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Caring for Dementia Clients

Training Manual
Rebecca Ralph
Instructor: Deb Hatfield
March 4, 2015

Table of Contents
Introduction3
Meaning of Differentiated Instruction
What it means to be a CAREgiver 4
What is asked of a CAREgiver
What is Alzheimers and Dementia.. 5
Symptoms of Alzheimers
Different stages of Dementia.7
Early stage
What to expect
Role of the CAREgiver
Middle stage
What to expect
Role of the CAREgiver
Late stage
What to expect
Role of the CAREgiver
Ways to Communicate..10
Best ways to communicate
Daily Activities.11
Organizing the day
Appendix
Handouts
Resources

Introduction
Welcome to this training session! Thank you for wanting to be a CAREgiver for those who
suffer from Alzheimers and dementia. As you are probably aware of, Alzheimers and dementia
is a serious disease attacking todays elderly people. This training manual will help guide and
direct you as a CAREgiver when handling with a client that suffers from this disease. Before we
begin, I will guide you in what type of training session this is. I will first explain what
differentiated instruction is and how it will relate to the clients you will come across. Once again
I am very delighted to have this opportunity to train you as you begin your journey as a
CAREgiver for those who suffer with Alzheimers and dementia. Welcome!
What is differentiated instruction?
Differentiated instruction is the way in which a teacher anticipates and responds to a variety of
student needs in the classroom. To meet student needs, teachers differentiate by modifying the
content (what is being taught), the process (how it is taught) and the product (how students
demonstrate their learning). In this training manual, I will demonstrate the seriousness of
Alzheimers and dementia, how to help loved ones to cope with the disease and I will have an
assessment at the end of the training session to test your understanding of being a CAREgiver to
our Alzheimers and dementia clients.
Being a CAREgiver affects adult learning in so many ways. Once you have a general
understanding of being a CAREgiver, you will be able to train other CAREgivers, including
family members, on how to work with those who suffer from Alzheimers and dementia. This
training session is designed to train not only the trainee but the trainer as well. In the following
pages, I will provide valuable information that will help the trainer to train others when it comes
to this disease. This training manual will also be useful when a client cannot understand what is
happening to him or her. This manual will help the CAREgiver be able to communicate with
those with Alzheimers and dementia on how to best explain the clients condition. I will provide
in the Appendix useful information from a number of sources that will guide and direct
CAREgivers to help the clients love ones to cope with this new lifestyle.
As mentioned earlier, thank you for considering being a CAREgiver. This is an awarding field
and learning experience for all of those involved.

What does it mean to be a CAREgiver?


According to Websters dictionary, a CAREgiver is a person who provides direct care (as for
children,
elderly
people,
or
the
chronically
ill)
(www.merriamwebster.com/dictionary/caregiver). Although we will not be working with children directly,
helping loved ones who has an elderly parent/grandparent cope with this disease can help the
loved ones attend to their children if there are any. Being a CAREgiver goes a long ways.
According to cancer.org, CAREgivers serve as home health aides and companions. They help
feed, dress, and bathe the client if need be. CAREgivers also arrange schedules, manage
insurance issues, and provide transportation. They are also legal assistants, financial managers,
and housekeepers. Moreover, CAREgivers help encourage clients to do simple daily tasks. As a
CAREgiver, the company handles the insurance and legal issues. The only role you play as a
CAREgiver is to be a companion and help to the client and the clients help. Your role as a
CAREgiver can be a blessing to those who were waiting for someone like you to come along.
What is asked of the CAREgiver?
The most important thing that is asked of the CAREgiver is to be patient and kind to our clients.
Being patient goes a long ways when handling those with Alzheimers and dementia. If this
description describes you then you are the right place to begin your career as a CAREgiver.
You will find that most of our clients do not have their family around. In this instance, you are
the only family they got to depend on. Although the loved ones handle a good portion of the
finances, they cannot always be physically present with their parent/grandparent. This is your
role as a CAREgiver, to provide the comfort that the loved one can provide, but is not able to
physically provide per se. You are not necessary taking place of the son/daughter that had asked
for your services, but you are acting in their position while they are gone. Just your warm and
gentle kindness means a lot to our clients in which they might even adopt you in as a family
member. Keep in mind though many of our clients family members do not want to be replaced.
Do not go in with the intention that you are going to replace the family member. Keep in mind,
that you are an aide helping to lift some of the burden that had been placed on the family
members chest.
Clients with Alzheimers and dementia can be very stressful. This training manual will help you
to level out that stress without you becoming so overwhelmed that it is impossible to care for
these clients. If you are able to work in a very stressful environment and are patient, once again
you have chosen the correct career for your life. Thanks again for becoming a CAREgiver for
our clients.

What is Alzheimers and Dementia?


Alzheimers
According to the Alzheimers Association of America, Alzheimers is a type of dementia that
causes problems with memory, thinking and behavior (www.alz.org). The disease usually
develops slowly and will get worse over time. The development of the disease will get worse to
the point that it will interfere with normal daily tasks.
Alzheimers Association provides basic facts about Alzheimers that will be beneficial for those
who have loved ones suffering from the disease. The facts are:
1. Alzheimers is the most common form of dementia
a. Counts for 60 to 80% of dementia cases
2. Alzheimers is not a normal part of aging
a. Up to 5% of people with the disease have early onset Alzheimers which appears
when the individual is in his/her 40s or 50s
3. Alzheimers worsen over time
a. In the early stages, memory loss is mild
b. Late stages, conversations with others will be lost and they will have trouble
responding to their environment
c. It is the 6th leading cause of death in America
d. Normally those affected by the disease live about 8 years after being diagnose, but
survival range can last 4 to 20 years
4. Alzheimers has no current cure; however, treatments are available to help slow the
process
a. These treatments can help ease the burden for loved ones and CAREgivers
Symptoms of Alzheimers
According to Alzheimers Association the most common early symptoms of Alzheimers is
difficultly remembering newly learned information (www.alz.org). The part of the brain that
Alzheimers typically attack is the learning part of the brain. As Alzheimers progresses
throughout the brain it leads to:
1.
2.
3.
4.
5.
6.

Increasingly severe symptoms


Disorientation, mood, and behavior changes
Deepening confusion about events, time, and place
Unfounded suspensions about family, friends and professional CAREgivers
More serious memory loss and behavior changes
Difficulty speaking, swallowing, and walking (www.alz.org)

A lot of our clients have early stages of Alzheimers, but for the most part it is difficult to
recognize it at first. Keeping these above points in mind when handling a dementia client will
help you as a CAREgiver recognize what you may be handling. This will make your career as a
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CAREgiver easy and enjoyable. Remember these clients need caring CAREgivers that will help
them perform daily tasks that they once could do on their own but not anymore.

Dementia
According to Alzheimers Association, dementia is a general term for decline in mental ability
severe enough to interfere with daily life (www.alz.org). Dementia is not considered to be a
specific disease and it consist a wide range of symptoms. With Alzheimers being the first most
common form of dementia, vascular dementia is the second most common form.
Symptoms of Dementia
Alzheimers Association lists the symptoms of dementia:

Memory
Communication and language
Ability to focus and pay attention
Reasoning and judgment
Visual perception (www.alz.org)

Keep in mind, that having these symptoms in mind will help your to perform well as a
CAREgiver with those who have dementia.

Stages of Alzheimers and Dementia


Early-Stage Caregiving
The early stage of Alzheimers is not a difficult thing to work with. At this stage, the individual
can function independently. He or she can still drive, work, and be a part of social activities. As
a CAREgiver, it is your responsibility to help plan for the future especially for the family
members. Although at this stage of the disease can last for several years, it is best to help family
members plan for the worse. At this stage of the disease, the most important thing a CAREgiver
can offer is companionship. Being a friend and someone the client can talk to will help ease
some of the burden not only on the client, but to family members as well.
What to Expect
According to Alzheimers Association, A person in the early stages may experience mild
changes in the ability to think and learn, but he or she continues to participate in daily activities
and give-and-take dialogue (www.alz.org). As mentioned above, these early stages can last for
several years and often go unnoticed. If a family member is puzzled on what to do, please
encourage him or her to take their loved one to the doctor for a full evaluation. A doctor can
properly diagnose the client if the client is experiencing any form of dementia.
Your Role as a CAREgiver
Your main role is to help with daily life, as needed, and to help the person with Alzheimers plan
for the future. A person suffering from the early stages of Alzheimers may need cues and
reminders to help with memory such as:
1.
2.
3.
4.
5.
6.
7.

Keeping appointments
Remembering words or names
Recalling familiar places or people
Managing money
Keeping track of medications
Doing familiar tasks
Planning or organizing

One way of being a successful CAREgiver is to know your clients strengths and weaknesses.
Our company will provide client information to help you with your care. At this stage, things are
changing for the client and another important thing to offer is emotional support. Keeping a
calm environment will help the client continue to function at ease.

Middle Stage Caregiving


This stage is typically the longest stage and can ultimately last for years.
What to expect
As the disease progresses, it can result in more damage to the brain which can make it difficult
for the client to express thoughts and perform routine tasks. According to Alzheimers
Association, Jumbling words, having trouble dressing, getting frustrated or angry, or acting in
unexpected ways, such as refusing to bathe can be signs of clients entering the middle stages of
Alzheimers (www.alz.org).
Your Role as a CAREgiver
At this stage of Alzheimers, a CAREgiver must be flexible and patient. Your role as a
CAREgiver you will have to take on greater responsibilities. Daily routines will need to be
adapted, and structure will become more important. Structure is the most important when it
comes to middle stage dementia clients. It is all about the structure. Because this is a very
stressful part of dementia clients, it is highly important to take care of yourself. Take periodic
breaks (you are going to need it). However, make sure that the client is not left alone.
Although your role becomes greater at this point, you still want to encourage the client to do
things independently. This will help ease the agitation that can often result in making it difficult
to provide adequate care for the client. You may need to help guide him or her when it comes to
dressing. Laying out the order in which clothes go on can help the client a lot. This still allows
the client to do things independently, but at the same time help him or her cope with the idea
things will be changing for him or her in the future.

Late-Stage Caregiving
At this stage, the client can be suffering from this for several weeks to several years. It varies
from client to client. At this stage, the client is required intensive care which means around the
clock care. The client cannot be left alone. A CAREgiver must be provided 24/7.
What to expect
Alzheimers Association provides a list of things to expect from clients who have entered the late
stages of dementia:
1.
2.
3.
4.

Has difficulty eating and swallowing


Needs assistance walking and eventually is unable to walk
Needs full-time help with personal care
Is vulnerable to infections, especially pneumonia
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5. Loses the ability to communicate with words


Your role as a CAREgiver
Your role as a CAREgiver is to focus on preserving quality of life and dignity. The clients
world at this point is primarily experienced through the senses. Some ways to help the client
cope with this stage of the disease according to Alzheimers Association is:
1.
2.
3.
4.
5.
6.
7.

Playing his or her favorite music


Reading portions of books that have meaning for him/her
Looking at old photos together
Preparing a favorite food
Rubbing lotion with a favorite scent into the skin
Brushing the persons hair
Sitting outside together on a nice day

As will all the stages, it is very important to monitor the food intake and report any changes that
may be happening. Our company will be providing daily logs that you can keep track of. This
daily logs will be located at each of the clients homes. At the end of this training manual, I will
be providing examples of what you will be seeing at the clients homes.
Some of the ways a CAREgiver can help with the feeding according to Alzheimers Association
is:
1.
2.
3.
4.
5.
6.

Make sure the person is in a comfortable, upright position


Adapt foods if swallowing is a problem
Encourage self-feeding
Assist the person with feeding, if needed
Encourage fluids
Monitor weight (www.alz.org)

Along with food monitoring, skin and body health is also to be considered:
1.
2.
3.
4.
5.
6.
7.
8.

Relieve body pressure and improve circulation


Learn how to lift the person
Keep skin clean and dry
Reduce the risk of bedsores
Maintain range of motion in the joints
Keep the teeth and mouth clean
Treat cuts and scrapes immediately
Protect against flu and pneumonia (www.alz.org)

Ways to Communicate
When communicating with a client that suffers from Alzheimers and dementia, communicating
with them can be a challenge. There are helpful tips on how to communicate with clients who
suffer from this disease. Alzheimers Association provides a useful communication guide that
will help you as a CAREgiver to communicate effectively with your client. These tips are as
follows:
1.
2.
3.
4.
5.

Be patient and supportive


Offer comfort and reassurance
Avoid criticizing and correcting
Avoid arguing
Offer a guess
a. Be careful not to cause unnecessary frustration
6. Encourage unspoken communication
7. Limit distractions
8. Focus on feelings, not facts
a. Offering to many facts can cause your client to feel overwhelmed and agitated
(www.alz.org)
Best ways to communicate
The most important way to communicate with a client who suffers from dementia is know how
to choose your words carefully. We all make mistakes and often those mistakes can leave one
realizing that he or she did something wrong. This is not a common thing when communicating
with those with dementia. It may not always be you, but the fact that communication can be a
tricky way to accomplish it is helpful to follow these tips when encountering a client with
dementia:
1. Identify yourself
a. Keep good eye contact
b. If the person is seated or reclined go down to his/her level
2. Call the person by name
3. Use short, simple words and sentences
4. Speak slowly and distinctively
5. Patiently wait for a response
6. Repeat information or questions as needed
7. Turn questions into answers
8. Avoid confusing and vague statements
9. Turn negatives into positives
10. Give visual cues
11. Avoid quizzing
12. Write things down
13. Treat the person with dignity and respect
14. Convey on easygoing manner (www.alz.org)
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Daily Activities
Having a daily structured life is very important to those who have Alzheimers disease. Keeping
the day organized and structured will not only help the client, but you as a CAREgiver as well. It
will also help teach family members on how to keep the day organized for their loved one.
Being the example will help family members cope with this disease and help ease the stress and
burden that this disease can cause.
Organizing the day
Alzheimers Association is a valuable source when it comes to organizing the day for clients who
suffer from this disease. According the organization, before making a plan, consider:
1.
2.
3.
4.
5.

The persons likes, dislikes, strengths, abilities and interests


How the person used to structure his or her day
What times of day the person functions best
Ample time for meals, bathing, and dressing
Regular times for waking up and going to bed (www.alz.org)

Need to allow for flexibility because not every day is the same. Some days a client will have a
good day and is willing to carry out the daily activity, but other days the client will have a bad
day and it is not willing to perform the daily activities.
Some of the activities that you can perform as a CAREgiver are:
1. Household chores
a. Allow the client to work with you on daily household chores
b. This will help the client to function as independently as possible with some
assistance of course
2. Mealtimes
a. Clients love to help with meals
i. Allow clients to help with the meals
ii. This will bring joy to many clients knowing that they can still operate
independently
3. Personal Care
4. Creative Activities
a. Does your client like puzzles?
i. If so, work on a puzzle together
b. Does your client like doing crafts?
i. Create some crafts for your client to enjoy
c. Does your client like watching movies?
i. Bring over some of the movies that he/she might enjoy
5. Physical
6. Social
a. Keep the conversation going
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b. Some of our clients love the companionship


7. Spiritual
a. Without getting into much arguments, ask about their background
b. Many of our clients love talking about their backgrounds
c. This will help you to get to know your clients in such a way as to assist them
Writing a Plan
Here are some questions to consider when writing a plan for your client:
1. What activities work best? Which dont? Why?
2. Are there times when there is too much going on or too little to do?
3. Are spontaneous activities enjoyable and easily completed? (www.alz.org)

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Caregiving for Dementia Clients Quiz


Multiple choice
1. Alzheimers is a type of dementia that causes:
a. Problems with eating
b. Problems with socializing
c. Problems with memory, thinking, and behavior
d. Problems with driving
2. Alzheimers accounts for:
a. 60 to 80% of dementia cases
b. 30 to 40% of dementia cases
c. 20% of dementia cases
d. 10% of dementia cases
3. Early stages of Alzheimers can occur in adults in their:
a. 20s and 30s
b. 40s and 50s
c. 60s and 70s
d. 80s
4. Alzheimers is the:
a. 4th leading cause of death in the U.S.
b. The leading cause of death in the U.S.
c. 6th leading cause of death in the U.S.
d. 5th leading cause of death in the U.S.
5. The most common early symptoms of Alzheimers is:
a. Difficulty remembering newly learned information
b. Learning how to drive
c. Learning how to walk
d. Difficulty remembering how to speak
True and False
1.
2.
3.
4.
5.

____Alzheimers worsens over time.


____There is a cure for Alzheimers.
____Alzheimers is not the most common form of dementia.
____Vascular dementia is the second most common form of dementia.
____Alzheimers changes typically begin in the part of the brain that affects learning.

Short Answer
1. List four advances that Alzheimers leads up to:

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2. List the five symptoms for dementia:

3. List four roles that a CAREGiver can perform during the early stage of Alzheimers:

4. What can a CAREgiver expect during the middle stages of Alzheimers? List the four
expectations:

5. List the five expectations that a CAREgiver can expect during the late stages of
Alzheimers:

6. List seven best ways to communicate with clients who have dementia:

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Appendix
Sample Activity Log
Client Name:__________________________________________________________________
CAREgiver:

Companionship
Hours

Shift Date:

Home Helper Hours

Start time:

Overnight Hours

End time:

Miles Driven
Client Activity

____________________________________________________
CAREgiver:

Companionship
Hours

Shift Date:
Start time:
End time:

Home Helper Hours


Overnight Hours
Miles Driven
Client Activity

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Helpful Resources

Alzheimers Association: www.alz.org


Your local Alzheimers Association charter
www.alzheimers.gov/caregiver_resources.html
www.alzfdn.org

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