Helping MiL with dementia to 'orientate' herself each day

[deccacards]

Sorry if this is a bit long.

MiL was in sheltered accommodation and moved into a care home at the end of last year. She has been wheelchair bound for some years and is also very hard of hearing.

She was already having some trouble with getting a fix on which day of the week it was and with managing her diary, and since moving into the care home it has got significantly worse. I gather that is far from unusual.

She now rings almost every day, and sometimes twice a day, to say that she has a note in her diary that DH is visiting her and why hasn't he turned up.

As patient as we try to be, it is beginning to send her and us slightly crazy. DH can tend towards denial and, at times, is reluctant to consider my suggestions to help her.

Currently, DH usually signs her diary when he has visited and writes his next visit in. He then asks her to find her diary when he calls, asks her to find today's date (often shouting down the phone at her because of her hearing aids/phone problems) and asks her to locate his own handwriting for the next visit. Frankly, it ain't working!

These are some of my thoughts, and I would appreciate any advice as to whether they might help:

• A couple of years ago I bought her a calendar clock that displays the day and full date, but DH doesn't really encourage her to refer to it. I think he should do so.
  

• Her diary is a small black pocket sized one, easily mislaid. I think she needs an A4 bright red one with the words "diary" in large letters stuck on the front cover. She often has her address book in front of her instead, and that looks very similar to her diary.
  

• If possible, we should ask the carers (lots of different ones) to make sure the diary is always next to the phone. (Doubt that will happen, as nice as they are.)
  

• When she calls, DH should ask her to look at the calendar clock, rather than repeatedly telling her the day and date himself. Although she wears glasses, she can see it quite clearly.
  

• When any family member visits, they should sign her diary, write a few words about the visit and ask her to countersign the entry with a few words of her own. A sort of "visitors' book" within the diary.
  

• As soon as someone visits at the start of each week, they should "bulldog clip" the previous week's page so the diary automatically falls open at the current week. (I suspect she will take the clip off though.) Maybe clipping the corners of the page instead?
  

• This one is from the "far side", I suspect, but I have suggested that if we can get her orientated to the right day by doing the above, she might be encouraged to write in her diary who she has called that day, e.g. on 2nd August: "Called Decca", and maybe a few notes about the call.
  

She is not far gone yet and quite capable of having a sensible conversation much of the time, but this issue is very distressing for her. If any of this might help, or you have other suggestions to make, I would be very grateful for your advice and experience.

[pippop1]

How about using a small loose leaf binder. Make a template page and print out loads of copies. Write in the day and date of the week e.g. Wednesday 14th November 2013.

Only give her a few pages at a time and store the used ones elsewhere.

The template could have boxes for what happened at the visit and space for signatures. Write clearly in large writing so it is easy for her to see while she is on the phone.

In other words, design your own page for her and clip it in.

[iliketea]

Can you put a whiteboard or chalkboard in her room that the carers write the day /date on and what plans are in her diary for that day?

I've seen it work successfully with residents who have dementia. Obviously, you need to have have a home with carers who are reliably going to change the whiteboard every day, but it might help with keeping er orientated to day and date.

[deccacards]

I'm not sure that a loose leaf file would work because I think she would end up rearranging the pages in order of what she thinks the date is! Thank you for the suggestion though.

I would love for the carers to put something on a whiteboard, but DH thinks it won't happen. The carers are very good, but they are a bit pushed for time and there seem to be a lot of them, so it's hard to get any consistency.

iliketea, do you think of the things I mentioned above might work?

[Needmoresleep]

I would look back and see how your MIL orientated herself when her memory first started failing. Mine used a calender on the wall, a diary and found the date through the daily newspaper. When my mother came out of hospital and started living in a new environment we tried whiteboards but found it too much for her to learn a completely new process. She refused a calender clock.

Now she is settled, the system is a calender on the wall, and a diary near the phone. She is luckily able to walk out to buy her daily paper, and has resumed the habit of using this for her orientation. However a diary/calender alone might help if:

1. when you phone, as her to put appointments in the diary or calender straight away...."in case she forgets"
   
2. ask if the carer can cross off each day when it has gone.
   

In short, if you can build on or reinforce habits she may already have, there is less to learn and is more likely to be accepted.