
Remember, you are required by law to report elder abuse and neglect and can even be fined or
punished with jail time if you fail to report the abuse and neglect in most states. Every state in the
U.S.A. maintains a special department of trained experts to investigate elder abuse and these
Tip Sheet
Report Abuse or Neglect to your Manager, 3 Types of Neglect are Active, Passive, and Self-Neglect,
Good hygiene for both the caregiver and the care client is essential for maintaining good health.
Preventing infection requires thinking about how to protect the client you are caring for along with
Handwashing Tips: Sing “Happy Birthday to Me” twice: Singing “Happy Birthday” to yourself
twice while washing your hands helps you remember the length of time necessary to properly wash
Watch Video from the CDC on Hand Hygiene for Fighting Infections - Clean Hands Matter: 1
Minute, 41 Seconds
Handwashing Techniques:
1. Wet each hand thoroughly and apply antibacterial soap.
2. Rub your hands together, making sure you scrub the entire hand, including in-
between the fingers.
3. Scrub each hand for 15 seconds.
4. Be sure to clean under the fingernails as most germs hide under and around your
fingernails.
5. Artificial nails should be avoided as they are difficult to clean.
6. Jewelry can serve as a nest for germs so remove when washing your hands.
7. Rinse both hands in warm water. Avoid very hot water as it can harm the skin and
add to infections.
8. Be sure to rinse ALL the soap off of your hands.
9. Dry hands completely. Paper towels are suggested, although motion-activated
dryers are the best (but obviously not usually present in a senior’s home.) However,
when in a public bathroom, the motion-activated dryers are the best option.
Before and after situations in which your hands are going to be contaminated
After sneezing
After coughing
Strict hand-washing routines are the gold standard for reducing infections associated with health
care. Infections communicated in nursing homes, hospitals and doctor’s offices are linked to nearly
100,000 deaths a year affect more than 1 million patients. When accompanying as senior to any of
these facilities, always ask the medical professionals: “Have you washed your hands?”.
Watch Video from the Centers for Disease Control on the Most Common Infection Sites: 1
Minute, 34 Seconds
Electronic sensors, thermal imaging, and video cameras are being used to help monitor consistent
Take hand-washing seriously, for your health and for the senior’s health.
Types of Soap:
1. Plain Soap: Removes surface residue but does not kill microorganisms that are on
the skin, instead it suspends the microorganisms.
2. Anti-Microbial Soap: Removes dirt and residue from your skin and uses an agent
that will kill most microorganisms. Some agents in this type of soap will continue to
kill microorganisms after your hands are dry.
3. Anti-Septic Handrubs: This gel-type of disinfectant will decrease the microorganisms
on your skin, but soap and water are always best.
Washing hands with soap and water assures you will reduce the number of germs and should always
be your preferred cleanser. If soap and water are not available, use an alcohol-based hand sanitizer
that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of
germs on hands in some situations, but sanitizers do not eliminate all types of germs and might not
Hand sanitizers are not as effective when hands are visibly dirty or greasy.
Watch Video from the World Health Organization on Proper Hand Washing: 1 Minute, 26
Seconds
Now practice what you saw in the video, re-play if necessary. Practice makes perfect; use the proper
handwashing technique in your everyday life, even when not working with a client and it will
become a habit.
About Gloves: Gloves may protect the person wearing the gloves but microorganisms can be passed
Be Sure the Gloves are Clean on the Outside and DISCARD AFTER USE
PUTTING ON GLOVES
1. Remove any sharp jewelry
2. Gloves come in small, medium and large. Be sure to use the right size for your
hands.
3. Remove gloves from the box.
4. Most gloves are rubber latex and are pre-powdered. If allergic to latex then use vinyl
gloves.
5. Hold glove with your thumb and forefinger and insert hand into gloves
6. Work fingers into proper places
How Infections Spread: Microorganisms are also called germs and are tiny living things seen only
with a microscope. This is why thoroughly washing your hands is important. Pathogenic organisms
Wipe up immediately by cleaning from the outside (cleanest) to the inside (dirtiest)
Watch Video on the Benefits of Handwashing, Food Safety and Caring for Someone who is Bed
Remember, as a professional caregiver, your skills in managing a clean and safe household include
infection control. As we age, our immune systems ability to fight infections also weakens. Proper
Tip Sheet
Gloves Do Not Take the Place of Good Hygiene, Fingernails Harbor Germs, Wash Hands Before and
Learning how to maintain a clean, safe and healthy environment will be explained in this section.
Environmental cleanliness enhances the lifestyle and creates a pleasant and safe environment for both
the caregiver and the senior receiving care services. A tidy home environment creates a happy home
Cleanliness is contagious. If you keep yourself and the care environment neat and clean, everyone
who visits will also want to keep the area neat and tidy, which will make the caregiver’s job much
easier.
Standards of cleanliness indicate a sign of overall care provided. It will be a cause of concern if the
bacteria from spreading. Be careful to keep food items separated as meat can contaminate other food
items. Immediately place meat in the freezer or refrigerator when returning home from the grocery
store or upon delivery. Cooking temperatures must be followed to destroy pathogens. Always handle
any meat, such as fish, chicken, pork and beef, with extra care. Wash your hands and utensils before
and after preparing meat, just as you do before and after cooking any other foods.
Using a food thermometer when cooking food on the grill or oven will help you confirm the food is
heated to a high enough temperature to kill germs. Most bacteria cannot live above 120 degrees
Fahrenheit. Meat usually requires higher temperatures, such as whole chicken requiring at
Watch Video from the Center for Disease Control on Food and Kitchen Safety: 2 Minutes
Cleaning Products
Use special antiseptics and bleach to clean in order to eliminate germs, making allowances for any
If an outside cleaning service is used, make a cleaning instruction list. Inform them of any special
areas that are overused and need extra cleaning attention. Check to be sure everything is cleaned
Note: Kitchens and Bathrooms are Used the Most and Require Daily Cleaning Maintenance
Stay Organized. Create a space for all of the care tools you will be using so that everything has a
As the saying goes, a messy house equals a messy mind. Less is sometimes better. Try to remove
clutter from your work area and be mindful that you can more easily maintain a clean environment
by being organized and getting rid of any unnecessary items. While you need to respect your client's
home and lifestyle, you can make sure that the tools that you use are well organized and limit the
Remember, a person’s home is their castle. Some seniors may have lived with extra “clutter” in their
homes their entire lives while other seniors lived the minimalist lifestyle. You will not be able to
change a senior’s style but can assist them to maintain cleanliness and order.
Tip Sheet
Create a Cleaning Schedule, Tidy Up Kitchens and Bathrooms after Each Use, Use the Right
outfit and clogs, along with gloves, face masks, eyewear goggles, and aprons.
Remember to always wash your hands before and after wearing gloves as gloves do not take the
place of handwashing.
Senior caregivers should follow the senior’s care plan for the use of protective equipment.
Cleaning Products
For off-the-shelf cleaning products, always review their ingredients and usage and warning
guidelines. If you are using any special products, find out what you need to do to keep yourself and
A document that contains information on the potential hazards such as: physical properties, fire,
reactivity, the toxicity of a chemical product and how to work safely with the chemical product.
The government's Occupational Safety guidelines have you protected by requiring all chemical
manufacturers to provide the details of their product for anyone to access something called the Safety
Off-the-shelf cleaning product precautions may be found by doing a GOOGLE Search with the
The Hazard Communication Standard requires that all chemical manufacturers, distributors, and
importers provide Safety Data Sheets or SDS's (formerly called MSDS or Material Safety Data
Sheets) for each hazardous chemical to downstream users to communicate information on the
potential hazards.
Properties of Chemical
Protective Measures
Infection
Be Safe - Be Able to Quickly Identify Infections: Infection is Spread in 3
Stages:
Stage 1
Stage 2
Stage 3
Germs use many routes to get from one host to another. Here are some ways that germs spread:
Blood
Mucous
Pus
Saliva
Stools
Urine
Vomit
Germs get into the new host when infected body fluids:
Are on a needle or other sharp thing that goes into the skin of
the new host
Some people are more likely than others to get sick from germs. They are susceptible.
Already sick
Under stress
Very old
Very tired
Very young
Have a weak immune system. That means their body is not good at fighting off things from
outside.
If a cut is infected:
The skin around the cut is red and puffy and feels warm
Very tired
As a home caregiver going into homes, you can face unpredictable and unprotected situations which
Verbal abuse from the client, family members, or people in the community is a form of workplace
violence. Verbal abuse may be subtle, such as asking for help beyond the scope of the job, or it may
be obvious, such as complaining about job performance or worker appearance—or even threatening
to cause harm.
Violence is a major disruption in providing quality care and disrupts the therapeutic and calming
setting.
Workplace Violence Defined by The National Institute for Occupational Safety and Health:
"....any physical assault, threatening behavior, or verbal abuse occurring in the work setting."
YOUR RIGHTS
You have a right to a safe place of employment free from hazards that are known or likely to
cause death or serious physical harm
You have a right to know about any potential security hazards and how to respond and
protect yourself should a situation arise
YOUR RESPONSIBILITIES
You are responsible for knowing your workplace policy for handling a difficult individual.
If you are in a situation where you feel threatened by a client, co-worker, family member or
Watch Video from Oregon Public Health on Staying Safe and Alert when Going into a Client’s
Most violent behavior is preceded by warning signs. The following cues (signs) are indicators of
possible violence.
Cues
o Swearing
o Clenched fists
o Heavy breathing
o Pacing or agitation
o A fixed stare
o Aggressive or threatening posture
o Throwing objects
Part of violence prevention is to be aware of your own feelings, responses, and sensitivities. Pay
attention to your instincts. For example, your "fight or flight" response can be an early warning sign
awareness includes acknowledging if you have a personal history of abuse which might affect how
you respond to situations that may spark flash-backs to your own past experiences.
Avoid Fatigue, Practice Self-Care: Be sure you are getting enough sleep, eating a healthy diet, and
Call your office and use the code word to let them know you're in trouble if you can't call the
police.
Personal safety and the safety of others is paramount. ALWAYS TELL YOUR MANAGER IF
Observing an out-of-control person is frightening and may trigger your own "fight or flight"
response. Emotional containment is important so that proper procedures and protocols are
Always Be Alert
drug overdoses and motor vehicle accidents. Don't take a fall while you are working. Learn how to
protect yourself and your future ability to enjoy life and enjoy your caregiving job by being in good
health.
Ankle
Foot
Back
Shoulder
Hip
Head
Slip
o Too little friction or traction between feet or footwear and walking surface, resulting in loss
of balance
Trip
o Foot or lower leg hits an object and the upper body continues moving, resulting in loss of
balance
o Fall on the same level, fall into or against objects (fall against a stack of books that are on the
floor)
o Fall to a lower level, fall to below walking or working surface (fall from one step to the one
below)
Falling Properly- Is There Such a Thing? Yes!
fit as a caregiver.
Remember - All the Precautions were Created to Protect You and Keep You Healthy and
Smiling!
Recognizing emergencies and knowledge of emergency procedures, including basic first aid and
Natural Disasters
Natural disasters do occur and many times with short notice.
Natural Disasters Are Defined As the Following:
Hurricanes
Tornadoes
Earthquakes
Flash Floods
Wind Storms
Rain Storms
Forest Fires
Fires in the house are usually preventable and because of this are not considered a natural disaster.
Preventing household fires and how to respond safely are also part of emergency planning.
Think through what you would do for each of the possible natural disasters and if the home lost
electricity or experienced a fire or flood. If you are providing caregiving services at a facility such as
a nursing home or assisted living community, learn their disaster and emergency procedures. They
will have instructions available and notices on doors and exits for evacuation procedures. Know
where the flashlight and matches and candles are at a senior’s home.
Follow these steps when you begin to care for a senior in their home:
1. Home Assessment: Know the layout of the entire home, including the basement and
attic to be prepared for an emergency
2. Know where smoke and water can go
3. Power Failure—Have a Plan: Know where to find flashlights, batteries, candles, and
matches
4. Smoke and Fire Alarms: Check batteries monthly
5. Where Do You Go? If an evacuation were necessary for fire, hurricane, flood, wind-
storm, or tornado, know the evacuation plan
Always call the office of the home care agency first and know the evacuation plan and for immediate
Hurricanes: As hurricanes show up on weather radar, you will have a prior warning before a
hurricane will strike and time to prepare yourself and your client for this disaster. Many times areas
are evacuated prior to a hurricane and your company will provide guidance.
due to the weather conditions. A Tornado Warning means a tornado has been spotted and is in your
area. You should take cover immediately, going to a basement or tornado shelter if possible. Be sure
Earthquakes: Earthquakes usually happen without warning. While earthquakes are more common in
California, there is also the New Madrid fault line near the Mississippi river, causing earthquakes to
even occur in Illinois and Missouri. Know where to go for safety in the home when a sudden
Floods: Floods usually are predicted but be aware that flash-floods occur quickly. Find out if the
senior’s home is in a flood zone and know the evacuation procedure if you are in an area that
advance more quickly than you can imagine. Implement the emergency plan and take the necessary
Fire: As most fires can be prevented it is important to review fire safety tips.
1. Do not smoke while working.
2. Do not allow a senior client to smoke in the home, if possible. If they must smoke in
the home, make sure they only smoke while using an ashtray.
3. Do not allow them to smoke in bed or when oxygen is in use.
4. Check electrical cords to be sure they are not cracked or frayed.
5. Notice if light bulbs blink or seem to burn-out quickly. This could be a sign of an
electrical issue that should be reported.
6. Turn off and unplug electrical appliances when you are not using them.
7. Be cautious to turn off ovens and stoves when not in use—always check everything
twice.
8. Keep flammable items away from the stove, radiators, and reading lamps.
9. Do not use candles.
CANDLE DANGER: If candles must be used for a dinner celebration or birthday, be very aware of
the importance to extinguish them when you leave your work assignment as a senior may not
remember to do so. Seniors also may have lost their sense of smell, making it even more dangerous
to have candles in the home. Candles are one of the leading causes of fires. Be mindful to keep
candles away from flammable objects and burn them only for short time periods.
Fire Preparedness
Note: Fire Extinguishers should be in the senior’s home if you are doing senior home care. Make
sure the location of the fire extinguisher is known to you and make sure it works.
Who does what (call the family to help or will a back-up caregiver arrive?)
Make sure your employer provides you with an Emergency and Disaster Plan when you are hired.
Ask them to review it with you. If you work in an area that has had previous disasters such as
earthquakes, hurricanes, or tornadoes and has a high probability of these natural disasters happening
again, ask your senior care employer to share experiences and stories on how the previous natural
Watch Video on Tips for Making a Home Emergency Kit: 3 Minutes, 20 Seconds
Medications
Clothing
Food
Water
First aid means being the first to treat an emergency injury such as a cut finger or a twisted ankle
which just needs some basic “aid.” Thus the name, Basic First Aid.
Cuts: Clean with an antiseptic (alcohol or antiseptic wipe) and apply a bandage. Deep cuts should
have a butterfly wound closure applied (tape together) to link the torn skin.
cardiac arrest and involves chest compressions and exhalations into the person’s mouth. Training in
CPR should be taken if you are caring for someone with heart disease. Sometimes additional heart
defibrillator life vests or machines are maintained in the home of seniors with heart disease. Proper
Tip Sheet
Call 911 for Medical Emergencies, Personal Protective Equipment is also called PPE, Infections can
be Avoided by Washing Hands and Wearing Gloves, Oxygen cannot be Near a Flame, Household
Cleaning Products can be Chemical Hazards, Natural Disasters Include Earthquakes, Hurricanes,
Floods, Tornadoes, Emergency Preparedness Plan provides an Action Plan for How to Evacuate,
Where to Go, How to Help the Senior, Who to Call and Who Does What, Basic First Aid is Just That
Performance of personal care tasks for clients, including: bathing, skin care, hair care, mouth care,
dressing, feeding, toileting, medication reminding, and transfers, positioning, and exercise.
Personal Care
Just think of personal care as all the activities you do when you wake up each morning:
Toileting
Bathing
Caregivers assist seniors as they may have physical challenges or memory loss which require
assistance to keep their personal care on track for the day. They may also have difficulty with easily
moving and coordinating physical activities due to age-related illnesses and the natural aging
process.
Bathing
Skin Care
Hair Care
Eating
Feeding
Exercise
Positioning
Toileting
Medication Reminders
Bathing
Bathing is a very important part of proper hygiene and infection control.
It is also something that is very ingrained into us, a task which the person may have a very specific
way they prefer to bathe. It is also one of the most personal tasks we perform, and maintaining
If the person can still perform the task on their own, it is important to maintain dignity and allow the
person to do so. In this case your role may be running the bath water to the proper temperature,
setting out supplies and towels and helping the person into and out of the bath.
How often?
Bathing once or twice a week is all that may be needed to avoid skin breakdown and infections.
Purpose of Bathing
1. Cleans the skin
2. Eliminates odors
3. Refreshing and relaxing
4. Stimulates circulation throughout the body
Many older people do not require the same frequency of bathing as young, active people
Fever or other illness may cause a person to need more frequent bathing
General Guidelines
Assisting seniors with bathing first requires assessing the bathroom to make sure the necessary safety
items are in place, such as grab bars and floor mats and shower chairs. Understand the size of the
senior and obtain special instructions from the senior’s medical doctor or physical therapist for
special equipment needed if physical challenges are present. Seniors recovering from a stroke or hip
replacement, for instance, will receive physical therapy and advice on medical equipment for their
bathroom.
1. Water Temperature: Check to be sure the water is warm and not hot
2. Secure soap, washcloth and bathing utensils before the senior steps into a shower
or bathtub
3. Discuss how you will assist the senior in and out of the shower or bathtub
4. Discuss tasks senior can do themselves and promote their dignity by allowing them
to do so
5. Towels and bathrobe: be sure the senior immediately has a warm, dry towel and
clothing to put on
6. Non-slip mats and rugs: be sure the bathroom has non-skid and non-slip mats and
rugs
7. Be sure necessary grab-bars are installed
8. Men may find warm water prompts an erection—stay professional and either ignore
it or use light humor but be aware that this can happen
9. Seniors may sometimes refuse a shower or bath—call your Care Manager for
guidance
10. Reassure the senior throughout the bathing or showering process
Always Promote Comfort
Give a massage or backrub with warmed lotion (can heat tube of lotion in hot water bath)
Tub Bath
Make sure the water temperature is comfortable, not too hot or too cold.
Pay attention to skin folds, area breasts, underarms and anywhere dirt can hide.
Shower
Make sure the water temperature is comfortable before allowing the client to enter. The client
can either use grab bars in the shower to stay standing or use a shower chair.
Dry the clients' skin before helping them move from the shower.
Bag Baths
Occasionally you may use a bag bath in the home, possibly during end-of-life care. You will
probably follow the bed bath instructions later in this section and not use a bag bath, but you should
Bag baths come prepared with 8 to 10 washcloths in a plastic bag. The cloths already contain a
cleaning agent which does not require rinsing from the skin.
There are times when you will need to wash someone while they remain in bed. Maybe they don’t
feel well, maybe they are injured, maybe they are in the late stage of the disease.
Just like in other situations, bathing is still important to maintain proper hygiene. Not only will a bath
clean the skin to help prevent infection, but it helps the person stay relaxed.
As in other situations, let the person do for themselves if they are able. What tasks are they able to
perform to stay part of the process, think about it and help them feel empowered and in control.
If they cannot physically help but are able to communicate, talk them through the process and asked
Gather the items needed and make sure the items are close at hand.
Disposable gloves
Soap, lotion, deodorant, comb, hairbrush, mouth care supplies, nail supplies
Watch this video demonstrating the procedures for Bed Sponging an Elderly: 4 minutes, 48
seconds
Perineal Care
The perineum (pair-uh-nee-um) is the last area to be washed. Wear disposable gloves when washing
this area.
This area is also called the pubic area or genital area. It is the area between the thighs and includes
the genitals and anus. This part of the body should be washed every day. Washing the perineum
Always wash the perianal area with a fresh cloth. Remember to wash from front to back on females.
Gently wash a male's penis, testicles, and foreskin if not circumcised. Dry the perianal area well with
a towel.
This can be a delicate situation and cause embarrassment. Have you ever had a procedure done by a
physician where you felt uncomfortable? Oftentimes the physician may ask you about something
completely unrelated to the task to take your mind off the situation. Maybe you tell a story or talk
about something funny in the news. Your professionalism during the task and how you make the
person feel comfortable, is why the client and their family hired a professional. Think about how you
would feel in the same situation and help the person feel at ease.
Watch for the following and follow your company’s guidelines for reporting:
The person has shaking chills or his temperature is over 101 degrees F.
The person has skin that is red or sore. These may be areas where the skin is broken down or
getting infected and could be the start of a bed sore.
Sometimes you will care for a senior who no longer desires to keep up with their personal care habits
and maintain personal hygiene. This can happen because the senior is experiencing:
Memory loss
Depression
Physical challenges
Fear of falling
Nobody likes to be embarrassed because they can no longer easily maintain a daily function. Most
seniors also fear losing control over their daily activities and reminders of the natural aging process
happening to them. Perhaps they have heard about a neighbor or friend who no longer can live alone
after falling and breaking their hip. They will often resist bathing when they feel they cannot easily
Seniors with memory loss such as Alzheimer's disease also can become resistant to bathing. There
are ways to combat this by implementing a strategy and supporting them to overcome their fears.
Watch Video on Tips for Assisting Seniors who are Resistant to Bathing: 4 Minutes, 20 Seconds
Dressing Clients
A daily routine with your clients will very often include assisting with dressing your client.
Remember, senior clients will often have poor circulation and possibly lower body fat. They may
complain of being cold, even when you are warm. Your client may need a sweater in the summer
Have you ever seen a toddler in an amazing princess dress, complete with tiara and little heels at the
store? It is immediately evident the child took great pleasure in selecting their outfit and feels like a
million dollars. That “little princess” is in all of us—the need to feel like we are wearing what we
want, what we selected. We like how it looks; we like how it feels. Do not underestimate the need for
your client to select what they want to wear and the impact it has on their self-esteem.
Does your client want to wear a bra or camisole or undershirt? Does your client want to wear
minutes tying their shoes when you can do it in mere seconds. Be patient, monitor, and assist as
Some of your clients will need more assistance. You will know this from the Care Plan.
1. Wash your hands: As with any activity when you will be touching your client, it is necessary to
2. Gather necessary clothing: Remember, ask their input. As long as items are clean and
appropriate for the weather, let them dress how they wish.
3. Explain what you are going to do each step of the way: “Mrs. Smith this is the time you get
dressed every day. Do you know what you would like to wear?”
This all depends on their ability to communicate. You may offer the choice between a few shirts if
the person has mid-stage Alzheimer’s Disease. Or the client may know exactly what they want to
wear.
4. Provide privacy: Remember, your senior client grew up in a different era and may have a
completely different sense of privacy. As a caregiver, you may have seen “everything” and modesty
is not a big deal to you. For your client, the loss of privacy can be tough. Make sure you respect them
5. Provide assistive devices, per the Care Plan: Please reference the adaptive dressing devices later
in this section.
7. Dressing the bedbound: If the client is in bed, you can help them put on underclothes, stockings,
down)
1. Put both legs in pants; slide up to hips.
2. Have the client lift his hips and pull his pants up.
3. If the client is unable to lift his hips, turn to one side and slip pants over one hip, then
turn to the opposite side and pull pants over the other hip.
4. Zip the zipper and fasten snap or button).
5. If the client has a catheter, leave the fly open to allow for tubing then pin the fly shut.
6. If the client has a leg bag, make sure it is not visible when he is dressed.
Putting on a bra
1. Have the client slip arms through the shoulder straps.
2. Position the bra properly and fasten.
Putting on socks
1. Fold the stocking down from the opening to just beyond the heel.
2. Support the client’s ankle and slip folded stocking over the toes.
3. Position it over the heel and pull it up smoothly over the leg.
Putting on shoes—Remember, socks should ALWAYS be worn for comfort and safety
1. Always help the client put on shoes before standing up from bed to avoid slipping on
the floor.
2. Loosen laces and pull the tongue of the shoe forward and up.
3. Support the client’s ankle as you slide the toes, foot, and heel into the shoe.
4. NOTE: USE A SHOEHORN, IF AVAILABLE.
5. If possible, have the client stand and tie his shoelaces.
Putting on a shirt
1. Raise the head of the bed to a near sitting or assist the client into a sitting position on
side of the bed or into a chair at the bedside.
2. Assist or have the client put their weaker arm in the sleeve of the garment first while
there is more “give.”
3. Put the other arm in next.
Care also has to be taken to undress your client. Check the care plan to understand how much
assistance is needed.
1. Wash your hands: As with any activity when you will be touching your client, it is necessary to
2. Let the client know it is time to change. Instead of saying I am going to change your clothes, get
their agreement when possible. “Mrs. Smith, it is almost the usual time to get changed, are you
ready?” In later stages of dementia, you may have to say “Mrs. Smith it’s time to change into your
comfy clothes, so you can get a great night’s sleep and have a great day tomorrow.” In this instance,
you are telling Mrs. Smith a benefit to her for changing clothes. It all depends on your client’s
willingness.
3. Gather clothing: Remember, your client should decide what they are going to wear, if possible. If
changing to night clothes, “what do they want to wear?” It may be an easy choice, as all could be the
same, but it is still important to ask. “Mrs. Smith, you have 3 nightgowns in your drawer. Do you
4. Provide privacy.
6. Assist your client from the chair to the bed: If they are able, have the client sit on the side of the
Remove pants/underpants:
Have the client stand if able and pull their pants down their legs.
If the client is lying down, have him lift his hips up and slip his pants down over his buttocks.
If the client is unable to do this, roll the client towards you, slip pants down over the hip, then
return the client to the back, roll to the opposite side, and pull pants down over the other hip.
Remove bra
Hang clothes that can be used again without washing, like sweaters in closet.
These are conditions that can cause your clients to have difficulty dressing unassisted
Stroke
Parkinson’s Disease
ALS or MS
Injury
Rheumatoid Arthritis
Alzheimer’s Disease
Cancer
Other diseases
Pain mediation
There are many dressing aids that can help your client have more independence in dressing. There
are also clothing options that can help dress your client easier.
You may want to suggest some items if they are not currently being used. This is apparel specially
You can suggest pants that stretch or shirts that button open or zip open to allow for them to be put
on and removed easily. Elastic waistbands or adjustable waistbands can be comfortable and helpful
to encourage independence.
When clothes and shoes do not fit well, it can lead to injuries and falls. This is especially dangerous
when going up in shoe size, as feet normally only change in width due to swelling.
Adaptive Equipment:
Adaptive Belts: One-handed belts to help clients who had a stroke or injury on one side.
Extended Shoe-horns: Helps the clients to put on shoes without bending over.
Elastic Shoelaces: Inexpensive to switch out traditional shoelaces, plus they look good.
Sock Aids: Help by forming the sock in an open, rigid shape and the person can guide their
foot in.
Buttoning and Zipping Devices: Wide range of rings, pulls and grips for zippers and
buttons that help a person dress with ease. If there is a person who can do simple sewing,
button shirts can be switched out to close with velcro.
Reacher and Dressing Stick: Other devices which help in dressing.
Proper socks and shoes are important to reduce slips, trips, and falls. If your client does not want to
wear shoes, encourage slippers that fit securely and are non-skid, or non-kid socks. Shoes and socks
A compression bandage is a stretchable bandage that is used to wrap around a body part that has a
sprain or strain to put pressure on it which helps reduce the swelling and help make the injured area
feel better. It is often used in First Aid as a part of therapy that is known as RICE (rest, ice,
Applying a compression bandage is easy, just make sure you apply the right amount of pressure to
prevent swelling and help stabilize the injury. The bandage should be snug but not so tight to let the
blood flow.
only with a prescription from a health care professional or with applying a sequential compression
device that can be purchased only with a prescription from a health care professional unless the
The client's prescribing health care professional has issued an order allowing the home
service worker caregiver to apply the compression device as a part of daily activities of living
The client or client's representative shall be able to provide ongoing feedback to the home
services worker including indications of potential harm and discomfort and advocate for their
needs.
The home services worker caregiver shall have completed training in the application of the
compression device, including observations of indications of potential harm or discomfort
and completes a competency exam.
Do's
The compression bandage should only be used in the first 24 to 48 hours after an Injury.
You must combine rest and elevation with compression whenever possible.
Remove the bandage at least twice a day for a few minutes before placing it back again.
Ask the doctor if the senior need to wear the bandage at night. If so, loosen it slightly before
bedtime.
Don'ts:
Applying ice and compression at the same time can cause frostbite, so please don't.
Don't wrap the bandage too tightly. This can cut off blood circulation.
Don't use a compression bandage to prevent re-injury. The bandages can help stabilize joints,
but they neither support nor protect them.
As people age, various causes can affect the brain and its thinking processes.
It can be caused by dementia or Alzheimer’s Disease or could be a completely different cause, like
Be non-confrontational
This allows your client to give their reasoning instead of, “You’ve been wearing that outfit for days!
It may not be such a big deal if they only change clothing every couple of days, especially if
they’re content in them.
If proper hygiene is an issue, like the outfit is visibly dirty, has an odor or is ragged, then
there is cause to help persuade your client to rotate their clothing more often.
Use their input to make a clothing schedule, if they are up for it, be creative (Floral Friday,
Striped Saturday, or items to match the time of year, like a Pumpkin sweater in the fall.)
Encourage them to buy doubles or triples of favorite items, so one item can be washed while
the other is worn.
Having extras of bras, underwear, and socks can encourage them to be bought in the same
color and style so they all are the same.
Promote laundry day: “Mrs. Smith, today is laundry day, all of your clothes will be clean and
fresh for next week.” It is positive and you’ve promoted it in a favorable light. Involve your
client in the laundry, maybe they can help you sort like colors or fold the clothes and put
them away with your assistance.
Place the clothes for the next dressing on a chair. Have the client help pick out the clothes
ahead of time. Oftentimes your client will be more alert and willing in the morning, so you
can use that time to select items. “Mrs. Smith, I see it is time for you to change for the
evening. You did a great job picking out your comfy night clothes this morning.” Now the
senior is tired and it is one less thing they have to think about.
Person-Centered Assistance
Assist the seniors in getting dressed each day based on their needs. Realize that getting dressed for
the day is part of a healthy daily routine. If a senior does not want to get dressed, this could be a sign
of depression or indicate they are not feeling well and you should explore why they are not in the
mood to get dressed. Assist the senior with choosing their outfits, if this is needed. If a senior has
physical limitations and needs help with dressing, discuss how you will be tackling the task ahead of
time so that everyone will be comfortable. Remember to keep a sense of humor and to respect the
senior’s dignity.
Layout the clothes in the right sequence and focus the attention on the next step
Demonstrate what comes next and make dressing one of the main activities each day
Try buying similar underwear and exchange it discreetly if changing underwear becomes a
problem
Buy easy-to-put-on shoes that are non-slip and comfortable and can be put on and taken off
easily (perhaps a velcro closure)
Don't use belts or other accessories which just get in the way
Tip Sheet
Bathroom Safety Equipment Includes Grab Bars, Shower Chair, and No-Skid Rugs, May use a bag
bath in the home during the end-of-life care, Make sure to prepare every item needed to use when
Sponge bathing (Bed Bathing), Perineum is the last area to be washed, Encourage independence to
Skincare becomes more vital when a senior becomes bedridden. The aging process causes the skin to
lose elasticity and become what we call “wrinkled” and thinner and more susceptible to bruising. In
addition, dryness can also be a challenge. Avoid bed sores and maintain healthy skincare by doing
the following:
Use disposable bed pads to wick away dampness and keep skin dry
Use pillows, gel cushions, water cushions or foam wedges to help reposition the body when a
senior must remain in bed or chair
Investigate using plush sheep rugs or a foam egg-crate mattress which can spread weight over
a larger skin area
Encourage appropriate exercise to stimulate circulation or assist with moving the arms and
legs if the senior cannot do so on their own
Avoid Moisture: Dampness or thick layers of lotions or general wetness can promote the
formation of pressure sores
Friction can cause a pressure sore on aging skin — avoid sliding, moving or sitting on a hard
surface
Rashes or skin irritations may cause a break in the skin and promote pressure sores — mind
these closely to prevent a pressure sore from forming
Just remember skin becomes delicate, just like you must be careful when handling an object you
don't want to drop and break, you must be very careful when caring for a senior's skin.
A home services caregiver MAY apply a simple bandage as first aid ONLY when:
Skin is unbroken
You can tell when a person has a problem with their skin as it will turn pale, white, red, or even
purple in some areas. The person may also get blisters or bruises. Complaints of tingling, warmth, or
Swelling
Broken skin
Changes in moistness/dryness
Hair Care
Seniors experience the natural aging process with hair care which includes hair loss or natural hair
Hair Salon or Barber Shop Visit: Try to facilitate visiting a hair salon or barber as long as the
senior is able to leave their home as this establishes a feeling of inclusion in social life and
also can be a fun activity
Maintain all facial hair care (waxing and tweezing by professionals if the senior cannot
maintain facial hair upkeep themselves)
Note: Discuss bringing a hair-care professional to the home for cuts, styles, and waxing if the senior
cannot easily go to the salon or barber. Our hair texture, color, and thickness changes as a natural part
of the aging process. Each person has to decide how to manage these changes. Haircare experts can
Shaving
Refer to the Care Plan for the senior’s shaving routine. If the seniors can shave themselves, this is
preferable, as they are able to maintain their dignity and a life-long routine. However, the caregiver
should monitor the senior before and after shaving and assist the process to go smoothly.
Age causes thinning of the skin and dryness which can complicate the shaving process. To prevent
Apply enough shaving foam on the area and spread thoroughly. Make sure to use the
appropriate shaving foam as there are special ones for sensitive skin, depending on the
client's needs.
Always use sharp and quality blades. Make sure they are cleaned and regularly changed.
Nail Care
Maintain healthy nails with the cleaning of hands and fingernails. Caregivers may assist with nail
maintenance including filing nails for clients with a medical condition ONLY when the client's
healthcare provider issued an order allowing the filing of nails. But caregivers are not manicurists
and should coach the seniors to keep their nails trimmed. Encourage a weekly nail care routine.
Volunteer to help with a manicure but avoid nail scissors or cuticle care which must be left to a
licensed nail professional. As we age, both fingernails and toenails become thicker and may require a
Mouth Care
Gum disease is linked to many health problems, such as heart attack, stroke, and diabetes.
Brush teeth after every meal, at the very minimum after breakfast and last thing before bed
If the client has experienced a stroke, be sure to check the side of the mouth affected by the
stroke, food tends to gather in that area. Gently wipe out the mouth with a soft cloth.
The outer enamel layer can thin over time and can allow yellower dentin to show through. It can also
Dry mouth
Reduced saliva flow can be caused by cancer treatment and some medications
Loss of taste
Root decay
Gum tissue recedes and the roots of the teeth are exposed and can cause sensitivity.
Gum disease
Generally caused by plaque and made worse by food stuck in teeth, use of tobacco, poor-fitting
Tooth loss
Thrush
Diseases or drugs that affect the immune system can cause an overgrowth of fungus Candida albicans
Age is not a dominant or leading factor in determining a person’s oral health, but conditions like
arthritis in the hands or fingers can make brushing or flossing very difficult.
Use a towel to protect the person’s clothing and for wiping the mouth
Good light is helpful—a camping head-light will keep your hands free and allow you to see
inside the mouth
How to brush
1. Encourage the person to relax their lips and cheeks
2. Introduce the toothbrush at the corner of the mouth
3. Start on the gum line
4. Brush one or 2 teeth at a time in small, gentle circles
5. Clean all surfaces of the teeth, outside, inside, and chewing surfaces
6. Gently brush inside the cheeks, gums, and under the tongue
7. Have the person spit out any toothpaste left in the mouth
8. Provide a glass of water for rinsing
Tips
If the person has trouble holding the toothbrush, use a strap, the same one used to help a
person hold a fork or spoon
You may be able to create a holder with a rubber band or elastic, make sure it isn’t too tight.
Some people use a racquetball or piece of a pool noodle to make a bigger handle.
There are many options for power toothbrushes now, and they may be more effective and do
the work for the client.
Try “tell-show-do” Tell what you are going to do, show what you are going to do, then do the
procedure.
If the person you care for cannot floss their own teeth, it is important you help floss. Flossing is very
Have the person get in a comfortable position. One of the best positions for flossing is to have the
person lie down on the bed or reclined in a recliner, while you sit alongside. Think of how your
dentist or hygienist positions themselves while you are in the dentist's chair, try to repeat the same
How to floss
1. Begin by putting on disposable gloves
2. Use a string of floss about 2 feet long. Wrap that piece around the middle finger of
each hand
3. Grip the floss between the thumb and index finger of each hand
4. Start on the bottom teeth and work from one side to the other, then repeat on the
upper teeth
5. Make sure to ease the floss gently between the teeth until it reaches the gumline,
don’t snap or force the floss into place
6. Curve the floss like the letter “c” around each tooth, keeping in contact with the side
of the tooth
7. Slide the floss up, down, and under the gum
8. Repeat for every tooth, one side at a time
9. Adjust the floss as you move, so you have clean floss
Special dental care needs should be included in the senior’s care plan. Denture care will have a plan
of action for cleaning to follow. Regular teeth cleaning includes brushing the teeth after meals and
after waking each morning and before retiring to bed. Some seniors will experience challenges with
bad breath due to their own loss of smell and because of medications or certain digestive issues.
Assist the senior to obtain a mouthwash and mints to maintain fresh breath throughout the day.
Remember, our sense of smell changes as we age too. This is why it can be easier for a senior to have
bad breath or spray on too much cologne—they simply are not able to smell as well anymore.
Provide kind feedback to them to know if there is an unpleasant odor or perhaps too much of a good
thing.
Assist to make sure the hearing device is properly placed in the ear
Replace batteries
Tip Sheet
Comb or Brush Hair Daily, Monitor Shaving if Client can Do This Themselves, Nails Become
Thicker as We Age, Use Soft Toothbrushes for Sensitive Gums, Not All Hearing Aids Are Alike
the bowels and urinary tract may lose functionality. Diseases, medications, and loss of physical
capabilities from a stroke, hip replacement, or heart surgery can all cause changes to toileting needs.
Catheter Care
Usually, you will just need to empty the container the catheter empties into
One of the ways to successfully discuss this challenge is to put yourself in their shoes and tell
the senior you know it is a challenge and that you want their feedback on how to make the
process go smoothly
Discuss the schedule for the catheter care and ask them if they would like you to check it at
certain times throughout the day.
Incontinence Care
Loss of bladder and bowel control are not normal parts of aging. However, women who have had
children are very likely to have a loss of bladder control eventually. Medical solutions exist for loss
of bladder control and bowel control and as a caregiver, you should discuss the situation with the
Adult diapers are one solution that can be used if more advanced medical solutions or retraining
programs are not performed. Today's adult diapers use modern technology and come in many shapes
Pee-Proof Underwear: these are also now available, in all shapes and sizes and even younger
people are wearing these for protection. Share with seniors that people of all ages are now wearing
Also, discuss bedtime solutions such as special bed sheets or bed pads.
Remember, a regular eating and drinking schedule will result in regular times for elimination
Watch Video on How to Apply and Change Adult Diapers: 1 Minute, 45 Seconds
Constipation
Inactivity and medications can contribute to constipation. There are both natural remedies as well as
medications that can help “loosen” the situation! Discuss the following with the senior and make sure
Stool Softeners
Drink More Water: a full glass of water upon waking and throughout the day
Call the doctor if bowels aren’t “moving” regularly — daily bowel movements are a sign of a
healthy digestive system.
The discomfort of bowel and bladder conditions have the added complication of bringing social
embarrassment. Caregiving includes showing compassion and understanding, along with assisting
1. If the problem has come on suddenly, the person should see their health care provider. It may be
Take the person to the toilet at times close to when they find themselves wetting.
Keep track of the time the person urinated to help determine a schedule
2. If the person suddenly CAN’T pass urine, call the office. THIS COULD BECOME A MEDICAL
EMERGENCY.
Antidepressants
Parkinson’s tablets
Sleeping tablets
Constipation medicine
2. Look for causes such as food poisoning, or eating different foods from usual.
3. When possible, to prevent this from happening again, try to remove or avoid these foods.
4. Stress can bring on diarrhea. Is the person anxious or worried about something?
5. Check for new medications, to find out if that may be the cause.
Use a cream to protect the person’s skin, the same ones that are used for diaper rash. Bowel motions
and extra wiping can make skin red and sore very quickly.
If possible, have a commode chair handy for the person you are caring for.
Antidepressants
Sleeping tablets
Parkinson’s tablets
Anti-inflammatory tablets
Strong painkillers
Laxatives/aperients
Fluid tablets
Dispose of used pads by wrapping in a plastic bag and placing in your garbage bin for
disposal
For clothing and linen, set up a soaker bucket with water and soaking solution
It is important to think about safety, so once you have soaked the clothing or bedding
overnight the bucket can be emptied into the washing machine
Plastic-backed disposable pads can be used around the chairs and beds to protect carpet and
rugs
This helps to soften the stools and improve bowel health and also add fluid to the body.
If the person you are caring for has constipation or diarrhea it may be helpful to look at the amount of
Too little fiber can make the stools hard and dry. Too much can make the stools soft and runny.
It is important for people with incontinence to remain well hydrated, so unless you have been advised
differently you need to provide the person you are caring for with between 6 to 8 cups of fluid every
day, including:
o Water
o Fruit juice
Water is your body's principal chemical component and makes up about 60 percent of your body
Every cell, tissue, and organ in your body needs water to work properly. For example, water:
Lack of water can lead to dehydration — a condition that occurs when you don't have enough water
in your body to carry out normal functions. Even mild dehydration can drain your energy and make
you tired.
DO NOT RESTRICT FLUIDS unless advised by a physician.
Take care with caffeinated and alcoholic drinks, such as coffee, tea or cola as these make the bladder
Alcoholic drinks and some medicines make the body produce more urine, so the bladder fills faster
than normal, which means that it may need to pass urine more often. It may also mean there is less
Mobility
People who live with incontinence may be unable to get to the toilet in time because they have
It may be that if the person can reach the toilet in time, they are no longer incontinent.
The Bladder:
Many people believe that drinking water may increase the risk of wetting themselves, so they refuse
While this belief is understandable, it is not the whole picture. In fact, not drinking enough water will
The normal, healthy bladder can comfortably hold 1 ½ - 2 cups during the day and 4 cups at night. It
A healthy adult will only pass urine up to six times in the day and up to twice overnight. More than
It's common for seniors with incontinence issues to become dehydrated, sometimes so severely that
Have you ever felt you had to go pee after you just went?
o High temperature
o Strong-smelling urine
o Confusion
Seniors may not have all of these signs. Instead, they may just have a sudden onset of incontinence or
They may also be tired with less energy than usual and may not be able to tell you how they feel.
When prescribed antibiotics for a UTI, it is very important that the patient finished the full course of
antibiotics. If the antibiotics are stopped before the whole course is completed, the infection may
return. When a person is taking antibiotics to help them recover from a UTI, it is important to
remember that they need to drink more fluids than usual which may help flush germs from the
REMEMBER: Wipe from the front of the body to the back — remind your senior clients to do this!
The bowel: The best way to keep your bowel healthy is to avoid constipation and have regular bowel
movements. Bowel regularity varies depending on the person. Fluids and fiber keep the bowel
healthy- it needs sufficient fluids, good fiber, and some exercise daily
Encourage the person to drink more water-based fluids (e.g. fruit juice, mineral water).
Encourage a minimum of three servings of vegetables and two serves of fruit daily.
Fruit can be fresh, preserved or stewed. It is important to mix different fibers from fruit,
vegetables, whole grain cereals, bread and products such as kidney beans, lentils, and butter
beans.
Train the bowel to pass a motion about 30 minutes after breakfast or lunch.
Encourage the person you care for to walk whenever they can, even if it is for a short
distance
Bowel problems
Constipation
Constipation occurs when the stools become dry and hard. This can make the bowel movement slow
and difficult to pass through the colon. The normal frequency of bowel movements in adults is
between three per day and three per week. Less than 3 bowel movements per week is normally
considered constipation.
The person for whom you are caring may have fewer bowel movements than usual and start straining
to pass these dry hard motions. People who have trouble with constipation may not feel hungry or
The constant straining may also lead to the start of a condition called piles or hemorrhoids.
Some medications
Long-term illness
Fecal incontinence: losing control of the bowels is called fecal incontinence or diarrhea. Diarrhea is
when bowel motions are loose and watery. The bowel motions feel urgent, are difficult to control and
If it is difficult to get the person you are caring for to the toilet or you have difficulty undoing their
Wash the person’s buttocks and between their legs after each bowel motion with warm soap
and water.
Settle the stomach- Certain food and drinks can make diarrhea worse.
Avoid milk-based drinks, spicy foods, caffeinated drinks, and alcohol, which can irritate the
bowel further.
Prevent the spread of infection-remember that if the person you are caring for has an
infection that is causing diarrhea, you need to avoid
Wash your hands after assisting with toileting or handling soiled garments.
Wash the person’s hands including between the fingers and scrub their fingernails after using
the toilet.
Prevent dehydration
Keeping track of a person’s bowel movements can be useful for a short time to help you know when
The Prostate
Men can have continence problems because of the enlargement of the prostate gland. Prostate
enlargement is part of the normal aging process. This may not necessarily mean cancer or cause
problems.
They should seek medical attention if these signs happen to a man you care for and they should take
a urine sample or be prepared to give a urine sample at the visit. It may not be a prostate problem but
it needs to be investigated.
Washable chair pads are designed to protect furnishings. They only have a small absorbency,
but do have a waterproof backing. They are not designed to be used alone; the person still
needs to wear a pad.
Absorbent bed sheets have a stay-dry surface and a thick absorbent underlayer. They must be
used over a waterproof undersheet (unless there is one already on the back) to protect the
mattress. They are highly absorbent, have a stay-dry surface that helps protect the skin,
require less need to change the bed during the night, and may be laundered at home.
In an older person with dementia, incontinence may become more of a problem as the person:
Becomes more prone to bowel changes such as diarrhea or constipation from medication side
effects
The burden for the caregiver may increase if confusion and memory loss leads to the person resisting
Bathroom:
If there is limited room in the toilet for a second person to assist, have the door adjusted to
open outwards.
Make sure the way to the toilet is clear, remove all clutter and loose mats from the bedrooms,
hallways, and bathrooms
o Small ‘night lights’ that plug into a socket or sensor lights are useful for directing the
way.
o There are affordable motion-activated, battery operated lights available that have a
For someone with dementia, place a picture of a toilet on the door. This will help the person
to remember the toilet and find their way there. It is important to keep the sign within their
line of vision, so place it at chest height.
Grab rails mounted on the toilet wall or a toilet surround or toilet seat will help to get on and
off the toilet.
Wipe up any spills to prevent slipping or falling. Keep cleaning supplies and disinfectant
handy.
Bedroom
Protect the bed with an absorbent bed sheet.
If possible, move the person to a bedroom nearer to the toilet. In the living room (Some men
with mental health problems prefer to urinate outside).
Give free access to the toilet by making sure you remove all clutter from doorways and along
the passageway to the toilet.
Arrange the living room furniture to allow free access from a favorite chair to the doorway.
Keep a bedpan nearby in case of emergencies. Make sure it gets washed and disinfected
regularly to prevent odors.
Tip Sheet
Seniors May Need Assistance with Eating, Make Sure the Senior is Getting Enough Fluids, Practice
Safety and Respect When Assisting with Toileting, Medications May Affect the Bowel, Keep
prevent them and the additional discomfort, pain and infection risks by properly positioning and
moving a bedridden patient. Bedsores can lead to infections such as meningitis, cellulitis,
Shoulder Blades
Tailbone
Elbows
Heels
Hips
These areas of the body have less fat, allowing for the pressure of the bones against the bedding to
develop sores from the weight of supporting the body. Just like a shelf will eventually fall if you
stack too many books upon it, the same thing happens to your body if you are in the same position
ongoing.
When the body doesn’t get any movement, it can reduce blood flow to the skin, depriving it of
nutrients and oxygen. If your patient is currently on bed rest, there are several things you can do to
prevent bedsores.
1. Change positions frequently: When you change positions often, there will be less
pressure on your skin, reducing the risk of developing pressure ulcers. It is a good
idea to reposition the body at least every couple of hours. For example, if they’ve
been lying on their back for a while, turn them to their side.
2. Keep skin clean and dry: The cleaner and drier the skin is, the less likely it will
develop bedsores. Dip a cloth in a bucket of warm water and mild soap and clean
the skin with it. Then, pat the skin dry with a towel. If you rub too hard, it can lead to
skin irritation. Older adults often have delicate skin, so press gently.
3. Use pillows: Another effective way to prevent bedsores is to put pillows between
parts of the body that press against each other. Place a pillow under the tailbone,
shoulders, heels and elbows. If they are lying on their side, it is better to put the
pillow between the knees and ankles.
4. Exercise: When you can’t even get out of bed, the idea of exercise seems daunting.
However, performing a few range of motion exercises in bed can help reduce the risk
of bedsores.
illness or recovering from a medical condition. Making sure they are repositioned regularly and
managing skin care and muscle movement are vital to both maintain comfort and prevent bedsores.
Pillows: Use soft, yet firm pillows or foam rollers or wedges to position legs and arms
Egg Crate Mattress
Pressure Points: Be aware of where the majority of the weight of the body rests on the bed, and
where bones are resting with the body weight. Elbows, hands, buttocks, feet and face. Reposition
from one side to the other side and use pillows and rolled towels, rolled blankets or foam wedges to
reposition. Try to assist the person to sit up in bed, if possible, and then move from one side to the
other. Monitor skin to be sure no redness develops, which indicates the beginning of a bedsore.
Repositioning in Bed
Pulling a patient up in bed
A patient's body may slowly slide when the person is in bed for a long time. The person may ask to
be moved up higher for comfort or may need to be moved up so a health care provider can do an
exam.
You must move or pull someone up in bed the right way to avoid injuring the patient's shoulders and
skin. Using the right method will also help protect your back.
Friction from rubbing can scrape or tear the person's skin. Common areas at risk for friction are the
Never move patients up by grabbing them under their arms and pulling. This can injure their
shoulders.
out of a bed sheet folded in half. Follow these steps to prepare the patient:
Pulling up
The goal is to pull, not lift, the patient toward the head of the bed. The 2 people moving the patient
should stand on opposite sides of the bed. To pull the person up both people should:
1. Grab the slide sheet or draw sheet on either side. If using a slide sheet, remove it
when you are done.
Watch Video on Moving Toward the Head of the Bed: 3 Minutes, 3 Seconds
Turning a Patient:
Preparing the Patient
1. Explain to the patient what you are planning to do so the person knows what to
expect. Encourage the person to help you if possible.
2. Stand on the side of the bed the patient will be turning towards and lower the bed rail
(if present).
3. Ask the patient to look towards you. This will be the direction in which the person is
turning.
4. Move the patient to the center of the bed so the person is not at risk of rolling out of
the bed.
5. The patient's bottom arm should be stretched towards you. Place the person's top
arm across the chest.
6. Cross the patient's upper ankle over the bottom ankle.
If you are turning the patient onto the stomach, make sure the person's bottom hand is above the head
first.
Turning
1. If you can, raise the bed to a level that reduces back strain for you. Make the bed
flat.
2. Get as close to the person as you can.
3. Place one of your hands on the patient's shoulder and your other hand on the hip.
4. Standing with one foot ahead of the other, shift your weight to your front foot as you
gently pull the patient's shoulder toward you. Then shift your weight to your back foot
as you gently pull the person's hip toward you.
You may need to repeat steps 3 and 4 until the patient is in the right position.
Exercise assists in preventing problems that can arise when someone is immobile.
Caregivers should monitor for constipation, swelling of joints, poor appetite, poor sleep, and
breathing issues.
CHECK with CARE MANAGER to CONFIRM SAFE EXERCISES APPROVED by DOCTOR
Make it Fun
Move Legs Up and Down, Side-to-Side, Bend Knees and Straighten Knees
Do Bed-Sit-ups, if Possible
Remember that exercising daily also assists with mental health, even if the exercises are performed
by the caregiving moving and repositioning the bedridden person's limbs and only involve minimal
Tip Sheet
Bedsores or pressure ulcers develop when there is too much pressure on the skin. Sores can cause
pain and discomfort, but also infection, even meningitis. Repositioning the patient in bed can reduce
or eliminate the occurrance of bedsores. Exercise can be beneficial for bedridden clients.
IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.
Prevention
Safe Transfers with Adaptive Equipment and Ambulation
Assistance with Ambulation
Understand the senior’s walking limitations. Always be near a senior when they are walking and if
they need a cane or walker, use the guard method of maintaining an arm near their waist or under
their arm and shoulder. Always be next to a senior with ambulatory challenges in order to be able to
block a fall.
Beware of Balance
Remember, balance issues can happen from changes in the inner ear canal and even a senior with
strong and healthy legs may lose their balance more easily as part of the aging process. Always stay
near a senior you are caring for when they are walking.
Exercise
Physical exercise should be part of everyone’s routine at every age. Develop a healthy exercise
routine you can do with the senior. Walking, leg lifts, arm lifts, and dancing may all be options. An
exercise routine should be included in the senior’s care plan. The National Institute of Health (NIH)
also offers a booklet on senior exercises. Muscle mass loss will progress if a senior does not use their
muscles. Especially if there has been a hip or knee replacement, exercise is vital to maintain the
Positioning
Being in a comfortable position in a bed or chair can be a welcome pleasure for a senior who may be
struggling with age-related diseases. Discuss what position the senior prefers while sitting or sleeping
and honor this. You will assist some seniors who have slept in a reclining chair for their naps for 20
years and this is what they prefer, rather than a bed. By understanding how the senior finds comfort
EVERY 2 HOURS, if the senior is bedridden or has memory loss and may not be aware of the need
to reposition.
Ability to assist in the use of specific adaptive equipment, such as a mechanical lifting device, when
Bending at the knees allows your buttock muscles and thighs to do the work for you. Always bend
A physical therapist or occupational therapist should diagnose necessary transfer equipment and
provide training for the senior and caregiver. If a senior’s condition changes while you are caring for
them and they begin to need more assistance with transfers, be aware that the following devices and
1. Back Belts
2. Gait Belts
3. Roller Boards
4. Slide Boards
5. Drawsheets
6. Trapeze
7. Mechanical Lifts
Proper training in using each of the devices is required, by a Care Manager or therapist.
Talk Your Senior Client Through the Process: Remember, for a senior, fear of falling can make
them extra anxious about a transfer. Be sure to make the senior feel at ease and confident in your
ability to transfer them. Be sure you are feeling well and understand how to use the transfer
equipment. If you have any doubts, don’t do the transfer alone. Call your Care Manager. Better safe
than sorry.
Helping a client move from a bed to a chair may be simple or difficult, depending on the size of the
client, the type of chair and bed, and the client's medical condition.
Consider these factors and think about how to plan for them when you are assisting the client to
transfer:
How well can the client move their legs and arms?
Is the client "connected" to medical devices such as a catheter bag or leg brace?
Can the client support their own weight without a walker or cane (stand by themselves)?
Be careful to perform safe transfers based on what is required for the size and capabilities of the
senior.
Guard and assist when walking: Drape your arm under the senior’s arm and around their
opposite shoulder when escorting for safe ambulation
Gait Belt: Use to assist with transfer from bed to chair and toilet and back
Transfer from Bed to Edge-of-Bed: Take another folded flat sheet (drawsheet), position
under the senior from their neck to calves, roll the senior to one side, place the sheet under
them, then use the sheet to pull the senior to the edge of the bed. Then swing their legs to the
side of the bed to proceed with the transfer.
Transfer from Bed to Wheelchair or Toilet: Use the gait belt and stay near the senior’s
body
Decide Upon a 1-Person or 2-Person Transfer. If you feel you could not help the client to stand and
prevent them from falling by yourself, then choose the 2-person transfer.
NOTE: All of us have nerves under our armpits and while it seems to make a lot of sense to grab
someone under their armpits when transferring them, this can be very uncomfortable for the client
and can pinch a nerve and cause them to lose balance. It is important to support the client by holding
Using a Drawsheet
Drawsheets are a safe way to assist a client to move up in bed or to transfer them from bed to
Drawsheets can be made from a regular flat bed sheet: fold the sheet in half from top to
bottom and place the folded sheet on the bed with the fold toward the head of the bed.
Carefully slide a drawsheet under a client by rolling them to one side or lifting their legs and
arms to pull the slide the sheet under them.
Two people may stand on each side of the bed and roll the edges of the drawsheet up as close
as possible to the client's body in order to use them as handles to then pull the person's body
up in bed or reposition their body for a transfer.
Using a Gait Belt
The gait belt allows caregivers to assist clients who have difficulty walking or who are recovering
Gait belts allow caregivers to more securely guide and support a client and are long canvas straps
Place the gait belt around the client's waist and tighten the loop buckle to be comfortable yet
secure
Hold onto the gait belt while the client is transferring from a bed to chair (for clients able to
support themselves this serves as a safety net if they should lose their balance or strength)
Use the gait belt to help steady a client when they are walking
Always communicate with your client to know when they are ready to walk or move in order
to be ready to support them with the gait belt
Follow the same system each time you transfer your client and they will learn the routine. By
knowing what to expect, your client will become more comfortable with the process. Be consistent!
Fall Prevention
Growing older will naturally impact some of our capabilities and eventually, the "Oldest Old" (80+)
will sometimes fall. Certainly, there are trips and slips, but the elderly can also fall because their
65% of seniors older than age 60 will experience dizziness or loss of balance, sometimes on a
daily basis.
Some level of imbalance will be present with all older adults. As part of the aging process, we may
lose:
Muscle Strength
Joint Flexibility
Vestibular System Function in the Inner Ear which Monitors Motion and Provides
Orientation Clues
Why? Something called "Functional Degradation" begins to happen in the body.
This means falls will happen because the body can no longer react quickly, and is called "Sensory
Degradation." Even if the senior wants to slow down and react quickly when their foot hits a
slippery surface, they may simply not be able to react quickly enough because of the body's
Think of your body as a computer. By the time you are over age 60, you are operating on an older
computer system that cannot process information as quickly as it could when it was new.
Understanding the body's loss of the ability to respond as quickly as a teenager, helps you to
understand that the best way to prevent falls will simply be to make sure the senior does not place
Use these guidelines to assist in making sure seniors you care for avoid being in a situation where
Managing Falls
Risk of falls will always be present when you are assisting a senior with care needs. Follow these
guidelines:
Assisted Falls — These are falls where the client begins to fall but the impact of the fall is
lessened either because the caregiver is able to hold the client, or the client breaks the impact
of the fall by holding onto something. In these cases, if there is no obvious injury, the
caregiver should make the client comfortable and ask if they have any type of injury or pain.
The caregiver should then contact the emergency contact person listed on the Care Plan (or
follow their company guidelines for whom to call for an emergency), and explain what has
taken place and ask if they would like anything further done. This discussion will determine
what further action, if any, should be taken.
Witnessed Falls — These are falls the caregiver observes when the fall is not broken in any
way and the client directly falls to the floor or ground. These types of falls can result in
serious injuries including internal bleeding, fractures, and dislocations. In this type of
incident, the caregiver should reassure the client that help will be on the way and determine if
and where the client has pain. The client should not be moved, and 911 and your Care
Manager should be contacted and advised of the fall and the location of the client. The Care
Manager will manage the next steps and an incident report.
Unwitnessed Falls — These are falls where it is discovered that a client has fallen but the fall
has not been observed by the caregiver or anyone else in the area. In these cases, 911 should
be called and the client comforted until their arrival. The Emergency Medical Technicians
will determine the next course of action. These types of falls require the Care Manager to be
contacted.
Remember that when someone falls, in addition to bruises and broken bones, internal damage may
happen.
Fall Danger Zones
Be aware that it can be easier to fall in situations that require better footing, simply because the older
Hold on to railings when walking up and down stairs, avoid walking on icy sidewalks and streets
(coach seniors to stay home when there can be slippery snow and icy weather conditions, as a fall can
More than 10,000 people die because of a fall injury every year.
The Centers for Disease Control and Prevention reports 1 million Americans are injured and
Tip Sheet
Bend Knees and Use Wide Stance for Safe Lifting, Communicate Transfer Game-plan, Receive
Nutrition is defined as the process of providing or obtaining the food necessary for body health.
Safe Food Handling ensures seniors will receive the proper nutrition and protect them from diseases
and infections.
As many as 1 in 6 Americans will come down with an illness from food-borne
microorganisms each year reports the CDC. This means everyone should learn safe food handling
Always take the time to think through all aspects of the food you will be eating or providing to
others.
Watch this video from the Center for Disease Control on Food and Kitchen Safety Watch
Video: 2 Minutes
What is Metabolism?
Metabolism is the process by which your body converts what you eat and drink into energy. Calories
from food and drinks are mixed with oxygen to release the energy your body needs to function.
Metabolism includes all the activities your body does to turn food into energy and keep you feeling
good. Think of how you toss wood in the fireplace to keep the fire burning. When the fire burns
brightly, the room warms up and absorbs the heat energy produced by the logs. Your body does the
A campfire, or fireplace in the home, will quickly burn dry wood or small twigs and newspapers but
Muscle cells require more energy than fat cells and the more active you are,
the more energy you need.
This is what it means to "burn calories" by staying active. Going for a walk, a run, doing situps, or
lifting weights burns calories. Just like a car will operate better when it has the right gas and oil and
regular service visits, you will be able to feel better and provide care services better when you are
As we age we are typically less active and lose muscle mass. Due to these changes, people require
fewer calories. As you age, your body does need the same amount of protein, vitamins, and minerals,
or nutrient-rich foods. And your body needs more of certain vitamins. A nutrient-rich diet is very
The National Policy and Resource Center on Nutrition and Aging from Florida University
reports that:
Men aged 50 to 70 need approximately 2,200 calories per day
Women aged 50 to 70 require 1,980 calories per day.
The calories required after age 70 will lower slightly if the person is living a more sedentary life
(mean sitting most of the day). The U.S. Department of Agriculture defines a sedentary lifestyle as
Walking briskly for more than 3 miles a day is considered active. A person needs more or fewer
Protein
Fiber
Fruits, vegetables, legumes (beans, lentils), nuts, and seeds are all foods that deliver fiber.
Fiber moves quickly and easily through your digestive tract and helps it function properly. It keeps it
A high-fiber diet can also help reduce the risk of obesity, heart disease, and diabetes.
Drink Fluids
Drinking plenty of fluids when eating a high-fiber diet will help your digestive system process
everything.
Breakfast cereals with added vitamins are one way to make sure you are eating enough of the B-
Watch this video on Promoting Healthy Aging through Nutrition 5 Minutes, 43 Seconds
Learn and Understand Doctor Suggested Nutrition and Meals for your
Senior Clients
Always follow the Senior's Care Plan for Meals and Aim for a Balanced Plate
Make notes in the Care Plan and call the Care Manager to discuss if there are issues with eating
certain foods. Also realize that there may be a number of different factors for why a senior may not
Nutritional Support
Here are tips and reminders to use to stay on track for healthy eating.
1. Coping with Loss of Appetite
2. Relax and Do Not Rush through Meals
3. Eat in the Company of Friends
4. Plan Small, Frequent Meals: snacking every 2 hours can achieve the same
nutritional goals as eating 3 meals
5. Serve Colorful Food
6. Sip a glass of wine with a meal, if approved by a doctor
7. Rely on Favorite Foods to help improve a Healthy Appetite
8. Keep Snacks on Hand
9. Leftovers may be Reheated as Snacks
10. Consume Nutrient-dense Foods (Nutrition Bars and Shakes)
11. Eat Largest Meal at Noon
12. Drink Fluids at End of Meal
13. Keep High-Calorie Foods and Beverages in Easy-to-Grab Locations
14. Create Pleasant Environment for Eating
15. Medications: Workout Best Way and Time to Take
Medications and Meals: Manage medications so they do not negatively impact meal time, based on
the senior's preference. Some medications can take away appetite, like pain meds. There could be
of the nose's ability to smell the food. Aromas are detected in your mouth and in your nose, as you
chew food which releases certain molecules. Medications and age-related physical and mental
changes and dentures will affect the ability to taste and smell.
Be aware that a lower interest in eating may be connected to the loss of taste and smell.
Find out what foods may still spark interest and what textures will still be appealing such as:
the sensations of eating these items, from melting cheese on top, adding ice cream on the side, or
Ideas for Coping with Taste and Smell Changes and Dis-Taste of
Medications
Seasonings: experiment with favorites such as cinnamon, mint, bacon bits, or lemon juice to
add a spark of flavor or tingling to the tongue
Offer liquids such as Juice or Lemonade to disguise the taste of the medication
Offer Chicken Broth (Bouillon Cubes for Instant Broth are Available)
Add a Multi-Vitamin with Minerals such as Zinc (with Approval) which can improve taste
detection
Notice Foods that are Satisfying to Serve More Foods with the Same Texture and Feel
Assisted Living communities show that serving food on a blue plate provides a sense of calm and can
increase the willingness to eat of those with memory loss by as much as 40%.
Nobody knows exactly what may be happening in someone's mind at mealtime when they have
memory loss. Research studies have tested all different colors of plates and designs and discovered in
study after study that serving food on blue plates delivers the best results for compliance at meal time
Serve food on a solid blue plate to help seniors be more willing to eat. Buy paper plates in solid blue
to test this out, perhaps, and if it makes a positive difference, let your Care team know.
Serving food on a Solid Blue Colored Plate lowers agitation and increases willingness to eat for
those with memory loss. Studies show that many seniors with end-stage Alzheimer's or other
dementia still have a craving for sweet foods. Making a healthy, somewhat sweet smoothie, could be
Swallowing Difficulty
Sometimes a senior will have difficulty with swallowing caused by illness or ongoing chronic
conditions.
Problems Using Tongue or Ability to Chew: Serve Light Foods that Stick Together +
Smoothies
Discuss serving a pre-packaged nutrition shake with your Care Manager as there is a variety on the
Diabetic Diet
Seniors with diabetes must follow their prescribed diet and usually will monitor their blood sugar
levels daily. Requires eating the healthiest foods in moderate amounts and keeping regular
mealtimes. It should be a diet rich in nutrients. Whole fruits and vegetables and healthy protein
Monitoring Carbohydrates
Foods to Avoid
Sodium: salt can be added to many canned foods and frozen foods - always check for sodium
level
Sugar-Sweetened Beverages
White Bread, Pasta, and Rice: instead substitute brown rice, whole grain bread, whole wheat
or gluten-free pasta
Dried fruit: high in sugar and lower in fiber than whole, fresh fruit
There are recent studies that show eliminating non-fiber carbohydrates results in improving or
reversing diabetes.
They eliminated bread, pasta, rice, and increased fiber-rich carbohydrates-think fresh fruits and
vegetables, limiting regular carbohydrates to only 20 to 50 grams a day. There was a control group
Both groups lost weight but the group that limited refined carbohydrates saw greatly improved
outcomes. However, the study group was very small. Most physicians still follow the American
Diabetes Guidelines for diet. As more research comes about, the recommended guidelines may
change.
There are essential fatty acids (found in fat) and essential amino acids (found in protein).
Carbohydrates have become a big part of the American diet and reducing refined carbohydrates-
Foods in their simplest form - fresh fruits, vegetables, and fish - is always the healthiest option.
Remember that diet impacts how medications work and how much energy we have.
Learn the meal plan suggested by medical doctors and record daily meals in the Care Plan Notes.
Food provides fuel for our bodies and must be monitored as an important component of maintaining
good health.
Feeding
Sometimes a senior will need assistance with eating and the caregiver will assist in feeding them and
helping them drink. Discuss the routine and be mindful of their feelings.
Feeding Tubes
A registered nurse, care manager, or medical doctor will manage the feeding tube. The caregiver
should follow the Care Plan instructions if assistance is needed in maintaining the liquid in the
feeding tube as prescribed, and draining and cleaning the feeding tube.
Spoon Feeding
Spoon feeding skills involve providing both safety and dignity to deliver a positive experience.
Assisting with eating will sometimes be necessary to help those recovering from illness to enjoy
As Alzheimer's disease or other related disorders advance, you may need to spoon-feed
Use a teaspoon
Small bites, filling the teaspoon only halfway instead of full may be better for some
Touch their shoulder and keep gentle touch as you feed, this lets them know you are there.
If you are both right-handed, you will be sitting on their right side, slightly in front of them.
You use your right hand to spoon food while keeping your left hand in place on their
shoulder.
Slowly feed
There are a lot of steps your body does to move food to your stomach.
Go slow and give time for each step in the process to take place.
Watch the Adam’s Apple and make sure it has moved up and down. It may take more than
one movement up and down to move the food out
Don’t assume the food is swallowed if you don’t see the movement, it could be in the
cheeks.
If possible let them lead, what do they want to eat first or next.
Don’t shove it in, allow them to remove the food from the spoon.
Just like in setting up the table in a way that is best for the client, the same is true with feeding. Did
they have a stroke and one side of the mouth works better than the other?
Position yourself on the dominant side of the client (right-handed, right-side, left-handed, left-side).
child, but most adults take bites from around their plates when eating. Doing the same when feeding
can help stimulate the senses and keep them engaged longer.
If they are able to communicate, let them tell you what they want to eat.
So even though they may not be able to feed themselves, they can still control the order in which
Coughing/choking
Drooling
Vomiting
Refusing to eat
What’s the latest?
Technology and spoons - Liftware, now owned by Google is helping people with different
Watch this video on Google Spoon Makes Eating Easier for People with Disabilities: 3 minutes,
5 seconds
SIGNS OF CHOKING
Excessive coughing
Help nourish the mind and body of the person when you are providing care.
Provide nourishment
If you are working with a client in their home, make sure you are giving nutritious food that they
enjoy eating.
For example—don’t spoon-feed a person if they can eat. Be patient and respect mealtime.
For example—do they have shaky hands and spill their drink? Put the drink in a container with a lid.
Watch for any changes in eating and weight, record meals and changes in the care plan
Do they pray before eating? Be respectful of their beliefs and customs, even if very different
from your own.
Tip Sheet
Metabolism slows as we age, B-vitamins and Calcium are important for strong bones, Tastes and
Smell may Decrease and Impact Interest in Eating Well, Memory Loss may Cause Resistance to
Mealtime.
IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.
Prevention
Respiratory Care with Permitted Home Oxygen Safety Tasks
Delivering the Air you Breath - Home Oxygen Therapy
As a caregiver, at some point, you will most likely provide caregiving for a person who needs
assistance with their breathing. Their lungs may not be able to function well without the assistance of
an oxygen tank to deliver air to their lungs through their nose or throat.
Doctors will prescribe the amount of oxygen needed per minute and provide the tools for delivering
the air which usually will be through an oxygen system that in some cases will involve an oxygen
tank that can be switched from a stationary stand to a portable purse or backpack system to take with
them on-the-go for attending events, running errands and going to medical visits.
Let's learn all about why someone will be prescribed oxygen and how to assist them.
Receiving help with breathing in oxygen has been defined as "oxygen therapy".
Oxygen therapy is a medical treatment. It must be prescribed by a doctor.
When oxygen is provided in the home, the terminology used for this is "home oxygen therapy". You
will see this in a Care Plan and then know you are assisting with monitoring and maneuvering these
The lungs work by bringing in the “good air” and getting rid of the “bad air.” As you breathe in
oxygen (O2), it is passed into your blood through the tiny air sacs (alveoli) in the lungs. From there it
goes to every part of your body. When your tissues and muscles use oxygen, carbon dioxide (CO2) is
made.
It’s important to get rid of CO2, the waste product of breathing. Carbon dioxide goes through your
blood and back to your lungs. You breathe out carbon dioxide.
Asthma
Bronchitis (chronic)
Cystic Fibrosis
Emphysema
Lung Cancer
Pneumonia
Pulmonary Fibrosis
Sleep Apnea
Oxygen therapy can help. In fact, getting oxygen can prevent all those bad effects that happen when
blood oxygen levels drop. Oxygen can reduce the strain on your heart. Oxygen can reduce shortness
of breath. It will help the person stay more active and exercise longer and harder. It will help them
think and remember better. And it will help them sleep better. Oxygen therapy CAN make a big
If the person needs oxygen for rest, exercise, and/or sleep, and how much in liters per minute
(lpm) for each activity.
Oxygen Safety
If a person is on oxygen therapy it is important they DO NOT RUN OUT. Be sure to educate
yourself on how to monitor the oxygen supply so that you can easily know the turnaround time for
refills and the system that is followed. In addition, learn where your client stores their backup
oxygen tank.
The "Contents Indicator" or pressure gauge on the tank tells you how much oxygen is left.
Have a backup oxygen supply in case of an emergency.
Oxygen Tips:
Oxygen does not burn, but it does support combustion. So, anything that can burn will burn much
faster in an oxygen-rich environment. "Don't fan the flames" has real meaning when oxygen tanks
are in the home. Be sure to keep them out of the kitchen or any room where there are flames.
Oxygen should NEVER be used near an open flame or anything that can produce intense heat,
flames or sparks, such as a burning cigarette, a lighted match, heaters, heating pads, hair dryers, a
from oxygen equipment. The highest safe temperature for an oxygen tank is 125 degrees Fahrenheit.
1. Do not use oil, grease, Vaseline or any other flammable substance on your oxygen
equipment or on your skin near the equipment. Use water-based products only.
2. If frost forms on your liquid oxygen equipment, don't allow the frosted parts to come
into contact with skin. It can cause frostbite skin injury.
3. Store cylinders in an upright position and secured in an approved cart or another
storage device.
4. If there is a humidifier, use only the recommended type and amount of water. Due to
the increase in backpressure and resistance to flow, disposable humidifier bottles
should not be used for oxygen flows greater than 6 liters per minute. There are
humidifier bottles available for higher oxygen flows.
5. A high-flow cannula should be used for oxygen flows above 6 liters per minute.
Oxygen-on-the-Go
Some people who need help breathing will be prescribed to have oxygen around-the-clock. This
means they will need to switch over to a portable oxygen tank when they leave their home.
Learn the required steps to switch to a portable oxygen tank and be sure that your client has the
Watch this video on How to Get Started with Oxygen Portable Concentrator: 2 minutes, 35
seconds
Pulmonary Rehabilitation
Pulmonary rehabilitation is a program of exercise, education, and support to help learn to breathe—
At pulmonary rehabilitation, the person works with a team of specialists who will help with
improving physical condition. They learn how to manage COPD to stay healthy and active longer.
Certain medical conditions will make it harder to breathe. And when it’s hard to breathe, it’s normal
There are two breathing techniques that can help get air without working so hard to breathe: Pursed-
technique, take a minute to drop your shoulders down, close your eyes, and relax.
Pursed-Lips Breathing
This breathing technique helps focus, slow breathing down, and stay calm. Pursed-lips breathing
To use pursed -lips breathing: Breathe in through the nostrils. Breathe out slowly. Do not force the
air out. Breathe out through lips pursed like you would blow out a candle. Breathe out two to three
Keeps airways open longer so your lungs can get rid of more stale, trapped air
To do purse-lips breathing:
1. Breathe in through your nose (as if you are smelling something) for about 2 seconds.
2. Pucker your lips like you’re getting ready to blow out candles on a birthday cake.
3. Breathe out very slowly through pursed-lips, two to three times as long as you
breathed in.
4. Repeat.
you breathe in. It should rise as you breathe out. The diaphragm is the main muscle of breathing. It’s
supposed to do most of the work. When you have COPD, the diaphragm doesn’t work as well and
muscles in the neck, shoulders, and back are used. These muscles don’t do much to move your air.
Training the diaphragm to take over more “work of breathing” can help.
teaching it.
This technique is best used when your client is feeling rested and relaxed, and while sitting back or
lying down.
As they become more comfortable with this type of breathing, they can use it to reduce their feelings
When showering
When exercising
Better Breathing Tip: Stop, Reset, Continue
When they are feeling short of breath during exercise or regular activities, use these 3 steps:
Avoid touching your mouth, eyes, and nose in public to help prevent germs from entering
your body
Stay away from crowds, especially during cold and flu season
Use your own pen, especially when signing in at the doctor’s office or other health care
appointments
Don’t smoke as it makes it harder for the lungs to fight off an infection
Get plenty of sleep. When the body is tired, it is more likely to get sick
Bonus Videos:
Tip Sheet
Oxygen is required for life, Keep away the Oxygen from an open flame, Learn how to recognize
Pulse rate and respiration rate can indicate how well your heart and lungs are working. While the
typical ranges may vary based on age, health status, and activity level, knowing how to measure
these vital signs in other individuals can help determine whether they may need to seek medical
attention.
Temperature
Body temperature is a measure of your body's ability to make and get rid of heat. The body is very
good at keeping its temperature within a safe range, even when temperatures outside the body
changes a lot.
When you are too hot, the blood vessels in your skin widen to carry the excess heat to your
skin's surface. You may start to sweat. As the sweat evaporates, it helps cool your body.
When you are too cold, your blood vessels narrow. This reduces blood flow to your skin to
conserve body heat. You may start to shiver. When the muscles tremble this way, it helps to
make more heat.
Your body temperature can be measured in many places on your body. The most common ones
are:
Mouth
Ear
Armpit
Rectum
Forehead
Thermometers show body temperature in either degrees Fahrenheit (°F) or degrees Celsius (°C). In
the United States, temperatures are often measured in degrees Fahrenheit. The standard in most other
Most people think a normal body temperature is an oral temperature (by mouth) of 98.6°F (37°C).
This is an average of normal body temperatures. Your normal temperature may actually be 1°F
(0.6°C) or more above or below this. Also, your normal temperature changes by as much as 1°F
(0.6°C) during the day, depending on how active you are and the time of day. Body temperature is
very sensitive to hormone levels. So a woman's temperature may be higher or lower when she is
A rectal or ear temperature reading will be a little higher than an oral reading. A temperature taken in
the armpit will be a little lower than an oral reading. The most accurate way to measure temperature
Fever
In most adults, a fever is an oral temperature above 100.4°F (38°C) or a rectal or ear temperature
above 101°F (38.3°C). A child has a fever when his or her rectal temperature is 100.4°F (38°C) or
higher.
Infection. This is the most common cause of a fever. Infections may affect the whole body or
one body part.
Medicines. These include antibiotics, narcotics and antihistamines, and many others. This is
called a "drug fever." Medicines like antibiotics raise the body temperature directly. Other
medicines keep the body from resetting its temperature when other things cause the
temperature to rise.
Severe trauma or injury. This may include heart attack, stroke, heatstroke, or burns.
Other medical conditions. These include arthritis, hyperthyroidism, and even some cancers,
such as leukemia and lung cancer.
A very low body temperature (hypothermia) can be serious or even deadly. Low body temperature
usually happens from being out in cold weather. But it may also be caused by alcohol or drug use,
Low body temperature may occur with an infection. This is most common in newborns, older adults,
or people who are frail. A very bad infection, such as sepsis, may also cause an abnormally low body
temperature.
High Body Temperature (Heatstroke)
Heatstroke occurs when the body fails to control its own temperature and body temperature keeps
unconsciousness) and skin that is red, hot, and dry, even under the armpits.
Heatstroke can be deadly. It needs emergency medical treatment. It causes severe dehydration and
Check for very low body temperature in people who have been exposed to cold
Check for very high body temperature in people who have been exposed to heat
Types of Thermometers
Electric Thermometers: are plastic and shaped like a pencil. They have a display window at
one end and a temperature probe at the other end. These thermometers can be used in the
mouth, rectum, or armpit. They are easy to use and easy to read. If you buy this type of
thermometer, check the package for information about its accuracy.
Ear thermometers: are plastic and come in different shapes. The small cone-shaped end of
the thermometer is placed in the ear. Body temperature is shown on a digital display. The
results appear in seconds. Some models also show what the oral and rectal readings would
be.
Temporal artery thermometers: have a small "cup" that is moved across the skin over the
artery in the forehead. When used correctly, these thermometers are accurate.
Disposable thermometers: are thin, flat pieces of plastic with colored dots and temperature
markings on one end. The color of the dots shows the temperature. These thermometers can
be used in the mouth or rectum. A patch form can be used on a baby's skin to measure
temperature for 48 hours straight. These thermometers are not as accurate as electronic or ear
thermometers.
Forehead thermometers: are thin pieces of plastic with numbers on them. You press the
strip against a person's forehead. The temperature makes some numbers change colors or
light up. These thermometers are not very accurate.
Pacifier thermometers: are shaped like a baby's pacifier. They have a display that shows the
temperature. You place the pacifier in your child's mouth to measure temperature. These
thermometers may take longer to get a reading and are not as accurate as other types.
Glass thermometers that contain mercury are not recommended. If you have a glass
thermometer, contact your local health department to find out how to dispose of it safely. If you
break a glass thermometer, call your local poison control center right away.
How to Take Temperature
Before you take a temperature, read the instructions for how to use your type of thermometer. Some
Oral (by mouth) is the most common method of taking a temperature. For you to get an accurate
reading, the person must be able to breathe through his or her nose. If this is not possible, use the
1. Place the thermometer under the tongue, just to one side of the center. Ask the
person to close his or her lips tightly around it.
2. Leave the thermometer in place for the required amount of time. Time yourself with a
clock or watch. Some digital thermometers give a series of short beeps when the
reading is done.
3. Remove the thermometer and read it.
4. Clean a digital thermometer with cool, soapy water and rinse it off before you put it
away.
This is the most accurate way to measure body temperature. It is recommended for babies, small
children, and people who can't hold a thermometer safely in their mouths. It is also used when it is
1. Apply a lubricant jelly or petroleum jelly, such as Vaseline, on the bulb of the
thermometer. This will make it easy to insert.
2. With a baby or small child, turn the child facedown on your lap or on a flat covered or
padded surface, such as a bed. Choose a quiet place so that the child won't be
distracted or move around too much.
3. Spread the child's buttocks with one hand. With the other hand, gently insert the bulb
end of the thermometer into the anus. Push it in about 0.5 in. (1.25 cm) to 1 in. (2.5
cm). Don't force it into the rectum. Hold the thermometer in place with two fingers
close to the anus (not near the end of the thermometer). Pressing the child's
buttocks together will help keep the thermometer in place.
4. Leave the thermometer in place for the required amount of time. Time yourself with a
watch or clock. Some digital thermometers give a series of short beeps when the
reading is done.
5. Remove the thermometer and read it.
6. Clean a digital thermometer with cool, soapy water and rinse it off before you put it
away.
Do not use a thermometer to take an oral temperature after it has been used to take a rectal
temperature.
Taking a temperature in the armpit may not be as accurate as taking an oral or rectal temperature.
1. Place the thermometer under the arm with the bulb in the center of the armpit.
2. Press the arm against the body, and leave the thermometer in place for the required
amount of time. Time yourself with a watch or clock.
3. Remove the thermometer and read it. An armpit temperature reading may be as
much as 1°F (0.6°C) lower than an oral temperature reading.
4. Clean a digital thermometer with cool, soapy water and rinse it off before you put it
away.
1. Check that the probe is clean and free of debris. If dirty, wipe it gently with a clean
cloth. Do not put the thermometer underwater.
2. To keep the probe clean, use a disposable probe cover. Use a new cover each time
you take an ear temperature.
3. Turn on the thermometer.
4. For babies younger than 12 months, gently pull the earlobe down and back. For
children older than 12 months and for adults, pull the earlobe up and back. This will
help you place the probe in the ear canal.
5. Center the probe tip in the ear, and push gently inward toward the eardrum. Do not
force it in.
6. Press the "on" button to display the temperature reading.
7. Remove the thermometer, and throw away the used cover.
Forehead thermometers are not as accurate as electronic and ear thermometers. If a baby is younger
than age 3 months or a child's fever rises higher than 102°F (39°C), check the temperature again
Pacifier thermometers are not as accurate as electronic and ear thermometers. If a baby is younger
than age 3 months or a child's fever rises higher than 102°F (39°C), check the temperature again
Taking an oral temperature causes only mild discomfort. You have to keep the thermometer under
Taking a rectal temperature can cause a little discomfort, but it should not be painful.
Taking an ear temperature causes little or no discomfort. The probe is not inserted very far into the
Taking a temporal artery, forehead, or armpit temperature does not cause any discomfort.
Risks
(2.5 cm). Pushing it farther can be painful and may damage the rectum.
Results
Body temperature is a measure of your body's ability to make and get rid of heat.
If taking a temperature using a method other than oral, mark the method used on the report.
The mouth is not kept closed around the thermometer when taking an oral temperature
The thermometer is not left in place long enough before you read it
Take oral temperature within 20 minutes after smoking or after drinking a hot or cold liquid
Take your temperature within an hour of exercising hard or taking a hot bath
A few things to remember:
Thermometers with a digital display usually have a battery. If your thermometer uses a
battery, make sure it is working before you take the temperature.
Glass thermometers that contain mercury are not recommended. If you have a glass
thermometer, contact your local health department to find out how to dispose of it safely. If
you break a glass thermometer, call your local poison control center right away.
A fever can make a person feel uncomfortable. To reduce discomfort, use light bedding. A
lukewarm (not cool) bath or shower can lower body temperature. A fever can also lead to
dehydration, so it is important to drink plenty of fluids.
PULSE
Your heart rate, or pulse, is the number of times your heart beats per minute. Normal heart rate varies
As you age, changes in the rate and regularity of your pulse can change and may signify a heart
Wrists
To get the most accurate reading, put your finger over your pulse and count the number of beats in 60
seconds.
Your resting heart rate is the heart pumping the lowest amount of blood you need because you’re
not exercising. If you’re sitting or lying and you’re calm, relaxed and aren’t ill, your heart rate is
normally between 60 (beats per minute) and 100 (beats per minute).
But a heart rate lower than 60 doesn’t necessarily signal a medical problem. It could be the result of
taking a drug such as a beta-blocker. A lower heart rate is also common for people who get a lot of
physical activity or are very athletic. Active people often have lower heart rates because their heart
muscle is in better condition and doesn’t need to work as hard to maintain a steady beat.
Moderate physical activity doesn’t usually change the resting pulse much. If you’re very fit, it could
change to 40. A less active person might have a heart rate between 60 and 100. That’s because the
heart muscle has to work harder to maintain bodily functions, making it higher.
An abnormal rhythm can feel like the beats are being skipped when the pulse is counted for
one full minute.
Gently place 2 fingers of your other hand on the artery on the thumb side of your wrist.
Do not use your thumb, because it has its own pulse that you may feel.
Count the beats for 30 seconds, and then double the result to get the number of beats per
minute.
Now try it on yourself. Was it between 60 and 100? Don't be alarmed if it isn't, while it could be
cause for alarm, it might not be. Take your pulse throughout the day to find your "normal."
Respiration
Counting Respiration Rate
The respiration rate is the rate at which a person breathes in one minute. It increases with fever and
some illnesses. The best time to count the respiration rate is when a person is resting, perhaps after
you take the person's pulse while your fingers are still on the person's wrist. The person's breathing is
Count the number of times the chest rises in 1 full minute. (or 30 seconds and multiply by 2)
Notice whether there is any sucking in beneath the ribs or any apparent wheezing or
difficulty breathing
Listen
Labored or difficulty breathing
Irregular breathing
Medication Reminders
A medication schedule should be included in the care plan. Reminding a senior to take their
As medications can impact appetite, sleep, and mood, it is very important to understand the
instructions for the medications and to monitor the medication schedule and any changes you may
Prescription Drugs
Follow the medication chart created for the senior in their care plan.
Over-the-Counter Drugs
Purchased over-the-counter by anyone at a store.
This means a caregiver must require the senior to obtain permission from their medical doctor if they
want to take an over-the-counter medication. Sometimes the senior’s care plan will include which
over-the-counter medications are appropriate, but be sure to check with your Care Manager if a
Watch this Video by Dr. Matt Tabakin to Learn Why Taking Medications at the Right Time
Tip Sheet
Temperature Measures Ability to Make and Get Rid of Heat. Temperature Can Be Mesured in Many
Places n the Body, Low Temperature = Hypothermia, High Temperature = Heatstroke, How and
Why to Take Temperature, Pulse is Heart Beating, Respiration Rate is Breaths per Minute, Listen for
Odd Breathing. Medication monitoring means remind seniors to take their medication. Over-the-
counter medication may be in a senior's care plan but check with Care Manager if a senior requests it.
IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.
Prevention
Understanding Types of Dementia and Memory Loss
Alzheimer's disease has been classified as a distinct disease and type of memory loss.
Definition of Dementia
The loss of intellectual functions (such as thinking, remembering, reasoning, and language) severe
enough to interfere with a person's daily life. Dementia is not a disease in itself, but a group of
In this video, Dr. Natali Edmonds, Board Certified Geropsychologist of Careblazers explains the
difference between Alzheimer's Disease and Dementia. A geropsychologist specializes in the branch
of psychology concerning mental health disorders, depression, anxiety, and age-related illnesses for
older adults.
Causes of Dementia:
Neuropsychiatrist.
Dr. Alzheimer had a female patient in her 50's who was having difficulty with her memory, trouble
with talking and visual spacing. She was becoming disoriented. Nobody knew how to help her. When
He discovered:
Atrophy
Amyloid Plaques
Neurofibrillary Tangles
The discovery of these 3 items together are the keystones of Alzheimer's Disease.
has been provided for research as compared to other diseases and it was not until the 1970's that
some doctors began to try to diagnose the type of memory loss, rather than classifying all memory
loss as simply "hardening of the arteries", or atherosclerosis, which means that fat deposits have built
upon the inside of a person's blood vessels, or arteries, causing the arteries to narrow and making it
more difficult for blood to flow throughout the body easily. Arteries carry the oxygenated blood from
Cancer and heart disease have received more than $1 billion each for
research from the U.S. government.
In December 2015, the U.S. Congress included in a budget vote to provide $350 million towards
Alzheimer's Disease research to find better treatments and a cure for Alzheimer's Disease.
NO CURE EXISTS for Alzheimer's Disease. Part of the training for caregiving involves
understanding that more help is needed to find a cure for this disease. Over the last 100 years, as
compared with research on other medical conditions, very little has been done.
Plaques (also can be called "blocks") form from protein buildup in the brain
People with Alzheimer's Disease have "Tangles" or plaque in their brain but NOT
Watch Video on the 10 Signs of Alzheimer's from Illinois Alzheimer's Chapter: 5 Minutes, 5
Seconds
As a caregiver, you have a unique perspective and bring a fresh set of eyes and ears. You can be a
Tip Sheet
Alzheimer's Disease symptoms involve forgetting Person, Place and Time, Stages of Alzheimer's
Disease, A Doctor Identified Alzheimer's Disease more than 100 Years Ago, Neurology Lesson:
Nerve Cells Tangle up and Die, Plaques Form, Chemicals that are Lacking in the Brain Don't Process
Information Properly, Alzheimer's Disease Advances at Wildly Different Rates and Is called a
mountain climb sometimes requires going sideways and back down the mountain, in order to
maneuver to the top of the peak, the way Alzheimer's Disease impacts a person also will zig-zag.
There will be days where the person seems to be completely aware and not impacted by the disease,
mixed in with days where they are displaying signs of the disease.
Even in the later stages of the disease, there can be moments when they share a profound memory.
Researchers and doctors began trying to define the disease in "stages" to assist caregivers to better
know how to care for the person and what to know where they are on the journey of this progressive
disease.
Much of this disease is still a mystery. Stages have been identified and as the disease progresses
differently with each person, it is important to know that the stages are simply a road map for this
journey which will involve some detours up and down the hills of the stages based on each person's
disease progression.
Early Stages
Middle Stages
May get lost at times and not know where they are
Late Stages
Final Stage
Seizures
Swallowing difficulty
Completely passive
identify the stages of Alzheimer's disease more precisely. Assessment scales are used by some
physicians to be able to better communicate care needs to family members and caregivers.
divides the progression of Alzheimer's disease stages into 16 successive functional stages and
assesses the loss of functional abilities within each stage, from Stage 1 (no impairment) to the final
Dressing
Toileting
Eating
Walking
Walking: Severe
Smile: Severe
/p>
Risks: Wandering
Because this disease can cause confusion with places, time and people, the risk of someone with the
disease doing what is called "wandering" is very high. Wandering means leaving a location to go to
another location that the person thinks exists and is available to reach at the time they are going there,
but in fact, their memory may be in the past and this causes them to wander and become lost. This is
why it is important for someone with the disease to have someone with them at all times.
Memories from a long time ago may be most active for the person with Alzheimer's Disease.
Many times people may try to walk or drive to their former place of employment, for instance, or
take a walk to a friend's house that is not actually in their neighborhood or within walking distance.
Establish a consistent routine and be sure to follow it daily in order for the senior with Alzheimer's
Disease to be better able to progress through the stages with a feeling of comfort. This allows seniors
in the early stages of the disease to more easily remember what will happen as they move through the
day and rely on their muscle memory. Many times the first signs of the disease are displayed when a
senior is traveling and out of their familiar environment and routine. Having a routine will help the
caregiver to also be able to better combat any behavior outbursts by focusing the senior back onto
Identify any wandering risk factors and do not allow the senior to go to the bathroom, for instance,
during a doctor's visit or outing where they are out of your view. Always stay with the senior and
have a back-up plan if they may become confused and want to leave the home on their own.
Door and window posters: sometimes posters of a bookcase are used to cover doors and windows so
that a senior who may be a wandering risk will not try to exit the home or become agitated.
Risks: Hoarding
A person with behavioral variant frontotemporal dementia (FTD) may be drawn to hoarding.
This can be frustrating for the family if items are disappearing from their normal locations because
Hoarding can be an attempt for a person with dementia to control their situation. What is happening
in their brain is so frustrating, that they want to control something, which could be physical items.
The person may also feel paranoid or have delusions and believe their things will get stolen, so they
Suggest a hoarding box or drawer where the person can put objects they want to keep safe.
Try to work out where the person seems to hide things, then show the person you’re helping
them to find them.
If the person becomes anxious about lost items, try to reassure them and help them feel
better.
Don’t leave important documents or items where they can be easily picked up.
Keep a spare set of things that are often lost, such as keys or glasses.
If the person hides food or other perishable things, check their ‘hiding places’ regularly, and
throw out things that have gone bad.
Put child safety locks on cabinets or locking cabinet if food is being taken.
Video cameras have come down in price and can be used to monitor places where items are
normally taken. There may be a pattern of time of day or other triggers that can be discovered
to help with the hoarding.
Hallucinations involve hearing, seeing, smelling, or feeling things that are not really there. Example:
the person may "see" the family dog which died years earlier.
Delusions are false beliefs that the person thinks are real. Example: the person may think you are
Sometimes an illness or medicine may cause hallucinations or delusions. Suggest on the care
notes that the problem is discussed with their physician.
Try not to argue with the person. Instead, comfort the person if he or she is afraid.
Remember, this is how the person really feels, regardless if you think they should feel this
way, they DO. Be kind and supportive.
Distract the person. Sometimes moving to another room or going outside for a walk helps.
Turn off the TV when violent or upsetting programs are on. Someone with Alzheimer’s may
think these events are happening in the room.
Safety First—make sure the person can’t reach anything that could be used to hurt anyone or
himself or herself.
Paranoia
Paranoia is a type of delusion. They may believe, falsely, that others are mean, lying, unfair, or “out
to get" them. The person may become suspicious, fearful, or jealous of people.
If the person forgets where he or she put something, they may become upset. The person may
believe that someone is taking his or her things.
The person may not know you are the person’s caregiver. Someone with Alzheimer’s might
not trust you if he or she thinks you are a stranger.
The person may think you are trying to trick him or her when you tell them something.
Paranoia may be the person’s way of expressing loss. The person may blame or accuse others
Explain to others that the person is acting this way because he or she has Alzheimer’s
disease.
Search for things to distract the person, then talk about what you found. For example, talk
about a photograph or keepsake.
Also remember: They may not be paranoid. There are people who take advantage of weak and
elderly people.
Find out if someone is trying to abuse or steal from the person with Alzheimer’s.
Keep it simple.
Example: The person is afraid someone is breaking into the home. Instead of saying, "no one is
breaking in."
"I'm so sorry you feel scared. I am going to protect you, so nothing happens to you."
Imagine you are in their world and seeing, hearing and feeling the same things. Pretend along with
them and respond the way you would want someone to respond to you. Remember, for them this is
real, it is not made up. You cannot rationalize with them and make them understand.
Remember the saying—if you can't beat 'em, join 'em.
Risks: Sundowning
Sundowning or LATE DAY CONFUSION
Sundowning is a symptom of Alzheimer's Disease and other dementia and is also commonly called
The term "Sundowning" developed as terminology in memory loss because often the confusion
begins to show in the evening or when the sun is setting. This seems to happen as memory loss
symptoms begin and also continues to happen ongoing as the disease progresses.
The term Sundowning now refers to confusion that happens at a specific time of day.
Sundowning can continue into the night. Sometimes people with Alzheimer’s disease have trouble
falling asleep.
Sometimes they get up from bed at night and they may think it is time to go to work or time or time
to eat breakfast.
When Sundowning becomes a regular occurrence, around-the-clock caregivers must be present for
safety.
What Causes Sundowning?
Like other issues with Alzheimer's Disease, the causes are not really known.
We know that the brain changes with Alzheimer's Disease. The thought is the biological clock, or the
Have you ever traveled from one time zone to another? Or stayed up all night? If so, you know that it
takes time for your body to change back to your normal sleep and wake schedule. The ability to
maintain a sense of day and night is regulated by sunlight and your body's biological clock.
Imagine if you can't change back to your normal sleep or wake schedule and how tough that would
be. When you miss a good night's sleep, you can become grumpy and unhappy and the same thing
Turn the volume down—or turn it off—turn off the TV and Music and have a quiet
environment
Provide an activity to the person to distract from pacing or other sundowning behavior
Go for a walk
Each day at dusk turn down off the ceiling lights and turn on the lamps to create a nighttime
environment
Physical activities and exercise during the day can help make the person tired and improves the
quality of sleep.
Make sure naps are short. If they are too long, they will disrupt night sleep, even for someone who is
healthy.
Spend time outside every day if possible. Schedule a daily walk of outdoor activity. Go sit in the park
Things to Avoid:
1. Caffeine late in the day: coffee, tea, cola
2. Alcohol: Can cause confusion and anxiety and not mix well with prescription
medications
3. An unstructured routine: Keep the daily schedule simple
If the problem is severe, make notes in the care plan and discuss it with your Care Manager. Make
sure the client discusses sundowning with their medical team to rule out pain or other medications
Tip Sheet
Stages of Alzheimer's Disease, Functional Assessment Staging (FAST), Wandering Risks, Severe
Stage Loses Abilities to Sit Up, Smile, Walk, Familiar Routines Bring Comfort, Structure Activities
for Morning, Afternoon and Evening, Minimize Distractions, Engage in Activities for Connection
How to communicate with older adults to connect with their generation and for seniors who are hard
Seniors who require caregiving services often are experiencing an age-related illness or a decline in
their physical abilities. Sometimes this means they will have difficulty with self-care and
communication. Marketers have given labels to generations of people born between certain years as a
way to stereotype their behavior based on the norms that were present when they were developing
into adults.
As a caregiver, you are caring for the G.I. Generation or Traditionalists, and the Silent
understanding the age of the person you are caring for you can communicate about topics they are
familiar with and learn how the events in their life impacted them. Every generation has a "Defining
Moment" that impacts their outlook on life. For instance, today's elderly (80+) were young children
when World War 2 began and will have strong memories of relatives or neighbors who may have
The DEFINING MOMENT for each of these generations may be used as a conversation starter
(Also called the “Greatest Generation”) lived through the Great Depression and fought in World War
II and the Korean War, went to college in record numbers as part of the G.I. Bill and experienced the
Cold War. They are known to be patriotic, loyal and fiscally conservative. G.I. stands for
"Government Issue" and a popular nickname for soldiers was "G.I. Joe.”
Great Depression
World War II
Members of the Silent Generation were born as wars were being fought and the economy was weak.
This generation was born during and after the Great Depression between 1929 and 1939 and World
War II (fought between 1939 and 1945). They were simply happy to be alive and to be able to have
jobs as they joined the workforce. They were not activists and felt it was dangerous to speak out as
young adults during the McCarthy Era. They were the first generation to be smaller in size than the
one before them. They may have lost a parent in the war or knew first-hand of loved ones their
parent's lost, and of the financial difficulties their parents suffered during the Great Depression. Some
call them "The Lucky Few" as they became young adults during the prosperous economy of the
1950s and 1960s when modern life became more "convenient" with appliances and automobiles and
Rise of the "Housewife" enjoying Modern Appliances: Dishwashers, Washing Machines, Air
Conditioning, Jello-Salads
(The babies born to those who came back from fighting World War II). The Baby Boomers
experienced the Vietnam War, Watergate, the Civil Rights Movement, the Kennedy and MLK
Assassinations, the Moon Landing and the Cold War. Boomers are known to question authority and
Vietnam War
Boomers have continued to make headlines as a generation that is living longer while being more
active during their senior years than their parent's generation. They are innovating to choose to age in
new ways with second careers after retirement and actually choosing to move to Active Assisted
Living Communities. As our lifespans increase and technology advances, this will be the generation
Realize that just as you have certain ways of communicating with your friends, seniors also learned a
certain communication style for the era when they were coming of age.
Remember that the older generations did not learn to communicate on smartphones or through text
messaging. Caregivers need to effectively communicate in the style a senior prefers while being
respectful of hearing and memory loss challenges. Even vocabulary words may have different
Be mindful of memory loss and how this may impact communication skills
Be aware of hearing loss signs: television and radio volume is too loud or speaking volume
becomes louder
If hearing aids are used, be aware that battery changes may be needed and communicate with
your supervisor if you notice a resident needs this assistance
Tips for Communicating With Someone with Hearing Loss
Speak Naturally: speak at a normal rate—not too fast, not too slow
continue the conversation, can help when communicating with someone. Maintaining a consistent
routine will help the person better know what to expect each day. When speaking to the person, say
their name and speak clearly and give them time to answer. Remember that often body language will
be part of the communication process, look for visual clues as well as verbal ones. Meet them where
they are each day with a wink, a smile, and a pat on the back as you keep their routine on track.
Use the Senior’s Name: for example, "Louise, how did you enjoy lunch today?"
Example of Active Listening
Resident says, “My son always arrives 15 minutes late, never on time.”
Associate says, "Since your son always arrives about 15 minutes late, why don’t we plan to wait
Speech problems may be temporary, for instance, if a senior is recovering from a stroke. Use pen and
Watch Video on Tips for Talking with People with Alzheimer's Disease and Dementia by Dr.
People may become demanding and express frustration when they cannot communicate effectively.
Always remain calm and try to connect with them by showing them you understand their frustration
Develop a communication system that will work between you and your client. Maintain a calm and
pleasant demeanor and keep an established routine for them to follow each day.
There may be good days and bad days and you must learn to never take it personally when someone
communication. There are techniques you may use to adapt your behavior to communicate better
Communication Changes
Early Stage
1. Vocabulary shrinks
2. The person may use wrong or similar words
3. The person may become quiet and withdrawn
Middle Stage
1. More vocabulary loss
2. Difficulty finding words for common items
3. The person may not understand what is spoken
4. The person may be aware of their language mistakes but unable to correct them
Late Stage
1. Limited vocabulary
2. Extreme difficulty speaking and cannot correct speech
3. May appear like they cannot speak at all
4. Probably cannot understand written words
5. Unclear how much-spoken words are understood
At any stage, do not assume the person can't understand. Never speak as if the person is not
there.
Someone told a story about a woman who appeared as if she could not understand. A friend spoke
about her to her husband as she stood next to him. Tears began to stream down her cheeks. She
VIDEO NOTES: This video clearly explains what is happening as Alzheimer's progresses and why
our non-verbal communication is so important. It also helps you to know how to better explain
The old saying, "It's not what you say, but how you say it" becomes so very important.
Non-verbal communication can be the majority of what is communicated, even when you are
speaking. Think about how the same words, said in a different tone of voice and with or without a
smile will have a very different meaning. Studies show that only 7% of communication comes
Remember this when you are caring for someone with memory loss.
Meet them Where They Are Each Day
It might be that the person with Alzheimer's disease wakes up one day and thinks it is their birthday
or your birthday. Or, they may think they need to get ready to go to work. "Meet them where they
are" means to acknowledge what they are talking about and feeling. Then change the subject and
discuss a task at hand, such as if they are ready to have breakfast. Staying focused on daily tasks and
Speech and vocabulary gradually lessen over time in Alzheimer's disease, but feelings and non-
Approach the person from the front, make eye contact: Address the person by name "Good
morning, Mary, it's Susan, your caregiver. I'm here to help you today."
Use simple, easy sentences, giving direction. "Mary, sit in this chair," NOT, "Would you
like to sit down?"
Give choices if they are able to make a choice, but don't give suggestions. For example,
instead of saying, "Wouldn't it be nice to get a shower and be clean before bed?" say, "Mary,
would you like to take a shower to be clean before bedtime now, or after your meal?"
Avoid inappropriate questions or asking a person if they remember. For example, don't say,
"You raised four children so you should remember how to brush hair." Instead say, "Mary,
you raised four children, I bet you brushed a lot of hair in your day.
If the person says they are hungry and have not eaten, explain to them when they will be
eating, such as: "It has been a while since you ate breakfast, I bet you are getting
hungry. We will have lunch soon."
Divide tasks into small steps. Instead of saying, "Get ready for lunch," say, "Mary, it's
almost lunchtime. Let's wash your hands before we eat." Then add the next step, "Please
place a napkin at each plate."
Touch is important. Use nonverbal cues. Do not patronize. Be kind in words and tone of
voice.
Speak slowly and repeat phrases using the exact same words.
NEVER argue or correct. If Mary asks when her mother is coming. Don't say, "You know
your mother is dead." Instead say, "Your mother was a kind person, tell me about her."
Acknowledge the person's feelings. We all want to be understood. This is how the person
truly feels, honor their feelings, play along and comfort them.
Once a client is noncommunicative, be alert to facial and body motions, which can signal
pain, anxiety, or distress.
We are told from the time we are young children to always tell the truth. As a caregiver for
Alzheimer's clients, it is important that you remember their reality may be very different. In order to
comfort them, you need to join their world. This may often mean that you pretend along to provide
Pay attention to non-verbal communication, it will often be more important than verbal. This goes for
both you and the client. In later stages, when the person loses the ability to speak, being attuned to
Always use professional and ethical standards while considering the person's religious, cultural and
individual preferences. As a caregiver, you will learn about the cultural and religious preferences in
the Plan of Care. If you are caring for someone from a different cultural background or religion from
your own, be sure to confirm with your Care Manager that you understand their preferences for care
Don’t expect the person to recognize you or recall your relationship each shift
Nursing home residents diagnosed with probable Alzheimer’s disease were divided into 2 different
groups. One group participated in planned walking while communicating for 30 minutes, three times
each week. The comparison group did not walk or perform any other type of physical activity, but
The study authors discovered that when group participants walked as they conversed,
after 10 weeks, those who "walked and talked" showed significant improvements in communication
ability.
The study data suggests you should plan consistently scheduled walking, at least 30 minutes, 3
Remember to:
Use touch
Try distracting the person or changing the subject if communication creates problems
Validation Therapy
Validation therapy was developed in the 1960s and '70s by Naomi Feil to help treat Alzheimer's
disease. It is a holistic therapy which focuses on empathy and helps people communicate to promote
Naomi Feil, a social worker for the elderly, was unhappy with the common practices at the time and
developed her own methods. She published two books on her validation methods.
Offer individuals a means for expression, verbally or nonverbally, so at the end of life they
can pass in peace
Example:
A woman is convinced someone is throwing away her most precious belongings, including photo
Instead of arguing with the woman, you could rephrase the situation, helping her reminisce about her
youth in a positive light: “Your wedding ring is gone. Do you think I’ve stolen it? It was a beautiful
Gain the Resident’s Attention by Touching their Shoulder, Hearing Loss of High Frequencies Often
Accompanies Aging, Use Active Listening to Better Communicate with Seniors with Alzheimer's or
Communication Abilities Change According to Alzheimer's Stages, Never Speak as Though the
Senior Doesn't Understand, You Can Still Communicate Non-Verbally, Never Argue or Correct,
over time, it can be difficult for family members and caregivers to know what each day will bring.
Some people with Alzheimer's say they have noises playing in their heads.
Can you imagine listening to a constant stream of loud noise in your head and trying to accomplish
Behaviors
Watch Video on Challenging Behaviors: 3 Minutes, 6 Seconds
They often misunderstand what they hear. Remember—the person is NOT trying to be difficult and it
Aggressive Behavior
This can be shouting, name-calling, mean remarks or physical like hitting, shoving, or smacking.
PINPOINT BEHAVIORS
Was it harmful?
CALM RESPONSE
Focus on feelings
Be positive
If you do need to call 911, it is important to tell the first responder the person has dementia and
1. Pain or discomfort
2. Medication
3. Hunger or thirst
4. Loud or busy environment
Confusion and Forgetfulness
Remember, patients can forget the purpose of common items like a pen, glasses, fork, spoon.
They can forget a person, even their most beloved, which can be difficult for everyone.
Stay Calm
Don’t overwhelm with a long answer—clarify with the most simple and short explanation.
Instead of correcting, suggest “I think it is used to eat your food” instead of “You use this
every day to eat your food, it is a fork.”
Show photos of the person with the loved one to "jog" their memory
Repetitive Questions
Many times someone with Alzheimer's disease will repeat the same question over and over again.
Sometimes there will be a recurring theme that they are concerned about such as worrying about if
Tips for repetitive questions include guiding them to focus on what they are able to understand and
giving them the tools to easily see reminders for their daily schedule.
Repetitive Actions
It can be difficult and slightly annoying when a person repeats something over and over again.
As long as the action is not harmful, keep calm and look for the reason why the person is doing the
behavior—the trigger. Most times repetitive behaviors are a calming response to something.
Turn the action into positive behavior. For example, if they are rubbing a surface, provide a cloth for
dusting.
If they are wringing their hands provide a wet cloth for them to wring out.
No one likes to be accused of something, especially when you didn’t do anything to deserve it. Even
if you are accused of something you find horrible or offensive—DON’T take offense.
Offer a very simple answer, then quickly focus their attention on something else, a new activity for
example.
Communication issues with loved ones who don’t accept or understand the disease
Meet them where they are (where they think they are)
Use REMISSION to get them to focus on a subject that makes them feel good.
For instance, if they are still able to communicate, they may enjoy talking about their spouse or their
Once they are talking, the caregiver can begin assisting with the care needs.
Learn about what they like or a person they love and talk about that when they are being aggressive.
Remember that their aggression is something that is not caused by you. Do not take it personally.
Catastrophic Behaviors
Catastrophic Reactions are more likely to occur in the middle stages of Alzheimer's.
Approach the person from the front, rather than the back or side which may startle them.
Know the person’s preferences. For example, some people respond very positively to touch
and others bristle even if someone is near them.
Explain clearly what you would like to have the person do before attempting to do it. (“It's
bath time. Let’s walk together to the bathroom.”)
Don’t attempt to continue whatever it was that triggered the reaction unless it is absolutely
necessary to accomplish that particular task at that specific time.
Reassure her. Perhaps she has a favorite stuffed animal. Let her hold the item and be
comforted by it.
Divert him as he’s calming down. Catastrophic reactions are traumatic for those experiencing
them, so encouraging him to focus on something else can help.
If the person has experienced a catastrophic reaction previously, you should always take note
of what appeared to trigger the reaction before and avoid that behavior if at all possible. Note
this in their care plan.
If a catastrophic reaction is unusual for this person, you will also want to consider if she has
any health changes that might be causing her to have pain, such as a fall or other injury, or
delirium. Delirium is usually caused by an infection or other illness. It can cause a sudden
change in cognition and/or behavior, and it can show up as increased confusion or aggressive
behavior.
Modesty Garments
Seniors from the Silent Generation who are age 60 and above, were raised in a time when nudity was
considered more shocking than it is today. Remember that even public schools had dress codes
requiring skirts below the knee and colleges had curfews for women. These earlier generations
considered public nudity more unacceptable and this may be escalated when a senior has memory
loss. This is why bathing and personal care can become a battle. The senior associates this as
behaving badly. This strong resistance to bathing and toileting often is because of their modesty.
Modesty garments are available to allow the caregiver to cover the senior's private areas while still
allowing the caregiver easy access for bathing and toileting. They will often help solve the senior's
resistance.
Watch Video on How to Respond to Dementia Behaviors: 5 Minutes, 44 seconds
Tip Sheet
Be Calm and Reassuring, Alzheimer's and Dementia Cause Unpredictable Behavior, Confusion and
How would you feel and want to be treated if you suddenly found yourself disoriented in an
unfamiliar place, not even sure of the year or even who you are?
The person you care for will have good days and bad days. Try your best to foster the good days and
even the good moments for the person with dementia, don’t try to force them.
Memory loss is a classic dementia symptom. But some types of dementia, particularly frontotemporal
dementia and Pick’s disease, show up as personality changes rather than memory loss. The
symptoms depend on the areas of the brain that is affected by the disease. Even when memory loss is
the most obvious symptom, the person with dementia is experiencing a neurological decline that can
lead to many other issues. In the latest stages of most types of dementia, patients become unable to
attend to activities of daily living (such as dressing and toileting) independently. They may become
non-communicative, unable to recognize loved ones and even unable to move about.
Watch Video There is More to a Person than Dementia: 2 Minutes, 25 Seconds
The only sure thing is change when you are caring for someone with dementia. Be mindful to
continually reassess the care needs and update the daily Care Plan notes of any changes. Remember
that care needs will increase over time. Help the family so they can be ready for the next stage.
and grace to process the information and adjust to the new challenge.
Acknowledge and identify emotions, and understand that a range of feelings can be a normal reaction
Shock and Disbelief: "I can't believe this is happening. I just want to wake up and find out
that this was a bad dream. It doesn't even seem real."
Denial: "There's no way that this is correct. The doctor didn't even ask very many questions.
I don't think anybody could have passed that test he gave me."
Anger: "I can't believe this is happening! Why me? It's so unfair."
Grief and Depression: "I'm so sad. Is life as I know it forever changed? I don't know how to
live with this knowledge."
Fear: "Will I forget my loved ones? Will they forget me? What if I can't live at home
anymore? Who will help me? I'm afraid—both of not knowing and knowing the future with
this disease."
Relief: "I knew something was wrong. I wanted to believe it wasn't a problem, but in a way,
I'm glad to be able to name it. At least now, I know what's happening and why it is."
As this is a progressive disease impacting the brain, it will progress, or advance, at different stages
for each person. This adds to the challenge of knowing 100% of how a medication will work for each
person.
Medications
Right now there is NOT a medication available to prevent or cure Alzheimer's disease. There are
suggested lifestyle habits that may assist in helping to prevent the onset of the disease and the
severity of the disease. However, the research in this area remains new and the studies are continuing
Resistance to taking medications naturally begins to happen as the disease progresses. There are
Cholinesterase Inhibitors work by slowing down the process that breaks down a key
neurotransmitter.
There is a shortage of acetylcholine in the brain and these drugs help to build it back up.
The medications are shown to assist in slowing down the rate of decline of memory loss by helping
Side Effects
Nausea, vomiting, and diarrhea can be experienced as side effects but they usually do not last more
Monitor any and all changes you may notice when someone is taking medication for memory loss.
Namenda is the only drug in this class, and it is approved for moderate to severe Alzheimer's
Namenda appears to work by regulating glutamate (an amino acid) levels in the brain.
Normal levels of glutamate facilitate learning, but too much glutamate can cause brain cells
to die
Namenda has been somewhat effective in delaying the progression of symptoms in later
Alzheimer's disease
Combined Drugs
In 2014, the FDA approved Namzaric, which is a combination of donepezil and memantine
—one drug from each class above. It is designated for moderate to severe Alzheimer's
disease.
Psychotropic medications are used at times to treat the behavioral, psychological, and emotional
Remember that the impact of medication may be modified if the medication is not taken at the proper
Time of day
by showing control over tasks that they can control. Seniors with memory loss can have days where
Explore other formats for the medication. Many times a pharmacy can offer a liquid version
of the medication.
Take with a Favorite Food? Using applesauce or other food (with medical doctor approval)
Routine for Taking Medications? Create a fun format for taking medications, based on the
senior's personality. Set a place setting and play music and customize this time to tell a joke,
share a memory or play a favorite song.
Tip Sheet
Alzheimer's Medications do NOT cure the disease, only slow down the progression. Review
medication instructions and maintain the medication schedule. Monitor for side effects or any
changes in the senior's behavior when a new medication has been prescribed to monitor a positive or
negative impact.
IL Caregiver 10-Hr, Alzheimer's 6-Hr & Sexual Harass.
Prevention
The Aging Process and Maintaining Safe Environments
People do not become old or elderly at any specific age. Traditionally, age 65 has been designated as
the beginning of old age. But the reason was based on history, not biology.
Most people do not need the expertise of a geriatrician until they are 70 to 75 years old.
Gerontology is the study of the aging process, including physical, mental, and social changes. The
information is used to improve the lives of older people. Some gerontologists have a medical degree
Geriatrics is the branch of medicine that specializes in the care of older people, which often involves
managing many disorders and problems at the same time. Geriatricians have studied the aging
process so that they can better decide which changes result from aging itself and which indicate a
disorder.
Normal Aging
People often wonder whether what they are experiencing as they age is normal or abnormal.
For example, as people age, the lens of the eye thickens, stiffens, and becomes less able to focus on
The condition is called presbyopia. This change occurs in virtually all older people. Presbyopia is
considered normal aging. Other terms used to describe these changes are usual aging.
Exactly what constitutes normal aging is not always clear. Changes that occur with normal aging
make people more likely to develop certain disorders. People can sometimes take action to make-up
But seeing a dentist regularly, eating fewer sweets, and brushing and flossing regularly may reduce
The goals of healthy aging are maintaining physical and mental health, avoiding disorders, and
remaining active and independent. For most people, maintaining good health requires more effort as
Exercising regularly
It is never too late to begin. We can have some control over what happens to us as we age.
The average life expectancy of Americans has been increasing dramatically over the past
century.
Life Expectancy
A male child born in 1900 could expect to live only 46 years, and a female child, 48 years.
Although the maximum life span—the oldest age to which people can live—has changed little since
Madame Jeanne Calment from France had the longest documented lifespan: 122 years (1875 to
1997).
A person who inherits genes that protect against cancer is likely to have a longer life.
There is good evidence that living to very old age—to 100 or older—runs in families.
Lifestyle: Avoiding smoking, not abusing drugs and alcohol, maintaining a healthy weight
and diet, and exercising help people function well and avoid disorders.
Exposure to toxins in the environment: Toxins can shorten life expectancy even among
people with the best genetic makeup.
Health care: Preventing disorders or treating disorders after they are contracted, especially
when the disorder can be cured (as with infections and sometimes cancer), helps increase life
expectancy.
How soon you notice age-related changes in stamina, strength, or sensory perception will vary based
on:
Your genetics
Some age-related complaints are common, and some symptoms aren’t caused by aging at all.
Eye Trouble
By around age 40, almost everyone will be reaching for reading glasses.
Presbyopia occurs when the lens becomes stiff and won’t adjust to refocus from distance to near
vision.
Cataracts, or a clouding of the lens, may begin to affect your vision when you reach your 60s.
Long-term exposure to sunlight increases the risk of cataracts, which can be corrected through
About a third of people who are 60 or older have some hearing loss.
Hearing Loss
This condition, known as presbycusis, may be due to the loss of sensory receptors in the inner ear.
At first, some sounds may seem muffled, and high-pitched voices may be harder to understand.
With age, we lose muscle tissue and our muscles become more rigid and less toned.
Weight training and stretching improve strength and flexibility, although we can’t completely
counteract this natural course of aging.
Aging of the heart is a major reason it may be harder to exercise when we are older as we could when
we were 20.
Aging is not a disease, but our body’s changes make us at risk for some medical conditions.
One example is essential hypertension or high blood pressure. The exact cause of essential
There are several factors that can cause high blood pressure including:
Genetic factors
Obesity
Salt intake
Aging
Blood vessels tend to become less elastic with age, and this stiffness may lead to high blood pressure.
More than half of people 60 and older have high blood pressure—a reading of 130 (systolic)
A low-sodium diet, exercise, and maintaining a healthy weight can help prevent high blood pressure.
Memory Loss
Can’t remember where you put your keys? Forgot the name of an acquaintance you haven’t seen in a
while?
multitasking.
Older adults typically outperform young adults in their knowledge of the world.
The red flag for dementia related to Alzheimer’s disease is the inability to learn and retain
new information.
People with Alzheimer’s have other cognitive problems as well, such as trouble with
language or recognizing objects.
Alzheimer’s disease rarely occurs among people who are younger than 65.
About one in eight people aged 65-74 have Alzheimer’s and 43% of people who are
older than 85 have Alzheimer’s.
Lumosity—Split into sessions of three games tailored to your goals: memory, attention,
problem-solving, processing speed, or flexibility of thinking. The games are played against
the clock and change every time.
Personal Zen—Players follow two animated characters, one of which looks calm and
friendly while the other looks angry, as they burrow through a field of rustling grass. A single
session of play can build resilience over several hours. Use the app right before a stressful
event, but 10 minutes a day will help build more enduring positive effects.
Happify—Train your brain to be happier? Research shows that some activities help build
your ability to conquer negative thoughts, show gratitude, cope with stress and empathize.
The app’s quizzes, polls and gratitude journal — combined with a positive community,
gradually teach life-changing habits.
Eidetic—Uses a technique called spaced repetition to help you memorize anything from
important phone numbers to interesting words or facts. It works differently from typical brain
training apps by using items that have meaning and context.
The home environment should help them know where they are and help them find where they
want to go
2. Keep poisonous chemicals such as gasoline, spray paint and paint thinner out
of reach.
4. Remove decorative fruits, sugar substitutes and seasonings from the table and
counters.
5. Keep knives and sharp items in a locked drawer or cabinet
addresses for local police and fire departments, hospitals and poison control
helplines.
o Install locks out of sight. Place deadbolts either high or low on exterior doors to
make it difficult for the person to wander out of the house. Keep an extra set of keys
hidden near the door for easy access. Remove locks in bathrooms or bedrooms so the
person cannot get locked inside.
o Keep walkways well-lit.
1. Add extra lights to entries, doorways, stairways, areas between rooms, and
bathrooms.
o Remove and disable guns or other weapons. The presence of a weapon in the home
of a person with dementia may lead to unexpected danger. Dementia can cause a
person to mistakenly believe that a familiar caregiver is an intruder.
are taken safely, use a pillbox organizer or keep a daily list and check off each
medication as it is taken.
Example of lockable electronic pill dispenser: Alarm beeps and pills are
dispensed at scheduled times
Remove tripping hazards. Keep floors and other surfaces clutter-free. Remove objects such
as magazine racks, coffee tables, and floor lamps.
Watch the temperature of water and food. It may be difficult for a person with dementia to
tell the difference between hot and cold. Consider turning down the hot water heater, so the
water is not as hot.
Avoid injury in the bathroom.
2. Add grab bars to the shower or tub and at the edge of the vanity to allow for
independent, safe movement.
4. Apply adhesives to keep throw rugs and carpeting in place, or remove rugs
completely.
Improve laundry room safety. Secure and lock all cleaning products such as detergent,
liquid laundry “pacs” and bleach. If possible, keep the door to this room locked.
Support the person's needs. Try not to create a home that feels too restrictive.
The home should encourage independence and social interaction. Clear areas for activities.
Creating a Safe Environment
This also means making sure you as the caregiver are safe.
It is not uncommon for people with dementia or Alzheimer's to be sexually inappropriate. It can be
Maybe you need to hide or lock things to prevent access to an area, like cleaning supplies in a closet
Maybe you need to accentuate an area to help the person find what they need, like putting the picture
of a toilet on the bathroom door or removing doors so the person knows what room it is.
You can put bright colored tape around a light switch cover to help the person find the switch or put
Use night-lights at night so they know it is night time instead of leaving bright overhead lights on.
and staying mentally active can help a person age healthier. Presbyopia is part of the aging process.
Life expectancy is influenced by heredity, exposure to toxins, healthcare, and lifestyle. Psychological
A Safe Environment is Important for Both the Senior and the Caregiver, Alzheimer's can Cause
Changes to the Brain and Affect Both Physical and Mental Capacities, Create a Home Safety
between feeling loved and needed and feeling unloved and unnecessary.
When planning activities and daily tasks to help the person with Alzheimer’s organize their day,
think about where they are in the stages of the disease and remember that creating a routine creates
comfort for them. As they may be forgetting people, engagement in activities helps to keep them
Watch Video Clip from the movie "Still Alice": 1 Minute, 46 Seconds
Planning
Your Approach to Developing a Daily Plan for Engaged Activities
Stress involvement by them — even if you are asking them which cup to use or which color
to pick
Simplify instructions
Match and Mirror Their Behavior (as long as they aren't harming themselves or others).
It will be common that a senior with memory loss will go back to a habit formed a long time ago. For
example, if they worked as a bank teller, they might be very comfortable sorting out money or paper.
Think about ways you can assist them to have the comfort of doing the motions of the activity, even
if actually doing the activity the exact same way is not appropriate. For example, this is why some
seniors with Alzheimer's disease take comfort in holding a doll as if it is actually a real baby. If you
can creatively think about how to safely give them some physical activity, you can often bring them
great satisfaction.
Activity Ideas
Reminisce
Read aloud
During the early stages of the disease, individuals often will have a difficult time remembering more
recent events and newly learned information. They will ask the same question over and over again,
for example. They may misplace items by placing them somewhere the item clearly does not belong,
such as placing a piece of jewelry in the silverware drawer. They may wear an outfit that is not
appropriate for where they are going or what they are doing. They may forget their address.
This is why developing a routine for each day and keeping a simplified and organized home are both
Simplify the daily events and connect with the senior based on where they are each day to keep them
Activities should be designed to follow familiar activities, understanding how very basic daily tasks
are being forgotten. Avoid making the senior think more. Instead, make any activity extremely easy
Play favorite music from their high school and childhood days to spark pleasant memories to
reminisce about. View photo albums or movies or television shows from their childhood or young
adult days. Many times seniors will remember an old sitcom or television series that was one of their
favorites and watching an episode daily can be built into their daily activities. Discuss with their
children or loved ones to learn about their former favorite pastimes. Very often by introducing a
positive entertainment option from the past, you will spark feel-good memories.
Dolls can deliver a calming effect for both men and women with Alzheimer's disease as the disease
progresses. Baby dolls that are close to the actual size of a baby bring them back to a time when they
felt loved and had a sense of purpose in caring for a child. A baby doll can bring pleasure and
security to a senior with Alzheimer's disease. Try to introduce a doll with the same hair, skin and eye
color of one of their children or another loved one to make it easy for them to connect with their
memories and to connect the doll as their own. Or, simply let them choose a doll they like.
Watch Video about Doll Therapy: 5 Minutes, 18 Seconds
Sometimes seniors with Alzheimer's disease will begin to constantly seek to engage their hands.
Their busy hands may add to agitation for them. Introducing an activity pillow or apron will allow
Buttons to button
Zippers to zip
Ties to tie
Find ways to safely engage their hands in repetitive activities, such as a magazine with pages to turn
or a jar of coins to sort. Anything which they may be familiar with can bring comfort and help them
feel included.
very sad events will more easily be remembered by all of us as we age. Seniors experiencing memory
Happy Memory Conversation Starter: Vacation photos and family photos can be used to spark a
happy memory. Ask your Care Manager or one of the senior's family members about a happy
memory you could spark by using a photo. You can also create a new photo album with pictures of
people who are currently important in the senior's life, including photos of you with the senior. Then
The Alive Inside documentary explains how music memory remains for a person with memory loss
and by finding the right song playlist, caregivers can connect a person with memory loss to
themselves and others. The emotion that music evokes remains and allows them to be "alive" even
Music ties us to events and memories which evoke emotions. Emotions are even more important
when a senior experiences memory loss because they are losing connections with their loved ones.
Playing a song as senior loved, you can allow them to tap into the present moment.
Our favorite songs transport us by conjuring surrogate emotions through our brain channels which
Watch this video from the "Alive Inside" documentary to see how music allows seniors with memory
See this video showing how music allows a senior with memory loss to reconnect with his
caregivers.
2) Talk with a senior's loved ones to learn about their favorite songs from different decades in their
life
3) Research songs that were popular during a senior's teenage and young adult years. This is when
4) Make a Playlist: Youtube allows searching for music by decade and other services such as Spotify,
6) Introduce the senior to the music. Plan for consistently scheduled music time each day. Take notes
on songs that connect with them to share with family members and your senior care team.
Brain imaging studies show that our favorite songs stimulate the brain's pleasure circuit, which
releases an influx of dopamine, serotonin, oxytocin and other neurochemicals that make us feel good.
The more we like a song, the more we are treated to neurochemical bliss, flooding our brains with
neurotransmitters.
When we are TEENAGERS, the neural activity sparks even more because our brains are sparking
with growth hormones. These hormones tell our brains that everything is incredibly important.
These songs that are the soundtrack to our teenage dreams and mishaps stay with us
throughout our lifetime. Think of this as a fireworks show of neurons in our mind, imprinting the
Kick up a song you loved as a teenager and you will also kick up those memories. Scientists say
that the years between age 12 and age 22 are when you "become you". These years are when you
Singing
Sing along to a song in your head and you will activate your "premotor cortex" which helps plan and
coordinate movements.
Dancing
Dance and your neurons will synchronize with the beat of the music.
When you pay attention to the lyrics and the beats of the instruments, you activate your "parietal
Listen to a song that triggers personal memories and your "prefrontal cortex" which maintains
information relevant to your personal life and relationships will begin to pull in all of the connections
Weddings, graduations, and all those "firsts" that happen when we are teenagers. As a caregiver,
remember the first movie you attended as a teenager, the first dance you attended and perhaps even
your first kiss. What were the songs that you can remember playing or listening to when you were in
high school? Do you remember who the top singers and musicians were at the top? Who was the
"Elvis Presley" of your teenage years? Part of the reason there are teenage heart-throb singers is
because this is when we are maturing into adults and feeling all of the hormones for the first time and
for reasons that scientists are still researching, these songs become imprinted within our brains
permanently, with the ability to bring back the memory even when we are experiencing a memory
loss condition.
Here is a guideline to begin a discussion with the senior or their family members to find the songs
they liked when they were teenagers and young adults. Remember, just like you may like a certain
artist but may not like all of their songs, the same is true for a senior. Talk to their family members to
learn that singers and songs they really liked, or, you can always experiment by playing songs to see
The senior who is age 90s+ will like music from the 1940s
Ella Fitzgerald
Billie Holiday
Hank Williams
Louis Armstrong
Benny Goodman
Charlie Parker
Dean Martin
The senior who is age 80s+ will like music from the 1950s
Elvis Presley
Chuck Berry
Buddy Holly
Perry Como
Carl Perkins
Fats Domino
Bing Crosby
The senior who is age 70s+ will like music from the 1960s
The Beatles
Bob Dylan
The Beach Boys
Ray Charles
The Temptations
Tammy Wynette
George Jones
Buck Owens
The senior who is age 60s+ will like music from the 1970s
Alabama
Olivia Newton-John
Kenny Rogers
Pink Floyd
Eagles
Aerosmith
Ramones
Bruce Springsteen
David Bowie
The senior who is age 50s+ will like music from the 1980s
Madonna
Celine Dion
Michael Jackson
Prince
George Michael
Elton John
Diana Ross
Duran Duran
George Strait
Marie Osmond
Willie Nelson
George Strait
Remember, all of us have our own tastes in music. We may like more than one style of music. Try to
discuss with your senior what type of music they have liked throughout their life to best find the
You can add playing certain songs or music to your daily routine with the senior. Scheduling a time
Songs of Faith
Songs that connect with a person's religion or with special life milestones can also spark strong
emotions and memories. If a senior attended a certain church as a child or an adult, they may connect
songs to their religion. They may also have a strong memory of some of the songs from their
Find out if the person you are caring for has any special songs that bring them comfort or joy that
If the senior you are caring for has a connection with religious songs from their church services, you
can find out which songs are sung at different church denominations from Woodsong Music. They
have organized church hymns by religion. This can be a way to find songs that connect with a senior
Laugh Daily
Think of a daily activity that will spark laughter for your senior client. Perhaps they would enjoy
watching a television show, such an "I Love Lucy" or another show they enjoyed when they were
younger. Maybe there is a joke of the day in the daily newspaper or you can find a joke book or a
website with jokes. Maybe they will like 'knock-knock' jokes. Or maybe there is something funny
that you can do each day to make a laugh such as standing on one leg to balance or doing another
personal funny "move". Maybe there is something you can always find to laugh about when serving
the meal or cleaning up after a meal. If you can find a way to laugh each day, this can be your
suit, flower in his lapel, smelling slightly of a good aftershave, presenting a well-looked-after image,
The gentleman walks over, sits alongside her, orders a drink, takes a sip, turns to her and says, “So
Tip Sheet
Develop Activities Customized for the Senior Based on their Past Favorite Activities, Develop
Activities Similar to Physical Tasks that Will Remind Them of Performing Activities They Did in the
Past, Smile When They Smile, Be in the Moment, Reminisce About the Past, Read Aloud, Sing,
Dance
Severe or pervasive verbal or physical conduct that denigrates, shows hostility or aversion toward an
(Meaning ongoing spoken or physical behavior that attacks, shows unfriendliness, or avoidance
Race
Color
Religion
Gender
National origin
Age
Disability
When submission to or rejection of such conduct is used as a basis for employment decisions.
When such conduct unreasonably interferes with job performance or creates an intimidating,
hostile, or offensive work environment.
Sexual Harassment
Unwelcome
Watch this Public Service Announcement created by the new non-profit Times Up: 2 Minutes
and 50 Seconds
2 Types of Harassment
on sexual favors in some capacity. For example, this might be a supervisor offering a promotion if an
employee will meet their sexual demands. Quid pro quo literally means "something for something".
Usually, this type of sexual harassment, by its nature, occurs between someone in a position of
power and a subordinate. This is because the person in a position of power has the ability to give
Promotions
Raises
This type of sexual harassment can also occur when there is a threat of negative work
consequences for refusing sexual favors. For example, this might mean someone is threatened with
Job loss
Demotion
Unfavorable shifts
supervisor who commits this act because supervisors are thought to be acting on behalf of the
employer.
comments, advances, requests, or other similar conduct. It can also occur when there is other verbal
or physical conduct that is not necessarily sexual in nature. This could include:
Sexual jokes
In general, this type of conduct must be unwelcome and either frequent or pervasive (or both)
to be considered a hostile environment.
It is not usually deemed a hostile environment if the activity in question was an isolated
occurrence or a simple attempt at initiating a sexual relationship that was not
reciprocated nor repeated. Whether or not this criterion (unwelcome, frequent, pervasive)
has been met is determined on a case-by-case basis.
Sexual favoritism
*Unlike quid pro quo harassment, a hostile work environment does not require any
employment benefit to be at risk. Since it is not tied to the promise or threat of particular
employment actions, this type of sexual harassment is found across all levels of employees.
Meaning that a co-worker not in a position of power can create a hostile work environment
for another employee
Also, the victim does not have to be the person harassed but can be anyone affected by the
offensive conduct.
Unwelcome
Frequent
Pervasive
If your attitudes and decisions are shaped by facts based on performance and behavior, you will
create a work environment free of discrimination where people are treated with respect based on
what they do—not on what they were born into. You will have created the kind of place where
This means that if a supervisor sexually harasses an employee and it has an impact on the
employee's job—it can be title, position, promotion, raise, overtime work shift, or other
details affecting an employee’s work—the employer is responsible.
reasonable care to prevent and correct the sexually harassing behavior promptly (has an anti-
This means that an employee was told what to do in this situation and the employee did not
notify the employer or take any steps to report the problem, then the employee failed and not
the employer. It is your responsibility to report the incident, otherwise, the employer is
not at fault.
If the employer quickly takes action when they learn of the problem, they will not be held
responsible.
Conduct or comments that have the purpose or effect of unreasonably interfering with an
The key issues here are frequency and severity, so how often and how bad.
Demonstrations of a racial or ethnic nature such as the use of gestures, pictures or drawing
which would offend a particular racial or ethnic group
Hostile environment
Negative comments about an employee’s age when referring to employees 40 and over
Key elements
Must be unwelcome
Can be based on race, color, religion, national origin, sex, sexual orientation, age or disability
The agency is liable if it knew or should have known of the harassment and failed to take fast and
Non-employees:
The liability standard for non-employees is the same as for employees—it is understood that a
company may not have total control over a non-employee. An agency may not be able to control the
actions of a one-time visitor to its workplace, but it would be able to correct harassment by an
independent contractor with whom it has a regular relationship. If a caregiver is with a client who
continually harasses the caregiver, the caregiver notifies the employer, and steps should be taken to
correct the situation immediately. The key is: the caregiver must report the situation. The caregiver
can't assume the employer knows and then decide to take legal action.
EXAMPLE
Mary dreads each time her office color photocopier breaks down because the repair person assigned
to her office always leers at her and makes sexually suggestive comments.
She has fears that if she complains nothing will be done about it because the agency does not have
control over the repair person because he is an employee of the photocopier service company.
The supervisor does relay Mary’s complaints to the service company, but no action is taken.
In this case, the employer has the same duty to create a safe work environment for Mary, the
company not doing so, even though they know there is a problem is supporting a hostile work
environment.
Non-Verbal: Staring, derogatory or suggestive gestures, winking, throwing kisses, shunning, and
ostracizing.
Physical: Unwelcome touching, hugging, kissing, patting, stroking, standing too close.
The conduct must be unwelcome to the target of the harassment. “Unwelcome” means that the
employee did not invite or encourage the conduct and does not like it.
The harasser can be the victim’s supervisor, an agent of the employer, a supervisor in another area, a
co-worker, or a non-employee.
If a co-worker repeatedly sends inappropriate messages, regardless if it happens during work hours, it
A supervisor who touches an employee in a sexual way, even if only one time, may be guilty of
sexual harassment.
Illegal harassment: Severe or repeated verbal or physical conduct that attacks or shows hostility or
Race
Color
Religion
Gender
National origin
Age
Disability
Tip Sheet
Harassment is a severe or pervasive verbal or physical behavior that attacks, shows unfriendliness, or
avoidance toward a person because of race, color, religion, gender, national region, age, disability,
reprisal for reporting an incident. Sexual harassment can be verbal, nonverbal, and visual as well.
Quid Pro Quo means "something for something". Hostile Work Environment is when sexual
If a co-worker repeatedly sends inappropriate messages, regardless if it happens during work hours, it
can still be considered harassment. A supervisor who touches an employee in a sexual way, even if
personality which makes the world go around, but there are still cultural norms that must be taken a
bit deeper to understand what may be offensive to someone else, and what can cross the line into
being considered harassment. Managers and employees must learn how to prevent inappropriate
Just because you don't consider something offensive or wrong DOES NOT mean that everyone
Visual Harassment
Verbal Harassment
Physical Harassment
Sexual Favors
TAKEAWAYS:
Employees and employers are expected to maintain a working environment that is free from
harassing or disruptive activity.
No form of harassment will be tolerated included harassment for the following reasons: race,
color, national origin, religion, sex, sexual orientation, disability, or age.
Any employee who believes that they are a victim of unwelcome harassment has the
responsibility to report or file a complaint about the situation as soon as possible.
The report or complaint should be made to the employee’s supervisor, or senior management
if the complaint involves the supervisor or manager.
Prevention
Employees should:
Clearly inform those engaging in inappropriate sexual oriented behavior that they find it
objectionable
Seek assistance promptly if they are the target of, or observe severe or repeated instances of,
behavior that they believe qualify as sexual harassment
Your employer is obligated to ensure a workplace free of sexual harassment and should:
Provide training to educate its workforce on sexual harassment and abusive conduct
Provide the company policy on sexual harassment and discrimination in the workplace,
including the complaint process
If you are the victim of harassment:
o Participation by the victim does not necessarily mean the conduct is welcome.
If the conduct continues after the perpetrator becomes aware it is unwelcome, further action
is necessary
Check your company's sexual harassment policy and take the appropriate action. Keep
records of each incident, with the date and time and any people involved.
The victim or person affected by the conduct should promptly report it or file a complaint per
company policy.
o If you do not report the conduct, you may not be able to hold your employer
responsible. However, supervisors and coworkers remain personally liable for their
own acts of harassment.
or
File a complaint with the Federal Equal Employment Opportunity Commission (EEOC).
(Complaints filed with DFEH or EEOC are automatically cross-filed with the other agency.
You only need to submit one complaint.)
o Ask opened-questions. This means questions that will not be a “yes” or “no” answer.
Once a harassment claim has been made, the employer must move forward, even if the victim
See a healthcare provider as soon as possible to receive a health exam and appropriate care
Tip Sheet
Just because you don't consider something offensive or wrong DOES NOT mean that everyone else
If a manager or supervisor learns of sexual harassment and the victim tells them not to do anything,
the supervisor is still obligated to take action, regardless of the request to ignore it.
If you believe you are enduring sexual harassment in the workplace, it is important to:
Case Study 1
Bill sometimes makes comments to his administrative assistant Ann Smith about how attractive she
One day, Ann requests a raise. Bill says that he will consider her requests and suggest that the two of
them go for drinks and dinner after work. Ann makes it clear that she wants to keep their relationship
purely professional and would, therefore, prefer not to go out with him. Bill says that he understands.
Two weeks later, Bill informs Ann that he has denied her request for a raise.
She asks Bill for an explanation, and he says that if she would be more “cooperative” with him, then
her chance for a raise would improve. Ann asks what Bill means by "cooperative". Bill smiles and
In this case, it is quid pro quo. Because she did not comply with his request, she was denied
a raise.
TIP: QUID PRO QUO is Latin for "Something for Something"—if Mary would give in to Bill's
Case Study 2
William keeps a large bible on his desk at work and always wears a large silver cross around his
neck. Sometimes William will use biblical quotations to support his comments and statements in
conversations with his co-workers. Additionally, he usually tells people to have a “Blessed Day”.
Joe, one of William’s co-workers, has started referring to him as “Saint Willy.” This has received a
lot of laughs around the office. William has confronted Joe about this and asked him to stop. Joe's
response was “Can’t you take a joke?” Joe not only has continued to refer to William as “Saint
In this case, William is experiencing a Hostile Work Environment. He has asked his co-
workers to stop; he feels that his beliefs are being targeted, which is protected under Title
VII.
Case Study 3
Joe asks Mary out on a date. Mary has no desire to go out on a date with Joe, so she declines. He
Case Study 4
Lily and Angela are laughing at something on Lilly's computer screen. Sheila approaches them,
curious about what they find so funny. On the screen, she sees a nude photograph of a certain very
well-endowed popular actor. "What do you think, Sheila?" asks Lily. "I'll bet you wouldn't kick him
out of bed," adds Angela. Sheila laughs uncomfortably. "I'd have to see what my husband would
Jim, who sits across from Lily, is also privy to the exchange. Everything about this makes him
uncomfortable—from the nude photo that he can clearly see, to how they put his friend Sheila on the
spot.
Another important distinction here is that inappropriate behavior between employees may
also create a hostile work environment for other employees who were not actually the target
of the behavior. Jim has a valid complaint.
Case Study 5
James (he/him) is undergoing a gender transition and is now Jamie (she/her). Almost everyone in the
office is respectful and accepting except for Tim, an older accountant at the company. Tim constantly
calls Jamie by her previous name and insists on using incorrect pronouns. When Jamie uses the
female restroom, Tim yells out, "Watch out ladies, there's a rooster in the henhouse." Tim insists that
he is joking and that "Jimmy" is going to have to get a thicker skin if "he" wants to keep working
here.
Tim is creating a Hostile Work Environment for Jamie by harassing her for her Gender Identity.