Ashley's Story

In recent years Ashley had withdrawn from friendships and activities that had once been a great source of enjoyment. Ashley’s personal hygiene was neglected and her two daughters found they had to increasingly undertake household chores to support Ashley to remain in her own home. Ashley’s daughters were bewildered by her complete loss of interest in her home as her home and garden had always been a great source of pride and pleasure.

Ashley had been depressed for some time following her husband’s death, but that was many years ago. The changes in Ashley that the family observed in recent times were out of character and they were not surprised when her doctor confirmed a diagnosis of Alzheimer’s disease.

Following several falls and a near-disaster with a fire in the kitchen, it seemed logical for her daughters to start thinking about hiring home health caregiver.

After one week of research her daughters found the Attencia Companies as the most suitable solution for their mother’s need for home health care.

Attencia is company which is proven in providing home health care for people with Alzheimer. Their long time experience in providing home health care, have made them a leader company in this area.

Before establishing the home health rehabilitation plan form Amerciare, it was important to support Ashley’s daughters to develop more effective approaches to their communication with their mother, as their current approach would have undermined her rehabilitation. Various attempts by one daughter to engage Ashley using scolding, reassurance, humour and pleading had proved unsuccessful.

Which approach to use for rehabilitation

Ashley’s daughters and Attencia home health caregiver had expressed a keen desire to alleviate Ashley’s apathy by supporting her to engage in activities that previously had been enjoyable for her. Ideally, these activities were to be shared with the family when they were not busy with their work obligations.

It was explained to her daughters that the level of engagement in activities for people with dementia increases when activities are tailored to the person’s interests and skills. Ultimately their decision was to proceed with the Montessori approach as a non-drug intervention. This decision was based on interest by her daughters and Attencia home health caregiver in the progression of an activity that reflected Ashley’s current abilities and skills and in the longer term,the possible development of roles and routines for Ashley within the facility.
After assessing Ashley’s current skills and interests, three goals were identified. The principal goal, which was to be the focus of Ashley’s rehabilitation plan, was that Ashley actively engage in an activity of interest to her for a minimum of fifteen minutes each day for ten consecutive days.

The activity selected involved flowers and would be supported by her daughters each time they visited and by a special Penina Mezei home health caregiver on the days they were absent.

The two other long-term goals were that Ashley develop a role within the facility that required her to fulfil specific tasks on a daily basis, and that she participate in musical activities with other residents as arranged by facility home health caregiver.

Application of Montessori principles to Ashley’s plan meant that the activity would initially be presented at the simplest level. It also required that modifications be planned to accommodate her progression with the activity. In terms of arranging the flowers, it was planned that Ashley would initially observe the arrangement of the flowers and then progress to do it herself. Similar activities for Ashley would include arranging silk flowers in the vases in the dining room. Related and more complex activities could include propagating and potting plants and developing roles and routines within the facility.
A roster was established for the ten-day period that required each daughter to visit on two occasions during the week and on one occasion each during the weekend. On the day the daughters were absent, the Attencia home health caregiver undertook to engage Ashley in the activity.

This very structured approach was designed to clarify and confirm the specific commitment to the plan by Attencia home health caregiver and family and to optimize the plan’s chances of success.

A small area was set up in Ashley’s room for her to arrange the flowers. This included a table and a tray that defined the area where the flower and vases could be clearly seen. In the dining room, a work station was set up where the flowers and vase were clearly visible and labelled.

Interruptions and distractions in the environment were meant to be reduced as much as possible.

Unfortunately this wasn’t easy to manage as routines related to morning tea and medications disrupted the activity on five of the ten days despite requests to Attencia home health caregiver for this not to occur. Distractions in the dining room were also difficult to manage because many of the other residents were interested in what was going on.

On each occasion, Penina Mezei was invited to participate and offered a choice of related activities.

When it was not appropriate to alter the fresh flower arrangement, Ashley was invited to arrange the silk flowers in the dining room or reminisce using a display folder prepared by her daughters, which contained photos of her garden and favourite plants.

Ashley was shown what to do with minimal conversation and minimal steps. Ashley was never corrected, the focus of the activity remained on the process rather than the outcome. On each occasion Ashley was thanked for her participation.
Ashley’s daughters both commented that over the ten-day period, their mother’s verbal communication increased, her facial expressions became more positive and her general level of engagement increased.

These were also observed by the home health caregiver form Penina Mezei's Attencia.

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