At this stage, people with dementia are emotionally perceptive, but very inwardly focused. Family members are no longer recognized. Or they are mistaken for friends or family known in earlier years. Confusing the present with the past is common. Yet they are still aware of physical sensations and are sensitive to the current environment.
An emphasis on comfort and calm
The emphasis of this stage, and in the final stage, is to keep the person you care for feeling loved, known, and safe. That starts with addressing the senses.
People in the late stage of dementia tend to be very aware of all their senses, so they find enjoyment in
happy or soothing music
clothing or objects that are soft to the touch
affection and gentle massage
In this stage 24/7 assistance is required.
Instinct is a primary driver A person with late stage dementia no longer has control over his or her environment. But he or she will be very perceptive emotionally. If you exude love and show caring with your body, face, and tone of voice, the person you care for will likely respond in kind. When he or she becomes anxious about something, even if it seems ridiculous, show concern. You need to demonstrate that you are trustworthy, that you are an ally. If the person you care for becomes anxious, you can often distract him or her away from the cause of concern and substitute a positive, engaging activity.
Communication is non-verbal Communication is severely impaired in the late stage. The person with dementia will have difficulty understanding what others are saying. He or she will likely talk less and less. What’s said may sound like nonsense. But listen for possible symbolic meaning. “I’ve been robbed” is a poetically accurate depiction of memory loss. “I want to go home” is often not so much about location as a longing for the sense of comfort that “home” represents. Studies have been done during which elders with dementia free associate, draw, and dictate their thoughts. They can be surprisingly insightful.
Music as a universal language. If the person you care for seems to have retreated into their own world, try a little music as a way to connect. Tunes from their youth will often bring a smile. Favorite hymns may even get someone singing who has not talked in quite a while. Try not to over-stimulate. Soothing music is best for starters. If that seems to be well-received, then you can build up to more rousing melodies. You may even be able to get your loved one up and swaying to the music for a little movement and body connection.
Emotional outbursts. Loud noises, cursing, refusing to cooperate, and even aggressive behaviors are usually a sign of pain or distress. It can be physical pain or emotional pain. Persons in the late stage of dementia usually cannot tell you what they are feeling. Look for nonverbal signs of physical pain, such as groaning, a furrowed brow, rapid breathing, or grabbing or clutching a part of the body. If there is no obvious physical problem, it may be something internal, such as a bladder infection. It’s wise to check with the doctor if outbursts are a problem. There may be a medical condition at the root of it. Or the source of the problem may be in the environment.
Look for triggers. Usually there is a purpose behind distressed behavior. Think about what was happening just before your relative did something strange or difficult. Was there pressure to get something done in a hurry? Did you ask him or her to do something that was perhaps too complicated, had too many steps? Or think about what need your family member might be trying to fulfill. For instance, wandering or restlessness may reflect a need for physical exercise. Anger or agitation may be a response to feeling out of control of a situation.
Use distraction techniques. One advantage of forgetfulness is that you can use the short attention span to distract your relative from a triggering situation. Perhaps there is a distressing program on the television. Maybe he or she was frightened by a noise or a picture. You can either remove the distressing object or suggest another activity and then take your family member to a different room to complete it. Distraction works best if you acknowledge your relative’s feelings first and establish a loving, nonverbal connection. Hold his or her hand, touch a shoulder reassuringly, and make eye contact. Then you might say something like, “I can see you’re upset. I would be too. Let’s go outside and check on the bird feeder.”
Accommodate their preferences. It’s easier to let your relative do what feels natural to them than it is to try to force them to do things differently. If carrying a baby doll gives purpose and a sense of meaning and comfort, then let the doll be part of the family. Your creativity and flexible responses can do much to generate an environment that feels safe and loving to a person who is confused and potentially scared much of the time.
Find “useful” activities. Even people with very clouded thinking like to participate and feel like they are helping. Folding towels, sanding wood, sorting coins, stringing beads, or sweeping the walkway…these are all familiar activities that can be comforting and very absorbing for a person with dementia. Plus time spent on these safe activities gives you a break. (Hint: The activity does not have to be literally useful. You can take the hamper full of folded towels to another room, and jumble them up again. Then come back and ask if your relative can help you by folding this load of laundry.)
Use short sentences and show rather than tell. As language capabilities diminish, your loved one can get easily confused. If you want your relative to do something, break it down into simple steps. Or better yet, show your relative what to do, one step at a time.
Wandering. Your relative may exhibit restless behavior. This can include walking aimlessly for hours. Or he or she may continually talk about needing to get home. Your family member may be searching for something and be unable to say what it is. Putting up signs for the toilet, the kitchen, and the closet can help your loved one stay oriented. Getting regular exercise can burn off extra physical energy. If you are worried about safety, something as simple as a “stop” sign on the door or a yellow ribbon across it can keep your relative inside. Plastic “child-safe” doorknob protectors can be useful, as can a home security system if you are worried about nighttime wandering outdoors. Many people with memory problems have trouble spatially. Sometimes a black mat placed in front of the door will be mistaken as a large hole and dissuade a person with dementia from crossing over it.
Following you from place to place. This is often called “shadowing” and it can be very unnerving. As your family member becomes less capable, he or she will want to stay beside you. Your presence provides a sense of safety and security. Providing verbal and nonverbal comfort and reassurance can help. Also, distracting your relative with an engaging activity can give you some moments alone.
Mealtime problems. Although your relative may still have an appetite, he or she may have trouble with the mechanics of eating. Using a fork or knife becomes too complicated. It may be better at this stage to change to finger foods. And a “tippy cup” or one with a built-in straw may be easier than a regular glass or cup for fluids.
After my mom fell and broke her hip, I was alone in trying to figure out how to best care for her in this maze of what is the senior health care industry.I had been trying to pull together what felt like 1000 pieces of disparate information......places to see, insurance companies, doctors to call, forms to be filled out, questions to answer. I was completely overwhelmed and under much stress.I am so incredibly thankful that I finally called Bonnie and scheduled a consultation. She was clear, knowledgable and so understanding. She immediately started making phone calls to find out the answers to some of my questions, and knew the answers to the other ones.I ended up asking her for further help and I will be forever grateful I did.She helped me move through a very difficult time with her knowledge, presence and help. She was there when I needed her and she knew exactly what to do. And she is fair, compassionate and has great integrity.My mom is now in a perfect place for her, and it all happened with as much ease as was possible.Thank you Bonnie, and everyone else we interacted with at AZ CareManagement.I don't know how I would have managed this journey without you.
Bonnie and Bob at Arizona Care Management went way above and beyond in helping me place my sister in a care facility to live out her last few months. Bonnie set up a medical transport from Newport Oregon to Arizona so that my sister could spend her final days looking at the beautiful scenery she cherished so much as a park ranger. The home in Cottonwood was well staffed and professionally managed and Bonnie and Bob made sure everything ran smoothly as I am on the east coast and care coordination was difficult to manage for me. Thank you both again for all you have done for my sister and our family during this difficult time.
I own two assisted living homes in the area and have worked with Bonnie, Bob and their staff several times. They always have the best interest of their client in mind when finding a long term solution for the family. It has always been my pleasure to accept one of their clients into my home. They continue to stay in touch with the family and assist them with any need they might have.If you are in need of an Elder Care advisor, I wholeheartedly recommend Arizona Care Management Solutions! If you live out of our area, you can count on them to fill in when you can't be here in person!
I live in Massachusetts and my 92 year old dad lived in Sedona. I was called in to take over his care because he could no longer live independently. I literally did not know where to turn. A social worker recommended Bonnie and her team to me. What a relief. They helped me get the necessary paperwork to handle his affairs while also finding him a safe and loving environment where he got the care he needed. He thrived there for nearly 6 months. During that time, I was kept abreast of his health and care by Holly. He enjoyed his visits with her and the treats she brought with her! I highly recommend Arizona Care Management to anyone needing help with their loved ones. They are excellent and I’m so glad they were recommended to me.
As the owners of GENERATIONS SENIOR LIVING LLC, we have the opportunity to work with Bonnie, Bob and the rest of the team at AZ Care Management Solutions with some frequency. Bonnie is absolutely the hardest working person we know! She has the knowledge base and the support team behind her to truly advocate for your loved one and they do a very good job! From assisting with POA paperwork, in-home care, assisting with MD appointments, or actual placement of your family member into a facility...... these guys can get it done!!! We highly recommend them.... Josh and Jamie Elliott
Most of us do not have any experience or training on how to make decisions or select assisted living accommodations. This group was a life saver in selecting a care giver, legal restructuring and finding a home. This was my first time dealing with dementia and I was guided down the path with their professional staff.
When I was having a hard time getting my dad's assisted living place to respond to his needs Gina stepped in with a firm hand and made things happen on Dad's behalf. She is kind, dedicated, tenacious, and extremely experienced and knowledgeable in this field. Bonnie has helped facilitate communication between me and a family member from whom I am estranged to make sure that all family members have access to the information about Dad that they want to have. AZ Care Management has been absolutely VITAL to me in helping me get difficult things done for Dad. I can't imagine navigating these challenging waters without them.
When our daughter was moved to Cottonwood for more extensive care, my husband and I were not able to travel for frequent dr. visits. We were not able, because we are both in our 80s, to visit as frequently as we wanted. AZ Cares takes her to appointments. They also provide very personable and capable assistants who take her on outings to provide social and emotional support for her in our absence. I cannot praise them enough for the support and help they have given our daughter and us. They are a blessing to us!
Arizona Care Management Solutions did a great job keeping my mom as safe as possible in her home for the last year. Once Gina came on board, she managed to do what I thought would be impossible - she convinced my mom to transition to living arrangements that would provide the care she really needed! Gina held her hand every step of the way, even through some VERY challenging situations. This lady has a heart of gold and can get things done!
As a Geriatrics/Internal Medicine specialist I relied on Bonnie and staffto find the best outpatient care for our patients. Her heart is passionate for the care of our seniors, and regards that as her mission in life. And I wasalways confident that Care Management Solutions would find the bestoptions for our families. God bless her! Dr. Paul C. Hanson of Cottonwood Internal Medicine
Bonnie, Bob and the team at AZ Care Management Solutions simply go above and beyond as advocates for seniors. Whether you may need assistance coordinating care, evaluating local facilities for placement, creating a plan for aging well or many other elder care services, you will find no organization more qualified or prepared to assist you than AZ Care Management Solutions. As a local Medicare insurance broker for several years, it is paramount that my clients have the right people in their corner. I have - and will continue to - recommend Bonnie and Bob and their team to any of my clients without hesitation.