WEBVTT

00:00:10.000 --> 00:00:14.999
Habilitation is not a
complicated approach to care.

00:00:15.000 --> 00:00:19.999
It\'s a very simple rather common sense and
a lot of good old fashion intervention

00:00:20.000 --> 00:00:24.999
on how to care for somebody who you
either have known for a lifetime

00:00:25.000 --> 00:00:29.999
or who are just getting to know.

00:00:30.000 --> 00:00:34.999
When habilitation is practiced
appropriately, it minimizes stress,

00:00:35.000 --> 00:00:39.999
it optimizes the level of functioning of the patient
and it makes life for both much more enjoyable.

00:00:40.000 --> 00:00:44.999
We no longer look at the ability

00:00:45.000 --> 00:00:49.999
to survive Alzheimer cure but instead

00:00:50.000 --> 00:00:55.000
we think in terms of how are we going to
thrive as we live out these final years.

00:01:10.000 --> 00:01:14.999
When we learn to speak Alzheimer\'s, we
are learning a new way of communicating

00:01:15.000 --> 00:01:19.999
and realizing that nothing is more important than
what is the emotion behind the failing word.

00:01:20.000 --> 00:01:24.999
That is the premise that all
of habilitation is based on.

00:01:25.000 --> 00:01:29.999
The night before we were
to be married. Right.

00:01:30.000 --> 00:01:34.999
You went to the piano and playing.
Then I thought… Oh! I got a bonus.

00:01:35.000 --> 00:01:39.999
, M.ed. Emotion remains intact with an
Alzheimer person. And he is a grown up

00:01:40.000 --> 00:01:44.999
adult emotion even though some of the behavior
may be childlike, the emotion is adult.

00:01:45.000 --> 00:01:49.999
So I just find I\'m very
vulnerable man, okay?

00:01:50.000 --> 00:01:54.999
My wife uh… is… is angry with me. I… I… I\'m…
sort of… Okay. So… What aren\'t you doing now?

00:01:55.000 --> 00:01:59.999
Well uh…

00:02:00.000 --> 00:02:04.999
My first memory of childhood
was I want to be a doctor.

00:02:05.000 --> 00:02:09.999
All of the things that I did (inaudible) all have been
granting away. I can still… You mean activities that you…

00:02:10.000 --> 00:02:14.999
Yeah, everything because
it gradually happens and

00:02:15.000 --> 00:02:19.999
I\'m not comfortable giving up.
What I was doing.

00:02:20.000 --> 00:02:24.999
And that\'s the plane that we need
to reach the patient on and realize

00:02:25.000 --> 00:02:29.999
that no matter what our communication skills are we can learn
to still communicate with somebody whose words are gone.

00:02:30.000 --> 00:02:34.999
It\'s very uh… difficult for
me to make a sentence.

00:02:35.000 --> 00:02:39.999
I get to the end of a sentence
and I forget the last words.

00:02:40.000 --> 00:02:44.999
Yes. I told Barbara. I was frustrating Barbara
because I\'m trying to tell her something,

00:02:45.000 --> 00:02:49.999
she\'s trying to communicate what
I\'m doing that I can\'t say it.

00:02:50.000 --> 00:02:54.999
And I got to tell you that
that, that drives me crazy.

00:02:55.000 --> 00:02:59.999
Their behaviors that finally
interfere with function

00:03:00.000 --> 00:03:04.999
and normalcy and that bring people to a support
group and they start asking for help with…

00:03:05.000 --> 00:03:09.999
with making changes. Uh… you\'ll have
some worries now as you think in head.

00:03:10.000 --> 00:03:14.999
I don\'t think too much of
what should have happened.

00:03:15.000 --> 00:03:19.999
(inaudible) very simply now

00:03:20.000 --> 00:03:24.999
and don\'t worry too much about as I
used to be when I was an engineer.

00:03:25.000 --> 00:03:29.999
[music]

00:03:30.000 --> 00:03:34.999
At this point in the disease, if Barber wanted around for three
weeks… It never happens… No, no, you\'ve never been without her.

00:03:35.000 --> 00:03:39.999
I\'ve never been without her so uh…
(inaudible) had to answer that.

00:03:40.000 --> 00:03:44.999
What scares me is not dying but… but my
husband going that\'s what serious for me.

00:03:45.000 --> 00:03:49.999
I don\'t care if I go but
I don\'t wanna lose him.

00:03:50.000 --> 00:03:54.999
We\'re finding a lot of the loved
ones are becoming ill or worse dying

00:03:55.000 --> 00:03:59.999
before their person with Alzheimer\'s disease because they don\'t have the
time or they don\'t think they have the time to take care of themselves.

00:04:00.000 --> 00:04:04.999
One of the dilemmas that we
face is if I do something

00:04:05.000 --> 00:04:09.999
and he is not doing anything in particular, then
it makes him feel that he\'s not contributing,

00:04:10.000 --> 00:04:14.999
he… he feels useless. So we come to the group to learn
how other people have solved some of these problems.

00:04:15.000 --> 00:04:19.999
He as a physician and so when
he had his first diagnosis…

00:04:20.000 --> 00:04:24.999
People who are caregivers
professional and family members

00:04:25.000 --> 00:04:29.999
must seek out a support group and find others who are
dealing with the same issues they\'re dealing with,

00:04:30.000 --> 00:04:34.999
learn from them, learn about the disease,

00:04:35.000 --> 00:04:40.000
learn about techniques and
know that you are not alone.

00:04:45.000 --> 00:04:49.999
After we get back we have to check the mail and
make sure we get the material for the Judy.

00:04:50.000 --> 00:04:54.999
You don\'t, you don\'t forget Judy.
You got to talk to Judy.

00:04:55.000 --> 00:04:59.999
Habilitation seeks to find a proactive environment for understanding
the needs of this person who has Alzheimer\'s disease.

00:05:00.000 --> 00:05:04.999
Habilitation works in all
stages of this disease process.

00:05:05.000 --> 00:05:09.999
Oh, that was a nice work.

00:05:10.000 --> 00:05:14.999
It\'s very important that we look at the environment
and create chances for success for the person in the

00:05:15.000 --> 00:05:19.999
early stage of this disease. Why don\'t we have a cup of coffee,
sweetheart? It\'s a good idea. Why don\'t you get the cups?

00:05:20.000 --> 00:05:24.999
It\'s important in the middle stage of the
disease that we create way finding paths

00:05:25.000 --> 00:05:29.999
and adjust lighting and
colors and other things

00:05:30.000 --> 00:05:34.999
but it\'s every bit as important that in the
final stage of this disease we pay attention

00:05:35.000 --> 00:05:39.999
to the person who may be in the final
chapter of their life and be spending that

00:05:40.000 --> 00:05:44.999
most of their time in fact in bed. What
are we going to do around that person

00:05:45.000 --> 00:05:49.999
so that the environment
creates a feeling for them

00:05:50.000 --> 00:05:54.999
of security and love and
dignity and safety.

00:05:55.000 --> 00:05:59.999
And I think that ability is as much our positive
feedback as it is an effective method of care.

00:06:00.000 --> 00:06:04.999
Yeah, you\'re right for
the red, there you go.

00:06:05.000 --> 00:06:09.999
The world changes for the person with
Alzheimer\'s once we use habilitation

00:06:10.000 --> 00:06:14.999
because we suddenly have given them chances
to succeed. They live in a world of failure

00:06:15.000 --> 00:06:19.999
and they have most of them for
many years, prior to now,

00:06:20.000 --> 00:06:24.999
wherever now maybe in your care giving.

00:06:25.000 --> 00:06:29.999
You know, we\'re going to take it and put a little frame
around it when we\'re done. Okay, I\'ll see what happens. Okay.

00:06:30.000 --> 00:06:34.999
Some people have the gift
of habilitation. You know,

00:06:35.000 --> 00:06:39.999
learning to speak Alzheimer\'s, that is a practical guide
we need to give people, practical tools to work with.

00:06:40.000 --> 00:06:44.999
No. No. Habilitation.

00:06:45.000 --> 00:06:50.000
It\'s saying, this is what you have left but
figure out what you have left and…and use it.

00:06:55.000 --> 00:06:59.999
When I was away from home on vacation, I put uh… signs on the
doors of the cabinets to… to remind me where to find things.

00:07:00.000 --> 00:07:04.999
It\'s a part of what we talk about in
this group all the time. Simplify.

00:07:05.000 --> 00:07:09.999
And the more you simplify right now,
the easier living with Alzheimer\'s is.

00:07:10.000 --> 00:07:14.999
That\'s why we\'re never moving.

00:07:15.000 --> 00:07:19.999
Simplify, that\'s what philosophy in life is simplify.
You get downhill, you go to cross Country.

00:07:20.000 --> 00:07:24.999
And spring is here and you want, Bernie
can play, the Bernie\'s can play tennis.

00:07:25.000 --> 00:07:29.999
The rule is to simplify but
I find it very difficult.

00:07:30.000 --> 00:07:34.999
Once they get it, they say, \"Aha. Oh,
that\'s why you do those things.\"

00:07:35.000 --> 00:07:39.999
And then there are people who
need to be talk habilitation.

00:07:40.000 --> 00:07:44.999
Also put our hands and then put a bra on. I mean, it\'s like she\'s
never put it on in (inaudible) her life and, of course, and that\'s

00:07:45.000 --> 00:07:49.999
one of the things you\'d expect would be just a natural… Right.
Eventfully, I don\'t, I don\'t put those things on. That surprises me.

00:07:50.000 --> 00:07:54.999
You\'re able to see where
things are going to go,

00:07:55.000 --> 00:07:59.999
you\'re able to learn patient technique.
You know, you gotta live.

00:08:00.000 --> 00:08:04.999
How to, how to help Bernie and to not try
to do everything for him all the time.

00:08:05.000 --> 00:08:09.999
There are steps to take. We really can

00:08:10.000 --> 00:08:14.999
help people while they\'re dealing emotionally also take
some very concrete steps. See you later, alligators. Bye.

00:08:15.000 --> 00:08:19.999
But there is a way of speaking,

00:08:20.000 --> 00:08:24.999
there is a way of listening and being present
that does change. There\'s, of course,

00:08:25.000 --> 00:08:30.000
the benefit of medication as well. There is absolutely a path
to take. And that\'s something that we just need to teach more.

00:08:35.000 --> 00:08:39.999
I have people step into the shoes
of those who have Alzheimer disease

00:08:40.000 --> 00:08:44.999
and I create a very negative environment.

00:08:45.000 --> 00:08:49.999
We use the radio static in comparison to maybe
in your facility when the people are vacuuming

00:08:50.000 --> 00:08:54.999
right beside someone who
has Alzheimer\'s disease.

00:08:55.000 --> 00:08:59.999
They were all quite disoriented because of
it and frightened and they didn\'t know why.

00:09:00.000 --> 00:09:04.999
And they shared with me that they had fear of
not knowing what was going to happen next.

00:09:05.000 --> 00:09:09.999
We blindfolded everybody,
made noises and ripped paper,

00:09:10.000 --> 00:09:14.999
banged and they actually express that after

00:09:15.000 --> 00:09:19.999
that they did enter the world of someone who
had Alzheimer\'s disease. And that\'s the goal,

00:09:20.000 --> 00:09:24.999
how would you feel if it were you?
No one\'s smiling, no one\'s talking,

00:09:25.000 --> 00:09:29.999
emotion, I want your emotions.
How did you feel? Ignored.

00:09:30.000 --> 00:09:34.999
Ignored, good. Appetite, nervous.

00:09:35.000 --> 00:09:39.999
Oh, you were angry? Oh, angry.

00:09:40.000 --> 00:09:44.999
Yep. Every single day

00:09:45.000 --> 00:09:49.999
and every single time they see your face is a
first impression to them. Do you agree? Yes. Yes.

00:09:50.000 --> 00:09:54.999
All right, because they have Alzheimer\'s
disease… And what is Alzheimer disease?

00:09:55.000 --> 00:09:59.999
I\'ve always said, I want
to live to be a 100.

00:10:00.000 --> 00:10:04.999
If I keep my facilities but I\'m
not gonna keep my facilities

00:10:05.000 --> 00:10:09.999
so… I\'m 84 years old

00:10:10.000 --> 00:10:14.999
and… and uh… I wanna keep going.

00:10:15.000 --> 00:10:19.999
There your lov Ed one. No, no one
asked to have Alzheimer\'s disease.

00:10:20.000 --> 00:10:24.999
Alzheimer\'s disease is not a choice. I
think we all ne Ed to remember that.

00:10:25.000 --> 00:10:29.999
The domains of habilitation are where
positive emotions are created.

00:10:30.000 --> 00:10:34.999
They include physical,

00:10:35.000 --> 00:10:39.999
social,

00:10:40.000 --> 00:10:44.999
functional,

00:10:45.000 --> 00:10:49.999
communication, and behavior.

00:10:50.000 --> 00:10:54.999
In any aspect of habilitation umm… maximizing
the strengths and minimizing the weaknesses,

00:10:55.000 --> 00:10:59.999
you\'re going to make them feel better.
If they retain their dignity,

00:11:00.000 --> 00:11:05.000
automatically the communication and quality
of life are going to be much better.

00:11:10.000 --> 00:11:14.999
In the home setting or where home care is
offered habilitation works wonderfully well.

00:11:15.000 --> 00:11:19.999
It not only affects the patient

00:11:20.000 --> 00:11:24.999
but it directly affects the caregiver or the care partner, the
person who is partnering in the care of the Alzheimer person.

00:11:25.000 --> 00:11:29.999
It changes dramatically the way
they interact with the patient.

00:11:30.000 --> 00:11:34.999
And when interaction becomes positive,

00:11:35.000 --> 00:11:39.999
the outcome is tremendous. We
need to simplify the environment.

00:11:40.000 --> 00:11:44.999
Can we get rid of things that don\'t really need
to be there? Can we define places in the home?

00:11:45.000 --> 00:11:49.999
Can we put a favorite hobby
beside a comfortable chair?

00:11:50.000 --> 00:11:54.999
And more importantly than anything, can he
see the chair? Does he know what it is?

00:11:55.000 --> 00:11:59.999
Does he know what it\'s for? We can define the
chair by contrasting it to what\'s behind it.

00:12:00.000 --> 00:12:04.999
We also need to know that if
we are in an assisted living

00:12:05.000 --> 00:12:09.999
or in long term care or in another community based
setting, that personalization is incredibly important.

00:12:10.000 --> 00:12:14.999
What is it that we can do to create the
feeling that this is where I belong

00:12:15.000 --> 00:12:19.999
and not only where I
belong but I can find it?

00:12:20.000 --> 00:12:24.999
One of the things we can do is to bring in very familiar
objects. Things that are important part of that person\'s

00:12:25.000 --> 00:12:29.999
individuality, part of their personhood.

00:12:30.000 --> 00:12:34.999
I think of things that might create

00:12:35.000 --> 00:12:39.999
memories of hobbies or life work that
they might have participated in.

00:12:40.000 --> 00:12:44.999
All these things that make personalization a
very important part of a special environment

00:12:45.000 --> 00:12:50.000
where this person has a
chance to feel successful.

00:12:55.000 --> 00:12:59.999
In the facilities that use habilitation,
medication usage has dropped dramatically.

00:13:00.000 --> 00:13:04.999
Sometimes, it\'s a zero use of
medications for behavior control.

00:13:05.000 --> 00:13:09.999
And we compare that against of facility
where habilitation is not practice

00:13:10.000 --> 00:13:14.999
and it\'s not unusual to see 50 to 70% use

00:13:15.000 --> 00:13:19.999
of medications to control behaviors
and emotions of Alzheimer people.

00:13:20.000 --> 00:13:24.999
[music]

00:13:25.000 --> 00:13:29.999
They can still feed themselves. Can they feed
themselves the way they did 20 years ago?

00:13:30.000 --> 00:13:34.999
No, but they have the skill to
feed themselves using finger foods

00:13:35.000 --> 00:13:39.999
and modes and getting rid of all these
extraneous things that are unneeded

00:13:40.000 --> 00:13:44.999
that we still for some reason think we
need to put before an Alzheimer person.

00:13:45.000 --> 00:13:49.999
It is far more dignified to feed myself

00:13:50.000 --> 00:13:54.999
than it is for somebody
else to be feeding me.

00:13:55.000 --> 00:13:59.999
We can\'t go back with them and regain
what they\'ve lost but we can capitalize

00:14:00.000 --> 00:14:04.999
on the memories that they retain,
the strengths that they still have,

00:14:05.000 --> 00:14:09.999
we try to create an environment
in which we\'re minimizing

00:14:10.000 --> 00:14:14.999
barriers to uh… daily success and…
and maximizing the opportunities

00:14:15.000 --> 00:14:20.000
that they have to interact with the
staff and each other in a positive way.

00:14:30.000 --> 00:14:34.999
She has to me uh… dress me
sometimes because I will

00:14:35.000 --> 00:14:39.999
mismatch my clothes so badly.

00:14:40.000 --> 00:14:44.999
As loving caregivers, we interfere
with what the patient is doing,

00:14:45.000 --> 00:14:49.999
when the person is trying to dress and… and eat
and use the bathroom appropriately. Al, hurry up.

00:14:50.000 --> 00:14:54.999
We want them to be better. In an
effort for them to be better,

00:14:55.000 --> 00:14:59.999
we do things for them. And what
happens when we do things for them

00:15:00.000 --> 00:15:04.999
is that we create an excess disability,

00:15:05.000 --> 00:15:09.999
a disability beyond what should be
happening with the disease process.

00:15:10.000 --> 00:15:14.999
And what happens as a result of that is they have behavior that
is looked upon as being very offensive behavior they act out.

00:15:15.000 --> 00:15:19.999
When in fact, what they\'re
doing is reacting

00:15:20.000 --> 00:15:25.000
and they\'re reacting to a world
they don\'t understand anymore.

00:15:30.000 --> 00:15:34.999
Honey, are you ready? I\'ll
prepare some breakfast.

00:15:35.000 --> 00:15:39.999
The framework of losing control is underscored
when somebody else is trying to help them.

00:15:40.000 --> 00:15:44.999
What we all need to realize
is that Alzheimer disease

00:15:45.000 --> 00:15:49.999
will never take away
somebody\'s dignity, we will

00:15:50.000 --> 00:15:54.999
and we do this by doing things for the patient
when they can still do things for themselves.

00:15:55.000 --> 00:15:59.999
We ask a lot of questions of
family members in terms of

00:16:00.000 --> 00:16:04.999
what can your loved one do,
what do they need help with?

00:16:05.000 --> 00:16:09.999
And that\'s how we base our activities of daily living.
We should do an art show because these are really great

00:16:10.000 --> 00:16:14.999
and we can have families come in and have a party in the community.
I don\'t want to do something for you that you can still do.

00:16:15.000 --> 00:16:19.999
People talk about that in group, they know the
things they can\'t do that they should be able to do

00:16:20.000 --> 00:16:24.999
that they used to be able to do. So we need to fill
that time for the people who are always active

00:16:25.000 --> 00:16:29.999
and we need to offer something for the people
who aren\'t social and never were social.

00:16:30.000 --> 00:16:34.999
[music]

00:16:35.000 --> 00:16:39.999
We\'ve examined it and you know it\'s there which
enables you to enjoy each day right now.

00:16:40.000 --> 00:16:44.999
Is that a fairer statement? Oh, absolutely. Bernie is still
very active in the house. Well, that\'s important too.

00:16:45.000 --> 00:16:49.999
So what I do is she\'ll go and
work in the house and fix things

00:16:50.000 --> 00:16:54.999
or wash it or clean it or fix
it and I don\'t like that.

00:16:55.000 --> 00:16:59.999
And everything goes in its poise.

00:17:00.000 --> 00:17:04.999
You make your own breakfast and
usually lunch. He does the laundry.

00:17:05.000 --> 00:17:09.999
I make the laundry. He
cleans that best for me.

00:17:10.000 --> 00:17:14.999
Though a parent may need help
with functions of daily living

00:17:15.000 --> 00:17:19.999
that appear to sadly strip
them of their adulthood.

00:17:20.000 --> 00:17:24.999
I think what we risk in our society
is infantilizing and patronizing,

00:17:25.000 --> 00:17:29.999
alter adults in people with memory loss by not
seeing them as the people they have always been

00:17:30.000 --> 00:17:35.000
but we lose a lot.

00:17:40.000 --> 00:17:44.999
Communication is more than just words and when words are
failing, the person is confounded by how to express themselves

00:17:45.000 --> 00:17:49.999
and by what somebody else is saying
to them. Communication is two part.

00:17:50.000 --> 00:17:54.999
One part of it is the speech that\'s put out in
the other part is the ability to understand.

00:17:55.000 --> 00:17:59.999
There you go. All of it. Yeah.

00:18:00.000 --> 00:18:04.999
People need to speak the language of Alzheimer\'s disease.
English isn\'t always the language that people understand.

00:18:05.000 --> 00:18:09.999
Our residents look at your face
first to see what\'s going on,

00:18:10.000 --> 00:18:14.999
that\'s what people understand. People
understand your body language.

00:18:15.000 --> 00:18:19.999
We need as care partners to figure out other
ways that we can communicate with the patient.

00:18:20.000 --> 00:18:24.999
And that means using gestures and
pictures, adjusting our tone of voice,

00:18:25.000 --> 00:18:29.999
being very careful as to what expression we are giving.
Alzheimer people are very adept at reading our body language.

00:18:30.000 --> 00:18:34.999
They know when we\'re in a hurry, they know
when we don\'t have enough time for them,

00:18:35.000 --> 00:18:39.999
they know when we\'re angry
or when we\'re upset.

00:18:40.000 --> 00:18:45.000
And those messages are sometimes much
stronger than whatever words we are using.

00:18:50.000 --> 00:18:54.999
Bill, Bill, can you give me a hand.

00:18:55.000 --> 00:18:59.999
Almost all behaviors associated with
Alzheimer\'s disease have a trigger.

00:19:00.000 --> 00:19:04.999
We as caregivers whether
we\'re professional or family

00:19:05.000 --> 00:19:09.999
much find out what the trigger is. And
we do that by keeping a log of sorts,

00:19:10.000 --> 00:19:14.999
we need to know the most
important thing of all

00:19:15.000 --> 00:19:19.999
and that is what is going on in the
environment around the person.

00:19:20.000 --> 00:19:24.999
And environment means anything that you
can see or hear or touch or smell.

00:19:25.000 --> 00:19:29.999
And all of the senses come
into play with behavior.

00:19:30.000 --> 00:19:34.999
We need to write down what exactly
what was going on in the environment

00:19:35.000 --> 00:19:39.999
at the time the behavior occurred.
It might be time of day,

00:19:40.000 --> 00:19:44.999
it might be the lighting or even odors that
go along with the preparation of dinner.

00:19:45.000 --> 00:19:49.999
We keep this log for about 10 entries

00:19:50.000 --> 00:19:54.999
and then we go back and we look at it and we realize
almost always that there is a specific trigger.

00:19:55.000 --> 00:19:59.999
Once we find the trigger,
we can stop the behavior.

00:20:00.000 --> 00:20:04.999
And the whole clue, of course, is to be sure
to stop the behavior before it happens.

00:20:05.000 --> 00:20:09.999
Late in the day, there is a syndrome

00:20:10.000 --> 00:20:14.999
associated with Alzheimer\'s that occurs
and it\'s called sundowning syndrome.

00:20:15.000 --> 00:20:19.999
Literally happens as the sun is
going down, behavioral changes.

00:20:20.000 --> 00:20:24.999
The very simple remedy for sundowning and historically
we\'ve always used medication to change behavior.

00:20:25.000 --> 00:20:29.999
What we need to do is turn up the
lights and close out the outdoors,

00:20:30.000 --> 00:20:34.999
close the curtains, close
the shades, pull the drapes

00:20:35.000 --> 00:20:39.999
so that we don\'t have a visual view of the
outside instead what we have is sunlight inside.

00:20:40.000 --> 00:20:44.999
We need to do this in long term care in
assisted living and in daycare centers,

00:20:45.000 --> 00:20:49.999
we need to do this in hospitals,
turning up the lights.

00:20:50.000 --> 00:20:54.999
If someone has behavior, we need to figure
out why. And are we creating that behavior?

00:20:55.000 --> 00:20:59.999
Is the family visit creating the behavior?

00:21:00.000 --> 00:21:04.999
Is the person sick? We need to look at all those
pieces. And oftentimes, people will say to me,

00:21:05.000 --> 00:21:09.999
\"I don\'t see a lot of behaviors.\"
If we do our job and engage people

00:21:10.000 --> 00:21:14.999
and make them feel comfortable
and safe, safety is a big key,

00:21:15.000 --> 00:21:19.999
that\'s going to show and
it minimizes behavior.

00:21:20.000 --> 00:21:24.999
If we realize using a log that behavior
changes between 02:30 and 03:30

00:21:25.000 --> 00:21:29.999
then we want to be sure that at 02:20, we
have the patient engaged in doing something,

00:21:30.000 --> 00:21:34.999
something that is not associated with
the kind of behavior that happens.

00:21:35.000 --> 00:21:40.000
Bill, Come on here.

00:21:45.000 --> 00:21:49.999
The caregivers world changes rather
dramatically as we practice habilitation.

00:21:50.000 --> 00:21:54.999
It becomes a rather
peaceful lovely place to be

00:21:55.000 --> 00:21:59.999
rather than in this world of antagonism
and fear of what the future holds.

00:22:00.000 --> 00:22:04.999
It\'s realizing that we focus too much

00:22:05.000 --> 00:22:09.999
on what the patient used to be instead
of capitalizing on this moment

00:22:10.000 --> 00:22:14.999
and who he is now.

00:22:15.000 --> 00:22:19.999
I used to walk five miles
in an hour and 15 minutes.

00:22:20.000 --> 00:22:24.999
I can\'t d that anymore and I\'m
lucky if I can do a mile now.

00:22:25.000 --> 00:22:29.999
I think it\'s very important that we realize
that the person who was may never be again

00:22:30.000 --> 00:22:34.999
but there is a new person there who has
basically the same personality and traits

00:22:35.000 --> 00:22:39.999
that the person had before they
had a debilitating disease.

00:22:40.000 --> 00:22:44.999
(inaudible)? No. Okay.

00:22:45.000 --> 00:22:49.999
And it\'s very important that we learn to be in that
world no matter where that world is with the patient.

00:22:50.000 --> 00:22:54.999
By doing that, it means that we\'re going to be
successful caregivers, we\'re going to have less stress,

00:22:55.000 --> 00:22:59.999
we\'re going to sleep better, we\'re going to feel
better about our partnership with the patient.

00:23:00.000 --> 00:23:04.999
[music]

00:23:05.000 --> 00:23:09.999
If we take the time

00:23:10.000 --> 00:23:14.999
to bond with them, to explain what we\'re doing, do not
expect things of them that they can no longer do.

00:23:15.000 --> 00:23:19.999
It takes far less time

00:23:20.000 --> 00:23:24.999
than it does if we set up confrontation.
And confrontation is set up any time

00:23:25.000 --> 00:23:29.999
that we challenge an Alzheimer person. Are you
doing with the 10 (inaudible)? Oh, big shower.

00:23:30.000 --> 00:23:34.999
Mind, what it must be light

00:23:35.000 --> 00:23:39.999
to not have a concept of
what time is all about.

00:23:40.000 --> 00:23:44.999
Well, let\'s think about what we\'re going to do
tomorrow. We\'ve got today pretty much done.

00:23:45.000 --> 00:23:49.999
Where do we go from here?
Where do we go for… umm…

00:23:50.000 --> 00:23:54.999
The caregiver at that point has the opportunity to get into the patient\'s
world. And that if the uh… if the red (inaudible) during the afternoon…

00:23:55.000 --> 00:23:59.999
You know, let me take a look at it and see what\'s going on. Yeah.
We can. And then you can take me out to dinner tomorrow night.

00:24:00.000 --> 00:24:04.999
I can take you out. Yeah, I\'m ready to go.

00:24:05.000 --> 00:24:09.999
It\'s making the patient feel as if they still are in control. And they
are always aware of the fact even in the very late stage of the disease

00:24:10.000 --> 00:24:14.999
that control is being lost.

00:24:15.000 --> 00:24:19.999
In a typical family, children are raised with the
parents in charge of us one way or the other.

00:24:20.000 --> 00:24:24.999
And if parents are feeling left out

00:24:25.000 --> 00:24:29.999
or patronized by children or by any
health care clinician for good reason

00:24:30.000 --> 00:24:34.999
they will be angry and resist intervention.

00:24:35.000 --> 00:24:40.000
It\'s unintentional, it\'s often a desire to…
to do, to take care but it doesn\'t work.

00:24:45.000 --> 00:24:49.999
One of the most difficult dilemmas for a
person living with Alzheimer\'s disease

00:24:50.000 --> 00:24:54.999
is the extraordinary amount of
leisure time that he suddenly has.

00:24:55.000 --> 00:24:59.999
Time that was filled with work, with
occupation, with hobbies once upon a time

00:25:00.000 --> 00:25:04.999
and now it\'s 24 hours a day of not being
able to choose what he wants to do

00:25:05.000 --> 00:25:09.999
or to make the decision about how
to fill up this leisure time.

00:25:10.000 --> 00:25:14.999
So we as caregivers need
to help the patient

00:25:15.000 --> 00:25:19.999
in terms of activity, enrichment,
use of leisure time.

00:25:20.000 --> 00:25:24.999
The things that I think of that work
most effectively as we well known

00:25:25.000 --> 00:25:29.999
music has an important role in
the life of an Alzheimer person

00:25:30.000 --> 00:25:34.999
but we need to be judicious in the kind of music
that we choose and in what time of day we choose it.

00:25:35.000 --> 00:25:39.999
In the afternoon, it\'s a wonderful
time to have social interaction

00:25:40.000 --> 00:25:44.999
and we can dance and we can sing along
with Mitch Miller and other people.

00:25:45.000 --> 00:25:49.999
In the evening, it\'s quiet time and it\'s a time when
we want to have music playing in the background

00:25:50.000 --> 00:25:54.999
that is probably similar
to our Brahms lullaby

00:25:55.000 --> 00:25:59.999
or something that\'s going to quiet the patients
and make them a little bit more subdued.

00:26:00.000 --> 00:26:04.999
Activities that focus on remaining abilities
and on memories are very important.

00:26:05.000 --> 00:26:09.999
Can we talk and have discussions about
things that went on in the 40\'s and 50\'s?

00:26:10.000 --> 00:26:14.999
Of course, we can.

00:26:15.000 --> 00:26:19.999
Greatest president ever? Greatest
president? I think Ben Franklin was also…

00:26:20.000 --> 00:26:24.999
We cannot have active participation if we\'re talking
about current events or what is happening in the 21st

00:26:25.000 --> 00:26:29.999
that\'s not going to work
with an Alzheimer person.

00:26:30.000 --> 00:26:34.999
I\'ve developed an acronym and I think COPE is the word that
we most need to put into our dictionary as caregivers.

00:26:35.000 --> 00:26:39.999
The \'C\' stands for communication,
communication with the physician,

00:26:40.000 --> 00:26:44.999
communication with our family members,
communication with the patient.

00:26:45.000 --> 00:26:49.999
Impossible that one my cognitive
sense was gone. Then the only way…

00:26:50.000 --> 00:26:54.999
Above all else, the person with Alzheimer\'s
disease has been left without anyone to talk to.

00:26:55.000 --> 00:26:59.999
And the question remains is
what is causing the person

00:27:00.000 --> 00:27:04.999
to not be able to function in the
world the way they once did.

00:27:05.000 --> 00:27:09.999
They see us repeat ourselves. We are not aware of it.
Yeah, socially, I\'ve… I\'ve a experience rejection.

00:27:10.000 --> 00:27:14.999
He needs the need chance

00:27:15.000 --> 00:27:19.999
to articulate what is happening to him and we
as care partners need to give him that chance.

00:27:20.000 --> 00:27:24.999
Well, I well, I still, last year
I still got a few checks, yes.

00:27:25.000 --> 00:27:29.999
What (inaudible)? What do you need?

00:27:30.000 --> 00:27:34.999
[music]

00:27:35.000 --> 00:27:39.999
The \'O\' is for organization.

00:27:40.000 --> 00:27:44.999
Just talking about how wonderful it is to be able to make a difference in people\'s
lives so they\'re able to really keep the people that they love where they want to be.

00:27:45.000 --> 00:27:49.999
We need to be organized. We
cannot wait until a crisis arises

00:27:50.000 --> 00:27:54.999
before we start making decisions
on what has to happen.

00:27:55.000 --> 00:27:59.999
And we also need to realize that the home and the
environment around the person needs to be organized.

00:28:00.000 --> 00:28:04.999
We\'ve removed the glass doors, kept the black frames
that are still again the contrast helps a little bit…

00:28:05.000 --> 00:28:09.999
You know, we came into the home

00:28:10.000 --> 00:28:14.999
and looked around and said, you know, are there any modifications that we
can make to make her every day routine run more smoothly, more safely.

00:28:15.000 --> 00:28:19.999
It\'s time to take the mirrors down. Okay.

00:28:20.000 --> 00:28:24.999
And if we take this mirror down, we can just replace it
with a… a non glossy picture or photograph of the family.

00:28:25.000 --> 00:28:29.999
Having the photographs of the family
around is such a wonderful thing. And so…

00:28:30.000 --> 00:28:34.999
In… in terms of habilitation, this
is something that really works

00:28:35.000 --> 00:28:39.999
because what we\'re doing is we\'re playing on… on her
strengths, we\'re… we\'re saying not what\'s not there,

00:28:40.000 --> 00:28:44.999
we\'re looking at what\'s there
and we\'re building on that.

00:28:45.000 --> 00:28:49.999
I imagine, she\'s probably in that stage where the perception is… is gone
and uh… you\'ve provided the contrast that she doesn\'t have. Exactly.

00:28:50.000 --> 00:28:54.999
There are ways to start planning
to having a discussion about

00:28:55.000 --> 00:28:59.999
health care proxy and health care decisions. We can
ask Mom or Dad, while they\'re still able to tell us.

00:29:00.000 --> 00:29:04.999
You know, what are your wishes?
What are your values?

00:29:05.000 --> 00:29:09.999
We also have to organize what our legal
matters are and our financial matters.

00:29:10.000 --> 00:29:14.999
And we need to do that right after
diagnosis not when the crisis happens.

00:29:15.000 --> 00:29:19.999
Umm… I\'d like to make a note for
(inaudible) umm… a follow-up, please.

00:29:20.000 --> 00:29:24.999
The \'P\' is for prioritize. What is
the most important thing today?

00:29:25.000 --> 00:29:29.999
What is the most important thing this hour?
What is going to be the next

00:29:30.000 --> 00:29:34.999
most important thing that happens for the
year or the years that lie ahead of us?

00:29:35.000 --> 00:29:39.999
We need to prioritize them and to keep
changing them as our priorities change.

00:29:40.000 --> 00:29:44.999
And the \'E\' is maybe for the most
important thing of all and that is

00:29:45.000 --> 00:29:49.999
for the caregiver and the
patient both to energize

00:29:50.000 --> 00:29:54.999
and activate their brain cells,
not just their physical activity.

00:29:55.000 --> 00:29:59.999
And I think sometimes when we think about energizing,
we think in terms of running around the block.

00:30:00.000 --> 00:30:04.999
Well, this means the mental floss just as we\'re going
to do anything else that\'s going to keep us happy

00:30:05.000 --> 00:30:10.000
and healthy and better caregivers.
Cope, COPE.

00:30:15.000 --> 00:30:19.999
(inaudible) Alzheimer\'s. She really writes from the heart
and… All caregivers have to learn to care for themselves.

00:30:20.000 --> 00:30:24.999
If they do not care for themselves and
this means professional caregivers

00:30:25.000 --> 00:30:29.999
as well as it does family caregivers
or community based caregivers.

00:30:30.000 --> 00:30:34.999
No matter who the caregiver is, if he or she does not learn
to cure for themselves, they will never be able to properly,

00:30:35.000 --> 00:30:39.999
appropriately, care for a person
with Alzheimer\'s disease.

00:30:40.000 --> 00:30:44.999
There is some difficulty understanding what am I
supposed to be doing or am I doing this right?

00:30:45.000 --> 00:30:49.999
And validating people that yes
in fact you\'re doing a great job

00:30:50.000 --> 00:30:54.999
because families and staff need that as well.
They need to know, they… they have the tools

00:30:55.000 --> 00:30:59.999
that they\'re honing the tools that what
worked yesterday might not work today,

00:31:00.000 --> 00:31:04.999
might not work tomorrow and people change.

00:31:05.000 --> 00:31:09.999
I don\'t really have any things,
anything that I can really

00:31:10.000 --> 00:31:14.999
like latch onto except my wife, well.

00:31:15.000 --> 00:31:19.999
Why not have my wife.

00:31:20.000 --> 00:31:24.999
I do believe that our efforts to sustain
life with compassion and common sense

00:31:25.000 --> 00:31:29.999
are simply a reflection of our own human needs. We
know that our lease on this planet is uncertain.

00:31:30.000 --> 00:31:34.999
Are we going to celebrate longevity
or are we going to celebrate

00:31:35.000 --> 00:31:39.999
a far greater degree of living well?

00:31:40.000 --> 00:31:44.999
I am far more interested in living
well than I am in living long.

00:31:45.000 --> 00:31:50.000
They predicted rain for today.