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For people who have lived as a dementia caregiver for sometime, it is a commonly known fact that the condition is often accompanied by challenging behaviours. Some of the most common challenging behaviours and personality changes which I have noticed in my past experiences, have taught me that we can’t completely eliminate these behaviours or changes as the disease progresses. However, as the disease progresses there are several better ways to understand and deal with it, one of them being - focus on prevention. Some commonly observed behaviours are restlessness, physical acting out (hitting), pacing, wandering, night time walking, mood swings, following another person around the house all day, communication problems, changes in personality, disinterest, issues with eating and feeding, repetitive speech and the most challenging issue could be increase in agitation and aggression.

As we spend more and more time with our residents, we have new learnings every single day. At Epoch we try to accommodate the behaviour instead of controlling it, we have also learnt to be flexible because what works today may not work tomorrow.

I always inform my team members to report any behavioural symptoms as soon as noticed, for it can be a trigger for any physical problem which we would want to rule out first. The senior may be expressing it in form of anger or aggression. The best way to handle challenging behaviours are to do something different or change our perspective, and, we develop coping strategies. For example a person who is bored, we redirect their attention to help with simple house chores (with supervision, of course). We realize that when you try to control the person’s behaviour, it will often be met with resistance. All  behaviours are motivated with something  although it may not seem like it. A person with dementia is usually making a statement, even when performing repetitive actions (such as taking all the dishes out of the cupboard). He/she may be acting out of a sense of needing to do something meaningful or productive.

There are several potential sources of agitation and anxiety in people with dementia, including confusion, fatigue and overstimulation.

**Couple of useful tips for handling agitation include:**

- Address any chaos in the environment by reducing noise level and the number of people around
- Avoid moving household objects around often (familiar objects located in the same places can provide a sense of security)
- Change the immediate environment when the person with dementia becomes agitated
- Play soothing music
- Safety-proof the environment to allow for as much autonomy as possible with the least number of hazards around

**Many people with dementia have challenges in communication problems, which includes forgetting words, using repetitive phrases and more.**

- Give reassurance (try using touch if verbal support isn’t working)
- Limit external distractions when attempting to communicate (turn off the radio and television)
- Listen for the meaning of the feelings behind the words
- Speak clearly and loud enough to be heard
- Use non-verbal means of communication (such as positive body language, facial expressions and touch)
- Be specific in what you say - avoid the usage of pronouns. Use short sentences

Apart from anxiety, delusions, hallucinations and paranoia are common behavioural issues in people with dementia, which may occur as a result of changes in the physical health of the brain.

**Tips for handling delusions, hallucinations and paranoia include:**

- Avoid arguing or trying to impose a sense of truth or reality into the person with dementia.
- Consult with a psychiatrist or neurologist to find out if medication is needed “to handle symptoms that may get distressing for the senior. Understand the basic emotions behind a paranoid episode, for eg., when a senior suspects that his money has been stolen - the underlying emotion would be fear or the feeling of being cheated. Address this emotion rather than focusing on the situation.
- Reassure the person by saying things like, “I am sorry you are getting upset by this”.
- Redirect the person with dementia to divert their attention to something more appropriate

Insomnia, sleeplessness, sundowning are common behavioural symptoms in people with dementia. It occurs due to a combination of factors and can be worsened by being exhausted after a day’s events.

**Tips on how to handle sleeplessness and sundowning include:**

- Avoid giving alcohol, caffeine or sugar to your loved one
- Consider hiring help at night so you can get enough sleep without having to leave your loved one with dementia unattended
- Discourage napping during the daytime and ensure they are sufficiently active during the day.
- Talk to a health care provider about natural sleep-inducing medication, such as melatonin
- Turn the lights on and close the curtains well before sunset to eliminate confusion about the time, particularly in the winter months
- Play soothing music during night time to have a calming effect on the senior

It’s not always easy to find out why a person with dementia is wandering, but caregivers can use these insights to help them more effectively deal with the problem.

**Tips on how to handle wandering include:**

- Don’t constantly prevent them from wandering, if possible walk with them
- Add “elder-safe” plastic covers to camouflage door knobs or locks
- Consider a GPS tracking device only if the senior is comfortable with a wearable”
- Take safety measures in case of emergencies. Have a current photo of the senior on file, just in case the person with dementia goes missing
- Install door alarms and set them to go off if the door is opened
- Install locks that require a key (keeping safety issues in mind for all people in the home)

Caregivers to parents and senior loved ones with dementia already know that it can be difficult to care for a loved one as the disease progresses but we need to keep in mind that although you cannot change your loved one’s behaviour, you can always change your own.



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Challenging behaviours with dementia

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There’s the music of sarod playing in the background while I write this, helps me write my memoirs!

When I was a child, I used to write diaries. What’s enticing to me at that point in time was the smell of new vintage-looking pages, and a unique feeling to ink it down. It all started then. Who knew the passion for writing would grow so strongly on me!

Hi, I’m Sneha, Business Assistant & Content Writer at Epoch. Yes, I own these words and wear them with pride. The journey to earn this was pretty savage, and I’ll like you to be a part of this! Hence, sharing a page from my memoir.

It was the dawn of the year 2020 when I promised myself to come out of the University with a Mass Communication and Journalism degree in one hand and a placement in other. Things started turning upside down when the covid wave came along and washed away all the aspirations I had of starting my career in a corporate world. Later that year, after graduating, I started freelancing.

Little did I know that the universe had something else up in its sleeves.  On 1st Feb, I started my journey at Epoch, and it’s already a year now! I’ll need pinches from myself to believe so. When I stepped out of my comfort zone, came to a new city, I met amazing people, especially women, who inspired me in the most unusual ways. It is my sheer luck and fortune that I landed in Epoch right after college. The journey of amazement and learning didn’t stop for me, I would say.

How often does it happen that a CEO of an organization holds your hand, mentors you, and walks you through your journey? Well, happened to me and to all those who started anew! Here, at Epoch, I saw myself under the guidance of domain experts. From each one of them, I learnt something, both applicable in personal and professional lives. My team pushed me one notch beyond my threshold, surprisingly that brought different colours to my work. To date, I am told to be the owner of not only my projects, but also my decisions, successes, and failures. I am learning.

Epoch has played a vast role in shaping me into Sneha 2.0. If you know me and don’t believe, let’s go out for a cup of coffee! A confident and radiant Sneha, you’ll see.

Epoch homes abode elderly those who need dementia care and assisted daily living support. When I started, I was briefed about dementia but the understanding of the daily life of a senior 75+, came to me when I was in their presence. Recently through one of the Epoch webinars, I heard a doctor/geriatrician say, and I quote, “there’s a person still behind the dementia patient”, and this made me realize how naïve are we to not notice this in our elderly loved ones!

Amidst the pandemic, there were fewer interactions with our elderly residents, regarding their own safety. But whenever I got the chance, covered in PPE kit, I would jump to know each one of them. With some I sang era old songs, with some I recited poems of Harivansh Rai Bachchan, Dinkar, Nirala, with some I learnt the concept of perspective, with some I learnt fashion, some taught me to live life with a bang, and that’s what I am doing!

Epoch in a way turned out to be a blessing in disguise. I would like to stop the roller coaster of my emotions here by simply being grateful. One day, when I close my eyes, I would love the memories with Epoch to roll in the cassette of my life. 

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To Epoch, a cassette of my life

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I want to share my unique professional journey with you. Personally, I have been someone who is always up for trying new things.

In August 2014, after completing my training as a General Duty Assistant, I got placed at Epoch Elder Care as a care attendant.  Even though I had prior care training, being a care attendant in an assisted living home was new for me and there was much to learn, especially about dementia care. At Epoch, everyone is encouraged to ask questions whenever they do not understand, your colleagues and seniors will answer them patiently and help you understand your issues. I realised how tough life can be with dementia and at Epoch I was able to increase the quality of life of elders with dementia and this was very satisfactory for me. 

Given my inclination to try new roles, back in 2018, I was chosen for the role of Admin Assistant which was a huge change for me professionally as I was moving from  care to an administrative role. With much support of senior colleagues, I was able to manage this role with confidence. Here I learnt new skills like vendor management, maintenance planning, and working with multiple departments. Being an ex-care attendant, I was able to understand the importance of this role where I had to ensure the upkeep of Epoch homes and how crucial it was for our care attendants to take care of our residents. Iss dauran maine apni life ko bahut hadd tak personally, professionally and financially grow bhi kiya hai (During this time, I was able to grow personally, professionally and financially). 

Then in January 2020, I saw an opportunity to move to a new role within Epoch as a Human Resource (HR) assistant and I confidently took the leap. Given my prior experience as a care attendant, I was quickly able to connect to prospective candidates for Care Attendant role and understand who could be a good fit at Epoch, and I learnt the aspect of people management. Ab dedication and guidance of my manager and colleagues ke sath grow kar raha hun or hope aage bhi yun hi grow karta rahunga. (With the dedication and guidance of my manager and colleagues, I am learning & growing  ,and will continue doing so!)

Thanks to Epoch, I have been able to understand this industry well and grow myself professionally in many different perspectives by gaining many new skills.

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Trying new roles and gaining new skills at Epoch

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I want to share my journey so far with Epoch Elder Care. I started my journey as a care attendant with Epoch’s Monet house at Pune location on 15th May 2016 and sab kuch naya tha mere liye (everything was new to me). It was a great year well spent at Monet house; and bohot kuch sikhne ko mila (great learnings came along). Under the guidance of our Facility Managers and Facility Nurses and other care attendants, I was properly trained to look after our residents. Epoch work culture bohot welcoming and unique tha mere liye (Epoch culture was welcoming and unique for me) - where the team was great & they treated me like a family member. Not only this, the relationship and bond I developed with residents was an amazing feeling. The concept of dementia and its management was something jo mujhe dhire dhire samajh aya. (The concept of dementia and its management was something I learned over a period of time).

After the completion of one year, the management decided to transfer me to Epoch’s other home (Vermeer House) in Gurugram. I was happy with the decision for two reasons. Firstly, my learning was about to expand and secondly, my hometown was nearby. After working as a care attendant for a year and a half at the Vermeer House, the management decided to promote me to the role of Head Care Attendant. Finally, my dedication & honesty paid off. My responsibilities increased and I had to oversee all errands related to our residents, other care team members, and the house overall, which I enjoyed throughout.

Then again on 1st May 2019, I was offered a role change based on my skills and eagerness to work. This time the management decided to offer me the role of Admin Assistant, which I accepted confidently. It was challenging at first, but with the constant guidance of the then corporate team, I managed with quite ease.

Epoch has not only helped me professionally but also personally. It is here that I met Sarita (Care Attendant at Vermeer House), married her and started another chapter of my life. She is always there to support & motivate me. 

During the outbreak of COVID-19, around Feb 2020, I was handed over the role & responsibilities of an Office Assistant in the new Vermeer house at Gurgaon. Covid ke first wave me hume bohot kuch naya experience karne ko and samajhne ko mila. Ye time humare liye bohot difficult tha but hum sabne milkar Epoch and ek doosre ko sambhala. (New learnings came along whilst managing and experiencing the first wave of coronavirus. It was a difficult time, but we managed to pull through). I was presented with the COVID warrior award. Epoch ke saath ab itne memories jud gaye hain ki yahan har koi apna sa lagta hai. 

Epoch me hamesha kuch na kuch naya sikhne ko and samajhne ko milta hi hai and mere liye bohot unique experience banta raha hai.

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My journey of multiple roles at Epoch

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 From the past 1 and half years, our lives have taken a complete turn and things are at standstill. These times have been extremely challenging for everyone across the globe especially for the Healthcare sector. 

I am Aditi and I take care of admissions and customer relations for Epoch. I basically act as a liaison between the Client and Epoch starting from the first call till the time the elderly stays with us.

At Epoch Elder Care, we have our elderly residents living in our Assisted Living Homes. Even during these unprecedented times, we know how difficult it must be for children and family members living in different parts of the world to remotely monitor their parents and we felt the urge to help people who were approaching us for any kind of service. 

At Epoch, for any admissions we do, there is a lot of thought process and weeks of planning that goes into it. Every individual has different needs and set of requirements and we try to make the transition as comfortable as possible for them. 

In the last one year, even during this Covid times, we did admissions from California, Gurgaon, Delhi and Washington DC. 

For the elderly who moved from Washington, we received them at the airport and  booked a separate quarantine facility where we isolated them for about 5-6 days before we received them in our home, as per our Covid protocol. 

Pre-bookings were done, customised food was arranged from our house as per the dietary requirements of the elderly and the family members. We also provided our caregivers with the current care plan of the elderly and made arrangements for them to stay within the same isolation unit. 

Before their move in our facility, we customised the room as per the preferences of the family and the elderly.. We are always happy to do it all , it's all about going that extra mile to make them feel at home.

Due to Covid, a lot of families couldn’t come physically to visit us but we arranged whatsapp video tours for them, tried to send as many pictures as possible for the room they chose. In some move-ins we have also got the beds customised, added a small temple in the room, received elderies from their home (in the absence of their children in the same country) , ordered new clothes and treated Covid in-house. 

A lot of coordination between all the teams is required for new move-in, whether it is liasioning with the care team for personalised care plan or with the Admin team, to make all the customisations in the room or with the Food Team to make a curated menu as per the dietary needs of the elderly or the care team on ground to make arrangements to receive the elderly in the night at 2am or going all out to surprise them with a small hamper with all essentials.The whole idea is to take care of the entire transition process in the absence of family members and still be able to execute it flawlessly. 

Our goal is to extend help to people who are staying in different parts of the world or cities and are planning to move the elderies to Assisted living homes but are not able to do so due to Covid or the long distance.

We as a company understand the kind of stress any family member goes through in these difficult times and the kind of responsibility we have on us as a company. It is of utmost importance to build that trust amongst the families, to be in constant touch for all the little requests and to keep them reassured. 

It is just not about the move and that particular day but it is about the faith the family is putting in us and the life-long relation we build from there on. It is about the constant updates and reassurances we provide that help in bridging the gap between the families sitting miles across and their parents. It is  the love we receive from the families and our residents that keeps us smiling and motivated. 

This is the new normal of the Covid world for us and I believe for others as well. We are constantly learning new things everyday and are constantly striving to make it better for the new families approaching us.

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The COVID move-in experience

For people who have lived as a dementia caregiver for sometime, it is a commonly known fact that the condition is often accompanied by challenging behaviours. Some of the most common challenging...

Challenging behaviours with dementia

Viji Varghese , Facility Manager, Monet House

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