Wednesday, April 25, 2012

Safety devices for families and caregivers

Safety Devices for Family or Caregivers caring for Dementia Sufferer's at Home or in Skilled Nursing

Adult children are moving back home to care for mom or dad as the recession has destroyed their parents 401k's leaving them unable to pay up to $7500/mo for dementia / Alzheimer's Memory Care Assisted Living. The other phenomenon that is becoming too quotidian is that the adult children are laid off from work and become the caregiver to the parent with dementia.
So how do you keep them safe if you can't be there all the time? Heck, how do you keep them safe if you're in the next room! Fortunately there are a number of great safety devices available on the market today to help keep your mom or dad safe in the home. Here I will go over some of the more common devices that are used to monitor the person with dementia and to alert the family or caregiver that mom or dad is either getting out of bed, off the couch, or going out the back door.
In the world of dementia and Alzheimer's, leaving a home or facility is referred to as elopement. In contrast, wandering is typically someone that walks all over a facility tirelessly, but does not leave the home or facility.
Combating Elopement (aka Leaving a House or Facility)
If mom or dad is safe during the day, but at night becomes more confused many times children will move in with their mom or dad so they can be with them during the night. The person with dementia can get into a lot of trouble and situations that are either unsafe or very risky if they leave the house. Sometimes all someone needs is a notification system to alert the family member or caregiver that mom or dad is out of the home. There are several helpful, simple, and affordable products for this purpose on the market at this time.
Magnetic Door Alarm
One of the most common devices is a magnetic door alarm. There is a magnet attached to the door and the door frame where an alarm will sound once the two sides are no longer in contact. Once the door is closed and the magnet re-aligns the alarm stops.
They even have devices that have a wireless alarm with a remote transponder (like a baby monitor) that you can keep next to the bedside so you will not sleep through the alarm should the front or back door be far from your bedroom.
Locking doors from the Inside may sound dangerous and it can be, you have to weigh out the worst case scenario in each situation. It may sound like a good idea and sometimes it's the only option, but having doors that lock from the inside is a potentially deadly solution. However, this article is dedicated to what happens in the 'real world' not just what is the perfect solution in a less than perfectly safe world. Because of this, I know there are innumerable solutions that families employ to keep mom or dad as safe as possible. As a home health Occupational Therapist I have seen solutions families that have conjured up that would make your jaw drop. This is one of the least desirable methods but it happens everyday when there is only one child that lives with the parent, and the child has to work during the day so staying up all night is not an option and many times the parent is in between not qualifying for Medicaid, but also can't afford to pay privately for a caregiver at night or to live in a dementia or memory care unit. If you have to use a lock on the inside of the door there are ways to make this safer although still not advisable.
Use is a hook and loop lock where you just lift up the hook on one end and drop it into the hole on the other. If mom or dad is short and you can put this up high then great. Otherwise, just because they have dementia does not mean they won't figure this out in two seconds!
A deadbolt can also be the type that has key inserts on both sides and it can lock from the inside. This should NEVER be used unless you've tried everything else! In a panic if you are trying to get out of a burning house in the middle of the night are you really going to think clearly enough to find the key? Much less get it in the hole without shaking so much you just can't do it?
The best solution here is to use a latch with a metal loop coming through the slit in the latch where there can be a combination lock that can go through the loop. A simple three digit combo lock can be undone in a matter of seconds and if there is a fire you won't have to worry about losing a key. Again, none of these options are a great idea, but they are used everyday by families in America.
Using a digitally coded door knob:
Using a door with a code to exit the home can keep the person with dementia inside the home at night while still allowing for quick access to escape in the event of a fire.
Lastly, it should go without saying, but if you ever leave mom or dad during the day even for a moment and have no other option to have a friend or neighbor stay with them or they can't go with you, you must remove the knobs to the oven and stove!
Dealing with Wandering at Night... Types of Alarms and Cameras Available:
Pressure sensitive pad alarms are one of my personal favorites although my clients and patients always hate them. There are pads that are typically as large as a piece of paper that can slide under a wheelchair/couch cushion during the day, and under someone's sheets during the night time. The pads are almost as thin as a piece of paper too! Once turned on, the alarm is silent as long as there is pressure on the pad. Once someone gets out of the wheelchair or bed the alarm sounds until it is either turned off or the person sits or lies back down. There are wireless devices as well that can be kept in a family members or caregivers bedroom.
Using a tab alarm or pressure sensitive pad-alarm:
A magnetic tab alarm a similar to the above except there is a little clip that is attached to the person and if that person stands up the clip is attached to a string and a magnet and once the magnet is no longer in contact, the alarm sounds. This device should only be used when the pressure sensitive pad can not be purchased. The reason being that most of my patients have been able to learn how to unclip the alarm, or they just take all of their clothes off and then get up from their wheelchair or from the bed. Also, many feel these clip-type alarms are a little degrading. Kind of like when parents put their children in those harnesses that have a leash attached to them making the toddler look like a miniature pony or something you would see at the county fair. I'm not saying I wouldn't use one on my kid, but come on, it's still kind of degrading. In the past we have had to use the tab alarm and the pressure sensitive alarm at the same time at night with a client, plus my favorite safety gadget I'll describe next. The pressure sensitive pad is usually as large as a piece of paper and only as thick as approximately 10 sheets of paper.
The magnetic alarm is a small box about 3 inches wide and 5 inches tall. Simply clip it to the back of their shirt or shirt collar and upon standing the string that attaches the clip to the magnet starts to beep loudly. Usually they are too smart for this however, so try a belt loop and place the unit under the chair or bed.
The cost for the above alarm types?
Pressure sensitive pad alarms between $70 and $240; Tab magnetic alarms from $35 to $110. Please shop around because as wrong and immoral as I believe it is, once you attach the word "medical" to anything companies quadruple the prices for no reason! If that isn't bad karma I don't know what it is....
Baby Monitors and Video and Infrared Monitoring devices
Nearly everybody knows what a baby monitor is but did you know it is probably the most utilized safety device for the elderly? This can allow seniors to call for help without getting out of bed, or if they have dementia and wouldn't remember to call for help then there are certain things that can be done to negate this fact. First you can use one of the above alarms in conjunction with the baby monitor so you will be sure to hear it. However, in the real world most of the time people just don't have the money to buy the above alarms and the baby monitor so they just get one. Well, if you just buy one of them, buy the pressure sensitive pad or tab alarm ONLY IF your bedroom is close to mom or dad's room and you know you will hear it.
If your bedroom is far away and you can only afford the baby monitor or the alarm then here is what we have advised families to do. Buy the baby monitor and use it this way. You want to get a couple glass or plastic jars and fill them with either coins, or preferably bells. Cut a small hole in the top of the lid so it will be even louder when shaken. Then you put two or three of these jars at the side-edge of the bed wherever mom or dad would get out of bed. When the jars hit the floor they are loud and you will here this in the baby monitor. We have even had people put a string across the room so if mom or dad stood up from the bed they would hit the string that is tied to the jar on a shelf and when it hit the ground it would be picked up by the baby monitor.
Now the ultra-deluxe-supreme-safety-pack is to have the pressure sensitive alarm in conjunction with the baby monitor that has built-in video with a monitor in the families or caregivers bedroom so you don't have to go all the way down the hall if you think you hear something. These devices are great!
COST: Standard baby monitor from $15 to $50; video baby monitor from $130 to $350. Although I'm a big believer in Craigslist, America's modern digital flea market. Why do you need a brand new one? Used video monitors for $50.
Lifeline other pendant or bracelet self-call devices
Here I am talking about the necklace or the bracelet where someone can push a button and an operator comes through a box in the home to find out if everything is ok. For the person with mild dementia this can be a viable option because they are often able to remember what the pendant or bracelet is for and to actually use it. This is normally only useful and appropriate when people are in the first stage of dementia and are still living alone from a few hours to 24 hours a day and would actually remember to use the push button on the bracelet or pendant if they were in an emergency situation.
Scott Kemp
Dementia Expert, Occupational Therapist

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