What does a day look like for your loved one? Routines give us a sense of control over our lives and are especially critical for those who are largely homebound or who have dementia. Whether you are a caregiver yourself or directing those who do the daily caring, it is important to have some rules around meals, exercise, mental stimulation, hygiene, and connection during each day.
Type of Routine: Rigid or Loosey-Goosey
Some people love a strict schedule; they like to know what the day holds on an hour-by-hour basis. Other people dislike the rigidity of a schedule; they prefer a more fluid approach that allows them some flexibility and creativity. If you’re a caregiver, it is essential to get input from your older loved one about what type of routine they prefer. “Planning is going to be your key. Involving each other in the planning routine increases compliance,” says Terra Coomer, heart failure coordinator at Baptist Health Floyd. She says this involvement is especially important when it comes to nutrition and meal preparation, especially for older adults who have to follow specialized diets due to chronic health conditions.
The fluidity of a routine may also depend on whether the individual has cognitive disease. “When you’re working with someone that has dementia, routines are especially important. It adds structure and predictability for someone whose senses and cognition can’t be relied on,” says caregiver Lisa Smith. A routine may help reduce feelings of anxiety and minimize agitation.
If an older adult prefers a strict schedule, it might be appropriate to have an hourly schedule with everything written down. An individual who prefers a more flexible routine might do better with a checklist schedule. As long as items on the list get done that day, it may not matter at what time (medications might be the exception). The most important thing about whichever routine is chosen is that it is planned and not a haphazard approach.
Meals: Smaller, more frequent food
When Lisa is caring for someone in their home, she often works small servings of finger foods into the daily routine versus large amounts of food on a plate. “Sometimes it’s pieces of cut up fruit or meat cut into strips,” she says. If a client is sitting and watching TV, Lisa will bring them a small plate of food to snack on. “We all do that mindless eating sometimes, but for someone who is not getting enough nutrition, that is a way to get some calories,” she says. Dementia patients who don’t have big appetites may be easily distracted when it is time to eat, so Lisa recommends having a clean, uncluttered table and using plain colored plates without designs or patterns.
Don’t Overlook Hygiene
Hygiene is an often overlooked part of the routine, but it is extremely important. “[Good] oral hygiene becomes very important and decreases the chance of pneumonia,” Terra says. “Open sores on the skin increase the risk of infection.” Caregivers need to, of course, consider their loved one’s privacy and independence, but there is also the need for some form of inspection, especially for difficult to see places, like the feet or back.
Keeping up good hygiene is important to physical health, but it can also be important to emotional well-being. Getting a shower, washing one’s hair, and shaving often make a person feel better especially if they are homebound and feel sluggish.
Exercise
It can be a challenge to work exercise into a routine for a mostly homebound individual, but it can be important to overall movement and continued quality of life. A person will be more willing if they are doing physical exercise that they want to do, whether that is dancing, walking around the yard, lifting small hand weights, or using an exercise bike. Someone who hates walking on a treadmill is going to resist even if they know exercise is important for their physical and emotional well-being. There are multiple exercises created specifically for different chronic conditions — mostly found through searching online — though it can take some time to find ones that work.
Medical Monitoring
Decide on a routine for medical monitoring, which can include taking medications, checking blood sugar, taking one’s blood pressure, or for heart failure patients, weighing themselves each morning. Also have a way of recording it — it can be a spreadsheet that you create or a daily calendar that has a place to check off each thing.
Fun and Games: Mental stimulation
Keeping one’s brain active relieves boredom and helps reduce the chance of future cognitive decline. It takes some effort to keep it part of a day. Here are some ideas. Start with 15 minutes and work up to a few 30 minute times throughout the day.
• Crossword puzzles or regular puzzles
• Reading or listening to audiobooks
• Knitting, quilting, sewing, woodworking, whittling, or repairing items in the house
• Listening to music or watching an orchestra perform in a televised concert
• Sitting on the porch and bird-watching
• Writing a note/card to someone
• A short drive to see some local sites
Interpersonal Connection
Anyone homebound has a need to connect with others. Make a schedule and plan a phone call from family or friends each day or every other day. Plan visits the same way if possible. Caregivers could read their loved one’s church newsletter to them about happenings in their community as a way to make them feel more connected or help someone get on a Zoom call to get updates about various community concerns.
Calm for the Caregiver
“If the person has significant mobility issues and you can’t leave them unattended, you might have to be within view of them. But you might be able to sit and read quietly while they are doing their activity,” Lisa says. “You really have to tune into self-care. You need to be deliberate about learning what brings you relaxation in short periods of time.”
Lisa says when her father was a caregiver for her mother, he enjoyed listening to birds but couldn’t be far from her. “We found a speaker that broadcasted sounds from the outside into the house,” she says. This small speaker brought her dad a sense of peacefulness throughout his day when he was largely inside with his wife. “A lot of times, the patient’s well-being has a lot to do with the caregiver’s well-being,” she says.
By Carrie Vittitoe
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