This worksheet acts as a simple guideline for people considering admission to a retirement home or to a frail care centre for either themselves or someone they love and care for. Emphasis is on the practical considerations. You are, however, encouraged to look at the emotional implications of your decision and discuss these with someone you trust and can confide in.

It is important to ensure that the home is registered with the Department of Social Development, as registration is required in accordance with the Older Persons Act. The certificate of registration should be visible, displayed in a prominent place.

Of course, no home will meet all these requirements and deciding to enter or admit someone else to such a facility is one of the most difficult decisions one can be called on to make. At our regional offices and on our helpline we have staff and volunteers who can support you as you make this decision and any other important decisions that Alzheimer’s challenges us to make.

ACCESSIBILITY OF THE HOME

• Is it close to family and friends?
• Is it close enough to essential community activities e.g. church, shopping centre, hospital?
• Is it in a familiar environment or a new area?
• Will the resident be able to meet his/her spiritual needs at the home?
• Is it a mixed-sex residence?

FIRST IMPRESSIONS

• Is the property secure and are there visible security staff?
• Can a resident wander around freely and can the resident leave the grounds undetected?
• Is there a security system at the front door?
• Is the home linked to an armed response company?
• Friendliness of staff on your arrival
• Is the interior clean and attractive, with functional and comfortable furniture and decorations?
• Are there bad odours (especially urine)?
• Do the residents appear clean and appropriately dressed for the weather?
• Do the residents seem to be happy and occupied or are they sitting staring into space?
• Did you see staff and residents sitting talking to each other?
• Does the staff appear to be respectful and caring?
• Are there any birds or animals? Are pets allowed to visit?
• Noise – Are the sounds at a normal level and is there soft music playing?
• Is there a lounge with television and one without?
• Are there demarcated smoking and non-smoking areas?

FUNDING OF THE HOME

• Who are the major funders of the home?
• Is it a profit or non-profit organisation?
• Is there any form of financial assistance if frail care is needed or additional care that the residents may not be able to afford?

FINANCES

• Will you be able to afford the fees, possibly for an indefinite period?
• What is the annual increase in fees?
• If you have medical aid/disability cover/insurance, will it cover any of the costs?
• Are there additional costs that are not part of the monthly rate?
• How is ‘pocket money’ handled?

RULES AND REGULATIONS

• Are the rules and regulations made for the benefit of the residents or are they regimented e.g. fixed bedtimes and strictly enforced visiting hours?
• How much is the family involved in the individual managed care programme of the resident?

RESIDENTS’ RIGHTS

• Is there a residents’ committee?
• Are there channels for residents’ complaints?
• What means of communication are available to the residents e.g. telephones, facsimiles, e-mail?
• Is there privacy available for telephone calls?
• Is there transport to a hospital, clinic, shops etc?
• Are residents encouraged to remain physically and mentally active and to see to their own needs where possible and suitable?
• Are residents allowed to assist in the chores/activities of the home?
• Are residents called by name by the staff?
• Do residents have a choice of food and quantity? Are second helpings allowed?
• Are residents allowed to be sexually active?

BATHROOMS

• Own or shared?
• Bath and/or shower that has been adapted to the needs of the older person?
• Is there easy access to the bathroom, for a wheelchair?

FOOD AND KITCHENS

• Is the food of good quality and varied?
• Is provision made for special diets e.g. diabetic, low fat, halaal, kosher etc?
• Are the services of a dietician available?
• Are desserts and fruit part of the regular menu?
• Are there separate areas for food preparation, dishwashing and garbage disposal?
• Are visitors allowed to have meals in the dining room and at what cost?
• Are there ever any special meals e.g. Christmas, birthdays etc?
• Are there regular teatimes, with tea supplied by the home? Is anything served with the tea?
• At what times are the meals served?

GARDENS

• Is the garden easily accessible and available to residents?
• Are more active residents encouraged to assist in the garden?
• Are there benches outside?
• Is there a suitable safe path to walk on, in the garden?
• Are frail residents helped to gain access to the garden?

VISITORS

• Are residents allowed to go out for days/weekends and/or holidays?
• Can visitors come and visit at any time or strictly only at visiting time?
• Is there a private room for visitors?
• Do visitors have to sign in on arrival?
• Are relatives/friends encouraged to participate in the care of the resident?

STAFFING

• There needs to be good staff-resident interaction
• Are there enough caregivers on duty for every shift?
• Is there a Registered Nurse on each shift?
• Does the staff receive on-going training?
• Is there a resident doctor? Are you required to use him or may you use your own?
• What specialist medical services are available e.g. doctor, podiatrist, occupational therapist, physiotherapist?
• Have senior staff and management been trained in institutional management and care of the elderly and frail?

SAFETY AWARENESS, EMERGENCY PROCEDURES

• Is there adequate lighting in the home?
• Are there safety rails in the corridors?
• Are the floor surfaces non-slip?
• Are there easily accessible panic buttons, especially in the bathrooms?
• Is there a disaster plan for evacuating the home?
• Are there visible and accessible fire hydrants?
• Are there smoke alarms?
• Do they have regular fire drills in the home?
• What emergency medical equipment is available on the premises?
• Are there procedures to deal with elder abuse?
• What part does the family play in these procedures?

BEDROOMS

• Is there a view from the room?
• Is there adequate lighting?
• Is there a problem with damp in the room?
• What personal furniture and belongings are allowed?
• Is it a single or double room?
• Are the rooms shared? What happens if someone does not like the person with whom s/he is sharing?
• Is there an emergency bell in the room?
• Are there enough cupboards and drawers in the room?
• Is the resident allowed to have a kettle, toaster etc in the room?
• Are there enough plug points for bedside light, kettle, hairdryer, radio, TV etc? If not, are adaptors allowed?

WHAT ADDITIONAL SERVICES ARE PROVIDED BY THE HOME?

• Podiatrists (foot care)?
• Hairdressing facilities?
• Tuck shop or canteen?
• Day clinic/examination room?
• Are there activity rooms?
• Is there a regular activity programme?
• Taking into consideration their capabilities, do frail residents receive physical and social stimulation?
• Are residents encouraged to learn new skills?
• Are outside trips, outings or shows arranged?
• Is there any community involvement?
• Does the home use volunteers?
• Is the laundry done on the premises or contracted out?

Compiled by Lindy Smit, Loraine Schirlinger and staff of the national Alzheimers SA office

My dad’s chronic malnutrition was a direct result of him being fed a high carbohydrate diet in his home for at least 2 ½ years with very little in the way of protein, fresh fruit and veg and probably zero omega 3’s by people who had no clue about even basic nutrition and care.  When admitted to Brenthurst Residence, his body and musculature were badly wasted due to this poor diet, but most likely, according to my research, his diet was also very likely the driver of his dementia.

Following on from those events, I’ve done a lot of research on nutrition and diet and feel the need to share some of it with you.  Namely, according to scientific research, a carbohydrate-loaded diet exacerbates both dementia and cardio-vascular problems (among others).

Anyway, please can I prevail upon you (I’m begging actually) to take a look at this lecture, and if nothing else, PLEASE listen to the last section from 36 minutes onwards: https://www.youtube.com/watch?v=ibUMRf7TPro The section on metabolic syndrome is also important for anyone in the health care field to know.

I very much hope that the struggle my dad went through would not have been entirely in vain and serves some kind of good purpose and benefit to others.  Please would you join me in seeing that the diets of the elderly and vulnerable contains minimal amounts of carbohydrates and sugars?  That they are eating LOADS of fresh green vegetables, olive oil, coconut oil (which may directly help dementia), healthy animal fats, nuts, eggs and other proteins?  The scientific evidence is overwhelming and mounting; Dementia is now being called a “Type 3 Diabetes” as it seems to be driven by elevated insulin and blood sugars (from a carbohydrate/sugar heavy diet).

Some of you well know that Dad gained over 6 Kg’s during the few weeks he was cared for at Brenthurst Residence and responded very well to Physiotherapy for his severely wasted muscles and the Occupational and other therapies there.  Many thanks again for all your help/interventions.

And … as a result of my Dad’s struggle, I’ve learned a lot about dementia and diet and am studying a course on Nutritional Therapy.  I post relevant news, research and info on Twitter and Facebook under the name of “Cape Treats” should you be interested.  I wish you the very best! 

Andi

Alzheimer’s caregivers frequently report experiencing high levels of stress. It can be overwhelming to take care of a loved one with Alzheimer’s or other dementia, but too much stress can be harmful to both of you.

1. Denial about the disease and its effect on the person who has been diagnosed. I know Mom is going to get better.

2. Anger at the person with Alzheimer’s or frustration that he or she can’t do the things they used to be able to do.  He knows how to get dressed — he’s just being stubborn. 

3. Social withdrawal from friends and activities that used to make you feel good. I don’t care about visiting with the neighbours anymore.

4. Anxiety about the future and facing another day.  What happens when he needs more care than I can provide?

5. Depression that breaks your spirit and affects your ability to cope.  I just don’t care anymore.

6. Exhaustion that makes it nearly impossible to complete necessary daily tasks. I’m too tired for this.

7. Sleeplessness caused by a never-ending list of concerns. What if she wanders out of the house or falls and hurts herself?

8. Irritability that leads to moodiness and triggers negative responses and actions. Leave me alone!

9. Lack of concentration that makes it difficult to perform familiar tasks. I was so busy, I forgot my appointment.

10. Health problems that begin to take a mental and physical toll. I can’t remember the last time I felt good.

If you experience any of these signs of stress on a regular basis, make time to talk to your doctor.

*Brenthurst Residence hosts a Dementia Care Support Group, which is open to all and meets at 15h00 on the first Wednesday of every month, in the Brenthurst Residence lounge.

Blog courtesy of the Alzheimer’s and Dementia Caregiver Centre SA. www. alzheimers.org.za.

On the 21st of September, people across the globe will observe World Alzheimer’s Day in remembrance of those who suffer from this debilitating disease. As dementia progresses, the person will become increasingly less able to look after themselves – but this does not mean their life has come to an end. Approximately 24 million people suffer from dementia worldwide; learning how to care for them is crucial.

Whether you choose to care for your ailed family member yourself or place them in the charge of a caregiver or home, a key element of their well-being is simply not to be forgotten. Regardless of how frequently the elder is lucid, they need the love and support of their family and friends. Whichever avenue of care you choose, the key is to ensure your loved one is in good hands.

“Caring for someone with memory loss, confusion, restlessness and anxiety – all components of changes in the brain that is no longer able to receive or interpret signals – is not for the weak-hearted. It takes deep fortitude and strength of spirit,” says Matron Painter of the Brenthurst Residence.

As the elder’s ability to communicate falters, Matron Painter believes their behaviour becomes their language. “Gauging behaviour with this understanding can offer vital clues for managing their care. We can’t simply write off odd actions as being due to memory loss. Should we not rather consider what they may need, and in filling that need, reset their behaviour?”

Let us not forget that this person, even in their diminished mental capacity, is still a person. They lived a full life, had meaningful relationships, and shared their intelligence with the world for many decades. “When you view the elder as a person, as someone who was and still is an ‘Elder Resource’, you realise that they still have many gifts to give,” states Matron Painter.

When considering whether a care home is the right place for your loved one, question whether they focus on memory stimulating activities and what steps are taken to ensure the residents are comfortable and cared for. “We make special allowances, such as allowing couples to stay together at the home when one is suffering from dementia,” says Painter. “This helps the resident feel comforted and safe, while their partner gets the help they need to care for them, without having to live apart.”

The staff at the Brenthurst Residence passionately care for the aged, ensuring that their lives are still made worth living, helping them to fight off loneliness, helplessness and boredom. “When this is achieved, it goes a long way towards drastically improving their lives, alleviating the scariest and most frustrating elements of ageing and dementia,” she adds.

Family support is also incredibly important, and a vital element in keeping the family involved in the resident’s life. As such, Brenthurst Residence hosts a monthly *Dementia Care Support Group for family members and the community at large. The focus of this Group is to provide family and friends with vital tools needed to care for a loved one dealing with Dementia.

“When you see the elder’s eyes light up when something is triggered in the deepest recesses of their minds; when you realise that they are still alive inside, caring for them with love, patience and gentleness is a calling that must be answered,” concludes Painter.

For more information on dementia care, visit www.brenthurstresidence.co.za or contact Matron Painter at matronlpainter@telkomsa.net.

*The Dementia Care Support Group is open to all and meets at 15h00 on the first Wednesday of every month, in the Brenthurst Residence lounge.