Training Trainers for the

1
Training Trainers for the Savvy Caregiver Program
Kenneth Hepburn, PhD Nell Hodgson Woodruff School
of Nursing Emory University
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Overview of the Afternoon

• What is the Savvy Caregiver Program and Where did
  it Come from?
• Overview of the Savvy Caregiver Program
• The Six Sessions

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Part 1 Origins of the Program
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Randomized Trials

• Two NINR-Funded Trials
• (1992-2000)
• Community Caregivers
• Treatment/Waitlist Control Design
• Hypothesis Treatment Group less Distressed than
  Controls

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Distress

• Composite Measure that includes 12 separate
  scales
• Factor Analytically Developed
• Weights Based on Factor Loadings
• Standardized to a Mean of 50
• With a Standard Deviation of 10

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The Distress Story
C53.60
54
C53.29
D I S T R E S S
ns P.095
53
P.04 by ANCOVA
E51.88
E52.63
52
E51.70
51
C50.56
50
baseline
6-month
12-month
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Conclusions

• Controls are significantly more distressed than
  Experimentals at 6-month
• Six-Month Between-Group Significant Effect on
  Distress Erodes but Within-Group Remains at one
  year
• Prevents/Retards Within Group Increase in
  Experimental Group Distress over 1 year
• Similar Effect with Burden
• Does not Affect Interpersonal Variables
• (Relationship and Loss of Self)

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Problem How to Transport Success?

• Challenges to Dissemination
• Replicating Faculty Training and Content
  Expertise
• How to package what faculty know and how they
  teach it so it can be provided by others who do
  not necessarily have content background but have
  group leadership skills?
• Maintaining Program Integrity
• How to assure that putting the program in someone
  elses hands wont just result in that person
  converting it to his/her own purposes?
• Incorporating Illustrations
• How to include demonstrations based on principles
  from other disciplines
• (e.g., occupational or music therapy)?

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Solution The Savvy Caregiver Program

• Through an Iterative Process, Developed
• Trainers Manual
• Detailed curriculum map (what teach when and for
  how long) instructions for talks and exercises
  slides and handouts homework assignments
• Caregivers Manual
• Text for the course all of the material for
  talks is included, plus assigned readings
  caregivers receive copies of slides
• Training Video
• Three-part video dementia stage presentation
  decision making putting the Savvy Caregiver
  guiding principles into practice
• CD-ROM
• Separately developed, includes stage presentation
  and content materials

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Developmental Activities

• Curriculum Development and Testing with a
  convenience sample
• Manualization
• Observation
• Field Testing
• (no observation pre-post data gathering)

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Testing the Savvy Caregiver Program(following
no-control field trials)

• Grant support from Alzheimers Association and
  local foundation (UCare, Minnesota)
• Randomized (Waitlist Controls)
• Same Measures and consent as NINR Trial
• Tested in Colorado, Mississippi, and Alaska
• Wide variety of program leaders
• - social workers, patient educators, public
  health nurses, recreation therapists, and
  physicians

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Study Sample

• About 40 caregivers in each group
• More adult children than in our previous
  randomized trials here
• 70 women
• Well-educated (as in previous trials)
• Non-Hispanic White

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Field Test (Formative) Results

• Effective for Caregivers (N88)

5. Strongly Agree
4. Agree A Little
4. 5. Total
87.5 10.7 98.2
More Knowledgeable
78.9 19.3 98.2
More Skillful
73.7 22.8 96.5
More Confident
67.8 25.0 92.8
Content Relevant
Useful Strategies
82.1 14.3 96.4
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Formative Results

• Acceptable to Caregivers (N56)

5. Strongly Agree
4. Agree A Little
4. 5. Total
74.1 22.2 96.3
Manual Understandable
80.7 15.8 96.5
Manual Tied in with Class
63.6 25.5 89.1
Will Use Manual in Future
72.0 25.6 97.6
CD-ROM Useful (n43)
CD-ROM tied in well
67.4 30.2 97.6
91.2 8.8 100.0
Trainers Effective
89.1 10.5 99.6
Class Info Clear
Would Recommend
93.0 7.0 100.0
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Non-Experimental Results -- Impact on Caregivers
(N57) 3-4 month pre-post trial
Variable All
p. Denver (21)
p.
Response to pre 8.77
9.74 Memory
Probs post 7.70 .089
7.30 .052
Response to pre 8.20
10.42 Behavior
Probs post 6.68 .022
8.26 .126
Response pre 30.39
36.24 Total
post 25.81 .023
27.61 .029
Zarit pre 38.66
45.15 Burden
post 36.32 .064
40.95 .109
Beliefs pre 47.69

47.18 (Monitoring) post 49.77
.009 50.71
.018
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The Savvy Distress Story
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C51.31
D I S T R E S S
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E51.66
E50.94
50
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Between Group Difference p .030 Within Control
Group Difference p .044
C48.67
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6-month
baseline
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Results

• Substantially Identical to NINR Trial
• Significant Effects on
• -- Distress
• -- Mastery
• Good Evidence for Fidelity to Program
• Glowing anecdotal material

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Limitations

• Done at a Distance (things we dont know) by
  people with their own agenda
• Homogenous Group no Diversity
• A Fair Number of non-adherent participants (no
  data)

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Part 2 Program Overview
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Caregiver Training

• Support and Counseling Important, but . . .
• Needed to Carry out the Role
• Knowledge
• Skills
• Outlook -- Attitude

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The Savvy Caregiver Program

• Six two-hour sessions (weekly)
• With groups of caregivers
• Lectures, Exercises, Homework, and Debriefing
• One or two leaders (from a variety of
  disciplines, including medicine)
• Leaders experienced in group leadership -- with
  varied backgrounds in dementia
• Community or clinic settings

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The Savvy Caregiver Workshop Objectives

• Help Caregivers Appreciate the Scope and Impact
  of Their Work
• Reduce the Potential Adverse Impacts of
  Caregiving
• Increase Caregivers Skills and Knowledge for
  Caregiving
• Help Caregivers Adopt a More Strategic Outlook on
  Their Work
• Help Caregivers Develop More Effective Strategies
  for Caregiving
• Improve Caregivers Self-Care Skills
• Improve the Quality of Life of Care Recipients
• Increase Involvement of Families and Other
  Resources

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Savvy Caregiver Knowledge

• Dementing Diseases -- what they are what they
  do what to expect
• Behavior -- how it occurs how to shape it
• Performance -- how dementia affects it
• Daily Life -- how to structure it

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Savvy Caregiver Skills

• Developing Strategies to fit the losses
• Avoiding Confusion and its consequences
• Designing tasks and activities to fit the
  persons performance abilities
• Maintaining a repertoire of calming strategies

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Savvy Caregiver Attitude

• Clinical Detachment
• Role Acceptance
• Experimentation and Evaluation
• Comfort with Control
• Self-Aware Self-Care

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How the Savvy Caregiver Workshop Works

• Group
• Sessions
• Exercises
• Talks
• Reports on
• Home
• Activities
• Feedback

• Caregiver
• Home
• Activities
• Reading
• Exercises
• Assignments
• CD ROM

• Group
• Sessions
• Exercises
• Talks

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Savvy Caregiver Program Materials

• Trainers Manual
• Handout Materials and Slides
• Teaching Videotape

• Caregivers Manual (200 page,
• large print)
• Handout Materials and Slides
• CD-ROM

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Part 3 The Six Sessions
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Session 1 Content

• Introduction to the program and program material
• Introduction of participants
• Welcome to the caregiving role
• Exploring dementia facts about dementing
  disorders
• The impact of progressive dementias on thinking
  and the implications of these losses
• Introduction to the resource materials for the
  program

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Session 1 Learning Objectives

• Introduce Selves and Purposes of Program
• Gain Appreciation for the Caregiving Role--
• an Unexpected Career
• Appreciate Dementia and its Impact on the Person
• Introduce Workshop Resources Text,
• Slides and Handouts

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Consider the Caregiver Role

• Assessment
• Care Plan Implementation
• Medication Management
• Treatment Monitor and Initiator
• Daily Life and Behavior Management
• Dietary and Activity Management
• Case Management

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Objectives of Caregiving

• Persons Safety and Comfort
• Meet Daily Care Needs
• Contented Involvement
• Fulfillment
• Reduce Suffering

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Facts about Family Caregivers

• Provide 80 of community care
• 70 of caregivers are women
• Provide 4-6 hours of care per day
• Provide care for 4-5 years
• 20 provide care for more than 4 years
• 30 are employed
• A growing percentage also care for children
• Typically only one family caregiver

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Compared to Other CaregiversDementia Caregivers
Are

• Twice as likely to have physical or psychological
  problems
• More than twice as likely to use Medications for
  mood and nerves
• At much higher risk of social isolation and
  economic distress
• Only half as likely to use health care

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Understanding Dementing Disorders

• Dementia is not part of normal aging
• Appreciate the scope and impact of these
• diseases and their prevalence in the elderly
• Separate myths from facts
• Identify own beliefs and fears

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What is Dementia?
Dementia is a condition of global deterioration
of memory and cognition that impairs thought
and social functioning.
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Facts About Dementia

• Not a part of Normal Aging
• Produced by a Number of diseases
• -- Alzheimers disease is the most common cause
• -- Vascular dementia the next most common cause
• Typically not reversible

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Required for Dementia Diagnosis

• Serious Memory Problems
• -- At Least One of the Following --
• Difficulties with social functioning
• Changes in Personality
• Impairment of abstract thinking
• Disturbances of other thinking processes
• Impaired judgment

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Facts About Dementia

• 5.2 Million Americans Affected
• Equal Opportunity Disease -- Perhaps
• Age Affects Onset

A F F E C T E D
50 25 10

• 70 75 80 85
• AGE

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The Course of Dementing Disease
Early Stages
Community-based Care
Late Stage -- Institutional Care
0 3 6 9
12
Years
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Myths and Fears

• Contagious
• Hereditary
• Bizarre
• Violent

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Medications for Dementia

• Some medications have shown some benefit
• -- appear to return the person to where s/he
• was 6-12 months before
• -- dont stop or reverse the disease process
• Research continues
• Beware of Questionable Treatments (Ginko Biloba,
  Chellation)
• Treat claims on the internet with suspicion

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The Impact of Dementia on the Person

• Teaching Sequence
• Identify Dementia-induced Problem
• for the Person
• Identify Caregiving Issues Stemming
• from the Problem
• Begin to Identify Broad areas of
• Caregiving Strategies

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Important Elements of Thought
Judgment
Attention
Memory
Thought
or
Language
Perception
Cognition
Abstraction
Reasoning
Organization
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Memory
Problems

• loss of recent memories
• long-term memories and over-learned behaviors
• remain longer
• gradual loss of detail in long-term
• eventually, virtually all memory fades

Caregiving Issues

• social skills forgotten
• cant depend on memory to prompt, orient, or
  stimulate
• dont expect new learning
• things may feel more familiar, but every day
  will be new

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Language
Problems

• word finding difficulty starts early on
• structure of language breaks down
• eventually, language not at all useable

Caregiving Issues

• frustration with word finding difficulty --
  supply
• missing words
• language increasingly unreliable for
  communication
• shorten and simplify sentences
• visual and tactile communication become more
  effective
• verbal skills may mask actual decline in thought
• Allow pleasure in available verbal interactions

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Savvy Caregiving Strategies for Memory Loss

• Be ready to supply missing information
• Create or strengthen routines
• Use preserved long-term memories for shared
  activities
• Avoid memory-linked language (Remember when. .
  . .)
• Dont point out memory loss (Ive told you that
  before.)
• Make use of over-learned skills

Savvy Caregiving Strategies for Language Problems

• Help out dont try to get the person to come
  up with the word
• Fill in the missing words, if possible
• Dont try to improve the persons ability
• Judge whats getting through
• match the persons ability
• If its funny, let it be funny

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Reason
Problems

• breakdown of connection between thoughts,
• objects, events, and actions
• behavior becomes more random and
• self-centered

Caregiving Issues

• cant reason with the person
• cant bargain or negotiate
• person will, increasingly, not think in cause
  and effect terms

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Judgment
Problems

• increasingly make poor choices
• safety issues
• may lead to hesitancy or impulsivity
• insensitivity to others

Caregiving Issues

• assume responsibility for safety
• -- but dont overprotect
• remember Its not Personal

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Abstraction
Problems

• loss of conventional concepts (time, distance,
• relationships)
• person increasingly concrete in thought
• inability to think in hypotheticals -- what ifs

Caregiving Issues

• providing directions -- need to be more
• and more concrete
• cant depend on abstraction to affect behavior
• (no If . . . then thinking)

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Attention
Problems

• harder to stay on task
• easier to become distracted

Caregiving Issues

• choice of suitable task
• attention to environment remove distractions
• increasing need for monitoring and refocusing

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Consider the Following Sentences

• Were going to your brothers for dinner on
  Thursday.
• Abstraction
• If we can have hamburger tonight, I wont have
  to go to the store till the weekend.
• Reason, Abstraction and Language
• Ill leave your lunch in the tupperware in the
  frig eat at noon.
• Memory and Organization
• Take the medicine 3 times a day for the next 10
  days.
• Memory, Organization, Judgement, Attention

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Make the Savvy Caregiver Shift

• Wait till Thursday pm to talk about dinner at the
  brothers house.
• Concrete
• Were having hamburger tonight.
• Directive -- not Reasoned
• Leave written note about lunch (plus reminder
  call)
• Reminders by YOU
• Set up the meds and remind -- or administer them
• no expectation -- Take Control

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Session 2 Content

• Review of previous weeks materials, readings,
  and homework
• Caregiver self-care Recognizing and dealing with
  Feelings
• Confusion the central problem in dementing
  diseases
• Taking Control The implication of Confusion for
  Savvy Caregiving
• A Simple Model of Behavior
• Communicating with Confusion Dealing in
  Emotional Truth

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Homework Assignments and Debriefing

• Development of Caregiver Self-Efficacy
• Experience own success
• Observe others successes
• Reinforce behavior of informed experimentation

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Session 2 Learning Objectives

• Develop Strategies for Self-Care
• Develop Caregiving Strategies Based on
• Appreciation of Disease Impact

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Caregiver Self-Care Four Quadrants of Feelings
Powerful
Negative
Positive
Powerless
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Identify and Deal With Feelings

• What Did/Do You Feel When
• You Got the Diagnosis of Dementia
• S/he cant Remember Something -- or Someone --
  Important
• S/he Couldnt Do Something S/he was Good at
• You Think about the Future

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Getting From Negative/Powerless to Positive and
(Maybe) Powerful
No Shortcuts Go Both Directions at
Once. Learning about and Acknowledging the
Disease is Empowering. So is Acting on Knowledge
Powerful
Do Something Use Knowledge and Skill to form a
Plan
Positive
Negative
Powerless
Let go Recognize the effects of the disease
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Confusion a Core Concept

• How it feels
• What it does
• What it means for the Caregiver

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Confusion
The World We Understand
Judgment
Attention
Memory
Thinking or
Cognition
Language
Perception
Abstraction
Reasoning
Organization
The World We Understand
CONFUSION
Confusion is Always a Possibility
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Accept Confusion as Central

• Youve Agreed to Help a Friend
• Three children under 6
• Two with earaches -- crying
• The other is cutting a tooth
• No naps and want things to do
• Dinner to be made
• TV and record player blaring in the background
• Your Spring allergies have just kicked in
• Key item missing for main recipe
• Pilot light goes out in oven
• A telemarketer calls

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How do you feel? What do you want to do?
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Emotional Impact of Confusion

• Need For
• Control
• Security
• Calm

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Implications for Caregiver

• You are the Anchor, the Safe Harbor, the North
  Star
• Shadowing
• Accompanying
• Questionning
• These are Cues -- Confusion is Present
• Tolerance (looking past the behavior) -- a basic
  skill and outlook for the Savvy Caregiver

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Take Control or the Swirling Universe Will

• Concern for Autonomy is Misplaced
• Capacity for Autonomy
• Progressively Diminished

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Confusion
Discomfort
Behavior
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Take Control
A Simple Model of Normal Behavior
Person
Behavior
Other
Surroundings
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Person

• People normally exert control over their actions
• They choose, based on some calculation of benefit

34
70
Support from Others

• Other people have an effect on behavior
• They may prompt a behavior
• They may encourage it to continue
• They may reward it -- or punish it

35
71
Surroundings

• The place or setting where a behavior takes place
  can have a powerful effect
• The way an activity is prepared, displayed and
  monitored affects its success
• Structuring Surroundings Helps to
• Channel behavior
• Encourage or discourage it
• Reduce options -- or increase them

72
How Progressive Decline in Dementia Affects
Behavior
Person
D I S E A S E P R O G R E S S I O N
Others
Surroundings
Person
Others
Surroundings
Person
Others
Surroundings
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Dealing in Emotional Truth
So the person says I want to go to the
cabin (but it was sold 30 years ago) I hope my
son comes over this afternoon(but the son lives
2000 miles away) Can we visit mom? (but mom
died 25 years ago
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Use Validation Strategies (Feil)

• Dont challenge the facts
• Search for the emotional connection
• (e.g., positive memories or feelings)
• Use the connection to find a diversion
• (reminisce, look at pictures, do something
• similar -- eg, with the cabin question,
• take a walk)

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Session 3 Content

• Propose a goal for caregiving
• Contented Involvement
• Fit matching tasks and
• activities to abilities
• The important elements of performance
• Stages of dementing disorders

76
Session 3 Learning Objectives

• Develop an appreciation for the benefits to the
  caregiver and care recipient of Contented
  Involvement
• Appreciate how Fit contributes to
• Contented Involvement
• Understand a staging system for persons with
  Progressive Dementing Disorders

77
Content and Involved

• Without distress
• Sense of Ease
• Pleasant
• Within ones limits and abilities -- not a
  stretch or effort
• Familiar
• Makes sense
• fits with who you are

• Engaged
• Zeroed in
• Attentive
• Focused
• Using ones available skills
• Busy
• Concentrated

78
Things that Take us from the Zone of Contented
Involvement

• Distractions
• Overload
• Boredom
• Fatigue
• Other physical needs (pain, hunger)
• Depression

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An Exercise in Fit
Youve got the neighbor four kids For the
afternoon. They are aged 4, 7, 10, and 14. You
decide to make chocolate chip Cookies.
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Cookie Making

• Materials Needed
• Recipe
• Ingredients (flour, baking powder, eggs, butter,
  choc. chips, nuts, sugar)
• Utensils bowls, spoons, measuring things,
  cookie sheet, mixer, cooling rack
• Old-Fashioned oven

• Actions Taken
• Set oven
• Measure things
• Other preparation
• Mix together
• Stir
• Shape cookies
• Prepare cookie sheet
• Put on cookie sheet
• Bake
• Cool

83
What do you ask each kid to do? What kind of
help do you expect each to need? How much
supervision do you provide for each? Punch
Line We intuitively understand and know how to
fit task and help to ability.
84
Key Elements of Performance
Youve got a fox, a chicken and a bag of grain
-- and youve got a rowboat. If left unattended,
the fox would eat the chicken, and the chicken
would eat the grain. You want to bring all three
across a river, but you can only take one item
with you at a time. How do you get them all
across safely?
85
Key Elements of Performance

• Purpose
• Order
• Appropriate Use

86
Purpose Order Use
Dementia Stages
First Signs Increasing Problems Significant
Impairment Dependent in Basic
Abilities General Confusion Minimal
Abilities Bedridden
87
Common Staging Systems for Dementia

• Global Dementia Scale 1-7 (1 is the earliest
  stage, forgetfulness 7 is comatose)
• Alzheimers Association Scale 1-4 (early,
  moderate late middle severe)
• Mini Mental Status Score 1-30 (30 is normal
  thinking)
• Allen Cognitive Levels
• 6-1 (6 Normal Thinking)

88
A Staging System for Progressive Dementia

• Time-Based
• (Alzheimers Association)
• Normal
• Early
• Early-Middle
• Late-Middle
• Late

• Performance-Based
• (Allen)
• 6.0
• 5.0
• 4.5-4.0
• 3.5-3.0
• 2.0-1.0

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Remaining Strengths

• Completely Independent
• Acts Effectively, but with Errors (of performance
  or memory)
• Needs Help Starting (may need prompting)
• Needs Direction throughout Follows appropriately
  and is independent in small parts
• Needs Detailed, Step-by-Step Directions
• Cooperates with Care Provided by Others

96
Session 4 Content

• Anchors of Contented Involvement
• Structure and Support
• Linking Disease Stage to Structure and Support
• Basic Communication Techniques
• Strategies for Common Behavioral Problems

97
Session 4 Learning Objectives

• Introduce Anchors of Contented Involvement
• Develop comfort with the stages
• Find a starting point for using the stages to fit
  structure and support strategies to the abilities
  of the person.
• Understand various forms of communication
• Be able to apply these principles to common
  behavioral
• difficulties

98
Person Personal Likes and Dislikes
Structure Nature of Task And How Task is Set up
for the Person
Content And Involved in Tasks
The Anchors of Contented Involvement
Support How to Instruct, Guide, Encourage, and
Keep on Track
99
Important Dimensions of Tasks

• Size
• Complexity
• Space/Distance
• Time
• Skills

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Support Any form of communication that helps a
person become or remain occupied

• Written directions
• Verbal directions
• Demonstrations
• Visual directions
• Examples of finished product

• Instructions to
• begin
• Reminders of
• steps and purpose
• Prompting
• Cues
• Redirection
• Guiding touch
• Handing things

102
The Order of Support Strategies
Abstract
Concrete
Visual cue linked to naming Handing step
by step direct by touch
Simple verbal directions Words linked
to demonstration visual cue (pointing) or
example
Writing Complex verbal directions Verbal
suggestions or reminders
103
Relationship Between Dementia Stage and Support
Strategies
Abstract Concrete
Early Early-Middle Late-Middle
Late
(5 4.5 4 3.5 3
2 1)
104
Relationship Between Structure and Support as
Dementia Progresses
Early Early-Middle Late-Middle
Late
Structure
(5 4.5 4 3.5
3 2 1)
Size small
large
distance in front
travel
Complexity one step
multi-step
Abstract
Concrete
Support
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Solving Common Behavioral Difficulties
106
Applying The Anchors and Fit Principles to
Behavioral Difficulties

• Is the task right?-- is this something the
  person likes?
• Is the structure right?
• -- too much/too little stimulus
• -- too much/too little help
• -- too much/too little space?
• Is appropriate support being provided?

107
Session 5 Content

• Designing tasks and activities
• for daily life
• Introduce a model for
• decision-making

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Manage Behavior Help Person Remain Calm and in
Control
Manage Daily Life Keep Person Enjoyably Involved
The Main Work of the Caregiver
Manage Resources -- Including Family Resources
for Care
Manage Own Well-Being Caregiver Self-Care
110
Designing Tasks and Activities for Daily Living
Review Handbook Materials regarding daily
tasks. Tie in with debriefing
111
The OOVL Decision-Making Model

• Options
• Outcomes
• Values
• Likelihoods
• Caregiver as decision-maker, more so as disease
  progresses

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Session 6 Content
Examine the role of the larger family in
caregiving Explore ways to strengthen the family
as a resource Review Savvy program
117
Session 6 Objectives

• Develop a way to understand their family and to
  incorporate them into caregiving (or not)
• Participants will appreciate that they have
  developed/strengthened their caregiving skills
• They will review the content of the program and
  appreciate and acknowledge that they have acquied
  more knowledge and skills -- and have altered
  their attitude about caregiving

118
Strategies for and Benefits of Family
Participation in Caregiving
Effective Use of the Family as a Resource
Improved Outcomes
Understanding what Kind of Caregiving Family
Situation Youre in
Quality of Life of the Person Good Involvement
More Caregivers
Knowing what Kind of Help you can Ask for and
Expect
Caregiver Quality of Life More Free Time
Being Able to Provide Specific Directions for
Enjoyable Involvement (Tasks, Structure, Support)
Family Satisfaction Feeling Useful
Family Harmony Greater Agreement
119
Five Types of Caregiving Families

• Solitary Caregiving
• Observed Caregiving
• Tag Team Caregiving
• Uneasy Caregiving Alliance
• Collaborative Caregiving

120
Barriers and Aids to Successful Family Caregiving
Barriers
Aids

• Denial
• Lack of Role
• Flexibility
• Lack of
• Experience

• Knowledge
• and Skill
• Having a Plan
• Communication

121
Family as a Caregiving Resource

• Understanding Family Caregiving Strategies and
  Types
• Overcoming Barriers to Stronger Family Caregiving
• Schedules
• Specific Plans (tasks and activities with
  Structure and Support strategies)

122
Dealing with Family Denial

• A Very Common Problem
• Share Information (e.g., the Savvy Caregiver
  Manual or CD-ROM)
• Offer Direct and Extended Experience
• Act as a Guide
• Choose an Activity likely to Succeed
• Give tips on Set-up and Support
• Draw in Other Resources -- Alz. Assn., MD, etc.

123
Major Areas of the Savvy Caregiver Program

• Improving Your Caregiver Skills and Knowledge --
  and Outlook
• Developing Skills for Self-Care
• Strengthening Family Resources
• Strengthening Decision-Making Skills

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Skills for the Savvy Caregiver

• Understanding the reality and meaning of losses
  in dementia the impact of Confusion
• Clarifying an appropriate goal for caregiving --
  Contented Involvement
• Mastering Savvy Caregiver Skills
• linking dementia Stages to Structure and Support
  strategies
• seeing troubling behaviors as part of Confusion
• developing a caregiving routine
• improving communication

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Caregiver Self-Care

• Recognizing and Dealing with Feelings -- Using
  the Quadrant Model
• Developing a Repertoire of Self-Time Activities

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Having a Savvy Outlook

• Role different from relationship
• Trial and error based in skills and knowledge
• Maintain modest goals
• Appreciate successes
• Be kind to self with disappointments
• Accept imperfections
• Recognize whats happening