PEARL MODULE - Homesteadneoshcaregivers.homestead.com/Pearl_Module.pdf · Since we know that a Pearl’s muscles are always turned on, it makes providing care very difficult. ut there

The Pearl Module

Senior Gems®

SENIOR GEMS® is based on GEMS™, techniques, strategies, and overall approach to care which was created and devel-oped by Teepa Snow, Positive Approach, LLC. GEMS and POSITIVE APPROACH are trademarks of Positive Approach, LLC. SENIOR GEMS® is a registered trademark of Senior Helpers. ©2011 SH Franchising, LLC

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Late-Stage Dementia

PEARL MODULE

Why do we use the Gems?

The Senior Gems® are based on the Allen Cognitive Disability Theory.

Each gem represents a stage of dementia from normal aging through

late-stage dementia. We use the gems to help us understand the chang-

es that are taking place and to know what our clients are still able to do

in order to provide the best care possible.

Dear Learner,

This training guide was designed for you to complete as a self-study

activity. Please do the following in order to ensure successful comple-

tion:

First, read through EVERYTHING. There is a lot of important

information throughout the guide. If you find something that

will be helpful to you and your clients, underline or highlight

that information.

If you have a question, please ask: ________________________

Once you are finished, take the quiz at the end, and review

these answers with your supervisor. You will need to answer

eight out of 10 questions correctly to pass.

The packet will be yours to keep, but you must turn the quiz in

to your supervisor.

Due date: _________________

Taking the time to complete these learning guides shows that you care

about your clients and want to provide the best service possible. Thank

you for your hard work and dedication!

Pre-Quiz

Test what you already know about

Pearls!

1. When working with a Pearl,

getting tasks and care done

quickly is the best approach.

True or False

2. Making connections with a Pearl

is no longer important.

True or False

3. If a Pearl doesn’t verbally tell you

that they are in pain or aren’t

feeling well, it’s safe to say that

they are OK.

True or False

If you answered FALSE to all of these

questions, you are well on your way

to working effectively with Pearls.

The Pearl Module

Senior Gems®


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What’s Inside?

Introduction p. 1

Objective p. 2

Characteristics of a Pearl p. 2

Amber and Ruby Review p. 3

What to Expect p. 4

Providing Care p. 5

Making Connections p. 6

Aromatherapy p. 7

Validation Therapy p. 8

Pain Management p. 9

Communication with the Family p. 10

Five Stages of Grief p. 11

When I Look at Her/

When She Looks at Me p. 12

Quiz p. 13

Caregivers completing this learning module will know the

identifying characteristics of a Pearl, what to expect at this

stage, how to continue to make connections, and the ben-

efits of aromatherapy and validation therapy. Caregivers

will also be able to identify appropriate ways to communi-

cate with family members and understand the five stages

of grief.

Characteristics of Pearls

On the Gems scale, Pearl represents late-stage dementia. A pearl was chosen to represent this stage

because the gem is hidden inside a shell. It looks as if there is nothing of value on the outside (the

shell), but if you open the shell and look inside, you see the amazing gem we are talking about. As

caregivers, we must remember to look past the shell and see the gem on the inside. Below are some

basic characteristics of a Pearl:

Muscle control is greatly diminished, leaving their muscles turned on; you will notice

them curled up and leaning to one side.

They are unable to have isolated muscle movement.

You may notice them writhing as they have moments where their muscles are unable

to relax.

Be careful forcing them to move; it can be very painful for them.

The Pearl Module

Senior Gems®


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Before we get started with Pearl, let’s do a review of Amber and Ruby. For each statement below,

identify whether or not they are true by circling either TRUE or FALSE. If you have not completed the

Amber and Ruby Modules, move ahead to page 4.

1. When talking to a Ruby, it is best to yell so they fully understand

you. TRUE or FALSE

2. Ambers are hypersensitive in the four main sensory spots: lips/

tongue/mouth, palms/fingers, soles of feet, and genetalia. TRUE or FALSE

3. Playing songs a Ruby is familiar with and that can provoke happy

memories is a great way to engage your client. TRUE or FALSE

4. When assisting an Amber with a task, using Visual, Verbal, Touch

can really help the individual understand what you want them to

do.

TRUE or FALSE

5. Due to the loss of fine motor skills, it is better to keep your client

stationary so they don’t hurt themselves. TRUE or FALSE

6. You should make sure you stay on schedule with planned activi-

ties for a Ruby, rushing them from one place to another. TRUE or FALSE

7. It is important to have a good balance of the four different cate-

gories of activities: productive, leisure, self-care, and restorative. TRUE or FALSE

8. When working with an Amber, you should give them multiple

things to do so they have choices. TRUE or FALSE

9. Since safety is a huge concern for an Amber, it is best to get rid

of all of the safety hazards and empty the environment. TRUE or FALSE

10. Rubies may not be able to recognize when they have to use the

bathroom or don’t remember where the bathroom is. TRUE or FALSE

11. When speaking to an Amber, you should keep speech short and

uncomplicated. TRUE or FALSE

1. False 2. True 3. true 4. True 5. False 6. False 7. True 8. False 9. False 10. True 11. True

The Pearl Module

Senior Gems®


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The top of the brain (muscle control) dies at this stage of dementia leaving all of the muscles turned

on, and there is no off switch. For the muscles there is no relaxing and no quitting. The disease is de-

stroying a lot of the control the brain has over the body. Since a Pearl’s muscles are turned on all the

time it is important to remember to try not to straighten a persons arms or legs, without relaxing them

first. Trying to straighten their arms or legs may cause them a great deal of pain and they may yell out.

When walking, a Pearl’s back is curled forward and their arms are pulled in. They are also taking small-

er steps and walk on the front of their feet. A Pearl no longer has isolated movements, making it im-

possible for them to sit down fluidly. As a result, they fall into a chair when trying to sit down. The

strongest muscles in their bodies are pulling across, in, and down, which is why the arms and legs are

pulled in. If a Pearl is sitting for a long period of time, their body is curled up. They fall off to one side,

unable to keep their balance and continue to sit up straight. A Pearl can also fall forward from a sitting

position. Due to no longer having isolated movements, they cannot straighten out their legs or arms to

catch themselves. This results in falls and injuries can occur.

It is important for our behavior to change when working with a Pearl and to remember that there is

still a person inside the shell.

The Pearl Module

Senior Gems®


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Since we know that a Pearl’s muscles are always turned on, it makes providing care very difficult. But

there are some tips and tricks to make providing care as smooth as possible!

As caregivers, we know that this could be uncomfortable for our clients. It is our job to change our be-

havior and use what works with our individual clients. We focus on taking care of the shell and forget

the most important thing is what’s inside.

Don’t be in a hurry to get a task done. Many believe that moving quickly to get the task done fast-

er is the best way to do things. However, the worst thing you can do is hurry up and try to get

things done quickly. They can get frightened since they don’t know what you are doing, and inju-

ries can occur.

Check for the presence of the grasp reflex. Knowing if they do or do not have the grasp reflex still

will help you provide better care. If the grasp reflex is still present, your client can grab your arm

while you are trying to provide care and potentially can cause an injury; they no longer have the

ability to release their hand. Put something safe in their hand to grasp so they won’t grasp you, or

use hand under hand.

Hum and sing to get the brain active. This will help to get your client to relax, which sends a few

messages to their muscles to relax. This will provide you with enough time to provide the neces-

sary care. Their relaxed muscles will give you the ability to lift their arm a little and do what you

need to do without hurting them.

Use only one hand at a time when providing care. If you use both hands, it can be very over-

whelming for your client since they are having two (2) sensory experiences at once. Use one hand

for the task and one for the connection, like placing your hand on their shoulder.

Start care from the back of the body. The main muscles of the body are in the back, so there is less

of a chance of hurting your client when providing care by starting there. If you need to, roll the

person to their side, and provide the support that’s going to make it easier for you and them.

Slow down! When giving your client any type of cue (verbal or visual), give them up to 30 seconds

to respond to the cue. It may seem like a long time, but it will be beneficial to both you and your

client.

Use increased energy if you want them to rouse and be alert and a calm voice if you want them to

relax and sleep.

The Pearl Module

Senior Gems®


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There are many ways to make connections with your Pearl, despite traditional communication meth-

ods not being effective anymore. If you look at just the shell, there is nothing of value there. But if

you open the shell and look inside, you see the amazing gem we are talking about. Your job is to be

there when the shell opens and make a connection. They are mostly isolated and away, but are still

capable of having moments. When making a connection with a Pearl, always be friendly and warm.

Even if your Pearl doesn’t respond, continue to talk to them; don’t act as though they are not there.

Here are some ways to help make meaningful connections:

Sing, hum, and move along to music that is

relevant to them.

Comfort the person with touch, like putting

on lotion or holding their hand.

Provide simple tastes or

smells.

Rock in a rocking chair or

glider chair.

Wrap them in something

warm, like a blanket or some-

thing fresh out of the dryer.

Make a mobile with things

they were interested in. For

example, if they enjoyed

playing cards, make a mobile

with cards.

The Pearl Module

Senior Gems®


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Individuals with dementia typically lose their ability to recognize dangerous smells, but don’t usually

lose their sense of smell entirely. This includes smoke, gas and chemicals, spoiled food, body order,

and urine and feces. Since their sense of smell is still somewhat in tact, aromatherapy can be used to

help give your client a relaxing and pleasant experience. Aromatherapy can be a great tool to use to

help relax your client. It also uses their sense of smell to create a positive, personal connec-

tion, and bring back some positive memories. Studies on aromatherapy have shown that it

can lower anxiety and stress levels, improve a person’s mood, and improve the quality of

life.

Aromatherapy can be used to help your client relax when it is time for you to provide care.

As we learned earlier, it is easier to provide the care Pearls need when they are relaxed.

Lavender and chamomile are excellent scents to help with relaxation. Applying lotion with a

lavender or chamomile scent to your client’s hands is a great way to introduce aromathera-

py as well as continuing to make that personal connection.

Incorporating a familiar and happy scent from a person’s past can also help them relax, lower stress

levels, and bring back a familiar memory. The Service Plan and Getting to Know You Guide are great

tools to use to find out what scents would be familiar from their past. Some examples would be:

Mrs. Jones was an avid baker and would always bake a fresh apple pie when her grandchildren

would come and visit. Using a fragrance or scent of apple pie will trigger memories from her past

of baking apple pie for her grandchildren and the joy it brought her.

Mr. Brown enjoyed gardening and took pride in his rose bushes. Fresh roses can be brought into

the client’s home and the fragrance can help relax Mr. Brown and remind him of the joy he experi-

enced when gardening.

What are some other aromas a Pearl might like?

The Pearl Module

Senior Gems®


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Validation therapy was developed by Naomi Feil, M.S., A.C.S.W. as a way of communicating and

better understanding individuals with cognitive impairments. Validation therapy can help caregivers

see the world through their clients eyes and gain a better understanding of what Pearls are experi-

encing. It is based on validation and the acceptance of the reality and personal truth of another’s ex-

perience. Validation therapy provides a caring, non-judgmental way for individuals with cognitive im-

pairments to express themselves.

It is really important to continue to make connections with your client at the Pearl stage. Despite

your Pearl not being able to communicate verbally, there are ways to continually make connections

and understand how they are feeling and what they are going through. Since there is little to no ver-

bal communication, it is important to be observant of the nonverbal cues your client is giving you. As

a caregiver. More than likely, if they are giving you that cue, there is a need. For example, if you see a

tear on your client’s face, there is a need that they are trying to communicate with you.

When trying to make a connection with your Pearl, you want to go wherever they go; when they are

through with something, go with them, and don’t worry about where you’re going. What does this

mean? When you start your shift, your Pearl is lively and tapping their hand on the arm of the chair.

You respond to this cue by singing a song that matches the intensity of their tapping and you have

made a great connection with them. Your Pearl then slows down their tapping and has become quite

relaxed. Rather than trying to keep them lively, you go with them into their relaxed state. You adjust

your song and/or actions to match their needs and expressions. Using this approach will help you to

better understand your Pearl and their nonverbal cues. It allows the two of you to become one per-

son.

An important thing to remember is that a break through won’t happen every time. The key is to keep

trying. If you continue with this process and mirror their movements, you will have communication.

What are some ways you can connect with your Pearl?

The Pearl Module

Senior Gems®


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As we have learned, a person’s ability to use their fine motor skills has diminished at

this stage of dementia, including their ability to speak. Since they are unable to ver-

bally communicate if they are in pain or are feeling sick, it is important that you are

observant of the nonverbal cues they are giving. If you notice any of the following

physical or nonverbal signs, or any sudden changes in behavior, contact your super-

visor.

Always keep an eye out for any of these signs, and remember to call your supervisor right away if you

notice any changes.

Physical Signs of Pain or Illness

Pale skin tone

Flushed skin tone

Dry, pale gums

Mouth sores

Vomiting

Feverish skin

Swelling of any part of the body

Nonverbal Signs of Pain or Illness

Facial grimacing

Writhing or constant shifting

Moaning or groaning

Restlessness & agitation

Guarding the area of pain

Tense face

Tears

Behavioral Signs of Pain or Illness

Any changes in behavior can indicate that your Pearl is either in pain or not feeling well. Be

aware and observant of their behaviors to help you recognize when something is different

or has changed. If you are working with a new client, be sure to look at the care plan for

any insight into what their behavior was like in the past. Having a discussion with your su-

pervisor can also help. Once you have a good idea of what your client’s everyday behavior

should look like, start a care journal to keep track of behavioral patterns so you can easily

identify any changes.

The Pearl Module

Senior Gems®


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As a caregiver, you want to make sure the lines of communication are open with the family of your

Pearl. Be sure to communicate both the positive and negative moments of their loved one’s day, al-

ways communicate in an appropriate manner. Even though the precious gem isn’t always showing,

they are still a person. When you are speaking to the family, be aware of your surroundings. Speak

positively about your Pearl when they are in the room. If your Pearl happened to have a bad day or a

bad moment within the day, pull the family member aside, out of hearing range of your client.

Read the following situations, and decide if it was an appropriate or inappropriate way to talk with

the family while the client is in the room.

1. “Your mother had a great day today. We looked through some old photo albums, and she smiled

at all of the pictures from her wedding and of the grandkids. We even got a chance to listen to

some of her favorite music. She was very happy when the music was playing, and that gave me a

chance to put some lotions on your mom’s arms like you asked me to.”

2. “Your mother had a terrible day! I played her favorite music, but she apparently didn’t like it to-

day. It didn’t relax her, so I couldn’t put that lotion on her like you asked me to. On top of that,

she had 3 accidents today, making a mess everywhere!”

1. Appropriate; 2. Inappropriate

What are some other appropriate ways to discuss your client’s day with their family?

The Pearl Module

Senior Gems®


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Knowing and understanding the five stages of grief is very important and very helpful at this stage of

dementia. Not only will the family of your Pearl be dealing with the loss of their loved one, so will you

as their caregiver. Understanding the five stages of grief will help you work through the process, and

you will be able to help the family as well. Each person goes through the stages of grief differently;

many do not experience the stages in order.

1. Denial and Isolation

This stage may come prior to the loss of a loved one as well as after the loss. Denial can be a reaction

to first learning of the diagnosis of Alzheimer’s or dementia. In the denial stage, words are blocked

out, and we hide from the facts. We try to convince ourselves that our loved one isn’t gone.

2. Anger

As denial starts to wear, the reality of the pain you are facing reemerges. Anger may be directed at

family, friends, inanimate objects, or strangers. Your anger may even come out toward the love one

you have lost, feeling resentment toward them for causing you pain. You may feel guilty for being an-

gry with them, which in turn makes you more angry. Anger may also come out toward the doctor. You

may feel angry with them that they were unable to cure your loved one. Take your time when trying

to work through this stage.

3. Bargaining

During this stage, we are trying to regain control of a situation that is not in our control. We try to

bargain with a higher power or our loved one in an attempt to postpone the inevitable. Some com-

mon statements are ,“If only we had sought medication attention sooner,” or “If only we got a second

opinion from another doctor.”

4. Depression

Two different types of depression come in this stage. One is the worry of the costs and burial of our

loved one as well as the worry that we have spent less time with our other loved ones. The second

type is more private, and it is our way or preparing to say goodbye.

5. Acceptance

The last stage is being able to come to terms with the loss of your loved one. This comes at different

times for each person, and some people may never reach this stage. Allow yourself to feel the grief

and go through the stages to hopefully be able to come to terms and be accepting of your loss.

The Pearl Module

Senior Gems®


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WHEN I LOOK AT HER/WHEN SHE LOOKS AT ME

Dedicated to Loretta Skovira

When I look at her I see a beautiful, blue eyed, strong woman that needs to communicate.

When she looks at me and says “where am I?” I respond “you are here with me and we will do our

best together.”

When I look at her and she says I want to see my Mommy and Daddy I say “let’s go for a ride.”

When she looks at me and smiles, I smile back and for a moment she knows who you are.

When I look at her while we are doing a craft project, I see a woman that is focused and wants to do

her best.

When she looks at me while I am putting lotion on her arms and legs after a shower, I see a woman of

appreciation.

When I look at her while she is putting a casserole together, I see a loving mother that enjoyed cook-

ing for her family.

When she looks at me while we are dancing in the middle of the living room to country music, I see a

woman that loves to have fun.

When I look at her when she is with her daughters and sons, I see a mother that loves and appreciates

what her children do for her.

When she looks at me while I am giving her a manicure, I see a woman that likes to look good when

she goes to church.

When I look at her while I am giving her a foot massage, I see a woman that is calm and relaxed.

When she looks at me and says “look at my hands, look at how ugly they are”; she sees the imperfec-

tions, as I hold her hands in mine I see love, compassion, and hard work. I respond to her lovingly, I

hope one day my hands will look as beautiful as yours.

When I look at her, I see a woman that has taught me to not be so judgmental, has taught me to love

someone like I never thought I could.

Written by, Vivian Keslar

This poem was written by a caregiver from the Pittsburgh, PA office who wrote this for her client.

The Pearl Module

Senior Gems®


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Quiz

The Pearl Module: Late-Stage Dementia

Employee Name (Please Print):

_______________________________

Date: __________________________

I understand the information

presented in this guide.

I have completed this guide

and answered at least eight

questions correctly.

Employee Signature:

_______________________________

Supervisor Signature:

_______________________________

Directions: Circle the best answer choice, and then check your answers with

your supervisor.

1. It is important to still make connections with your Pearl at this stage of

dementia.

True or False

2. It is best to talk to your client’s family in front of your client so they

know what they did right and what they did wrong.

True or False

3. What is a sign of pain or illness?

A. Facial grimacing

B. Pale skin tone

C. Both

4. Validation therapy is a good way for a caregiver to better understand

their client and what they are experiencing.

True or False

5. It is important to understand the five stages of grief to not only help

yourself through the process, but to help your client’s family through it

as well.

True or False

6. A Pearl’s muscles are always turned, on so you need to be careful when

trying to move them.

True or False

7. It is best to move quickly when trying to provide care for your client or

trying to get a task done so the client isn’t in pain for too long.

True or False

8. A Pearl has no issues sitting down.

True or False

9. We must allow a sufficient amount of time (at least 30 seconds) for a

Pearl to respond to a cue we are giving them.

True or False

10. The Senior Gems® program focuses on:

A. Pretty colored gems

B. What clients can do

C. What clients can’t do

Documents

PEARL MODULE - Homesteadneoshcaregivers.homestead.com/Pearl_Module.pdf · Since we know that a Pearl’s muscles are always turned on, it makes providing care very difficult. ut there