The end of life care program for people with dementia.

Namaste Care Quality Of Life Until The End Of Life

Description

The Namaste Care Group Program

Morning Program

Namaste Care can be offered in a small group setting in care homes or in an adult day program. Namaste Care does not require expensive equipment or supplies, a dedicated space and extra staff. People who attend the program are usually those who cannot participate in traditional activities, they usually have some type of dementia.

Namaste Care takes place in a room or space that is as free from distractions as possible. The environment is made peaceful and calm by lowering the lights, playing beautiful music and permeating the room with the scent of lavender or one appropriate for their culture.

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All supplies are gathered before the program begins so that the people are never left alone. The morning and afternoon sessions begin by the Namaste Carer welcoming each person as they enter the room. Namaste Care is person-centered so that the greeting is individualized with some receiving a handshake and other a hug or kiss on their cheek. They are placed in a comfortable reclining chair and their personal blanket is tucked around them. Each person is assessed for pain and discomfort as quality of life is not possible if these are present. Nursing is notified if any pain or discomfort is observed.

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After they are made comfortable each person is offered a beverage in a cup marked with their name to meet infection control standards. Beverages are offered on a continuous basis throughout the program as people with dementia rarely ask for beverages and easily become dehydrated. The Namaste Carer is aware of any swallowing problems for the people who attend the program.

After the majority of people are in the room, morning activities begin. They include a gentle washing of the persons face. Women have a familiar scented face moisturizer applied. Men may be shaved the “old fashioned” way with shaving cream and a safety razor. Their favorite aftershave lotion is patted on their face as they are told how handsome they look.

Hands and arms are moisturized, and their hair is gently combed or brushed. For people who have thinning hair or are bald, scalp massages seem to be comforting. The Namaste Carer moves around the room so that every person has some activity provided. Everyone is continually offered beverages. About 30 minutes before the program ends, lights are turned up, music becomes livelier and items they remember from the past are shown. Many people, even those with advanced dementia, enjoy fun things so when the Namaste Carer is wearing a clown nose or blowing bubbles it is a time that produces smiles and laughter.

As each person leaves the room, they are thanked for being with their friends, some are hugged other have a handshake, everyone is invited to come back whenever the next session is scheduled, that afternoon or the next day

After they leave the Namaste Care room their caregiver toilets them as most are incontinent, then they have lunch. Some people take a nap in the afternoon in their rooms, especially those with fragile skin as they may need to be lying down and perhaps positioned to lessen the chance of skin breakdown. Others are brought back to the Namaste Care room where they can nap but are not isolated. In Namaste Care we believe that being in the presence of others is important.

Afternoon program

Afternoon Activities

Afternoon activities include range of motion exercises while dance music from their past is played. Many people do not go outside, so the outside is brought inside. Seasonal flowers, leaves, cut grass and even a basin of snow are reminders of the changing seasons.

Feet may be soaked, legs moisturized, hair stylized, fingernails cleaned, and the women may enjoy having brightly colored polish applied. In the afternoon many family members visit, and they are encouraged to become part of Namaste Care. They are given lotion to massage their love one’s hands.

They are taught the slow, gentle way hands are massaged as a Namaste Care activity. Family visitors are encouraged to bring pictures their family member might recognize and offer them ice cream or puddings. Weight loss is a problem for people with advanced dementia, so sweets are encouraged. If a person is safe to suck on a lollipop they usually enjoy the taste along with the memories of when they were children and a lollipop was a treat! Children’s groups and pets are always welcome!

The day ends with the Namaste Carer again thanking the person and their visitors for being part of the group.

 

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The Namaste Care Individual Program

Namaste Care can be taken to a person no matter where they live. Some reside in care homes and are bedbound, others are in a hospital or hospice inpatient unit and many are living at home with family caregivers. Supplies for the program can easily be stored in a washable bag or in a homelike rolling cart that can be taken to the bedside. All of the activities offered in the group program can be provided to a person on an individual basis.

End of Life Care

Namaste Care helps a person have quality of life until the end of life. When a person is actively dying, the environment is made comfortable and soothing by eliminating noise and lowering the lights. If the person was religious, music that reflects their religion is played. When they were not a person who felt close to a particular religion, soft calming music is played.

When the person is in a private bedroom the door is closed, if they are in a room with others privacy curtains are pulled around the bed creating a cocoon like feeling. Room dividers may also provide some privacy.

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Families and caregivers are urged to talk to the person as hearing is the last sense to be affected in the dying process. The four simple phrases suggested by Dr. Ira Byock, are “Please forgive me,” “I forgive you,” “Thank you,” and “I love you”.

Unscented lotions are available so that families can give gentle hand massages as the person is dying. Families may also read favorite passages from the bible or poetry the person enjoyed.  Family members who cannot be present may have written farewell letters that may be comforting to both the person who is dying as well as the family and friends sitting by the bedside.  Internet services like Skype and Facetime are ways families and friends can say goodbye no matter where they live.

After death care in the Namaste Care Program include the body being accompanied to the hearse by at least one person. Some care homes have special quilts made that are placed over the body bag as the person is taken to the hearse.  The quilt is taken off when the body is placed in the hearse, so it can be used again. One home had a quilt made with some quilt pieces in beige where staff could sign their names with indelible ink. Another made a quilt with hearts around the border and each heart had the name of a staff person on it.

The “No One Dies Alone” program is an excellent resource to use when someone is actively dying and has no family or friends to be with them.  Joyce has adapted it for care homes and if you are interested in having her send you what she developed, email her joycesimard@earthlink.net

Outcomes

Namaste Care was found to improve quality of life of nursing home residents with advanced dementia (Manzar & Volicer, 2015), decreased behavioral symptoms of dementia (Stacpoole, Hockley, Thomsell, Simard, & Volicer, 2015) and this allowed the discontinuation of antipsychotic medications (Fullarton & Volicer, 2013). Decreased rejection of care is probably mediated by the loving touch the residents receive during Namaste Care sessions, which makes them less likely to resist care activities involving touch even outside of Namaste Care program. Because the Namaste Care program provides stimulation during the sessions, the residents are less likely to sleep during the day and there is less need for hypnotic medications (Fullarton & Volicer, 2013). There is some evidence that Namaste Care decreases depressive symptoms (Soliman & Hirst, 2015; Soliman & Hirst, 2015), improves ability to communicate with family members and staff and decreases complaints of pain. Namaste Care is well received by both family members of persons with dementia and by staff (Manzar & Volicer, 2015). Namaste Care programs are currently offered in a variety of settings in 10 countries and receive good reception everywhere (Magee, McCorkell, Guille, & Coates, 2017; Trueland, 2012; McNiel & Westphal, 2018).

 

Reference List

Fullarton, J. & Volicer, L. (2013). Reductions of antipsychotic and hypnotic medications in Namaste Care. J Am Med Dir Assoc, 14, 708-709.

Magee, M., McCorkell, G., Guille, S., & Coates, V. (2017). Feasibility of the Namaste Care Programme to enhance care for those with advanced dementia. Int J Palliat Nurs, 23, 368-376.

Manzar, B. A. & Volicer, L. (2015).  Effects of Namaste Care: Pilot Study . American Journal of Alzheimer's Disease, 2, 24-37.

McNiel, P. & Westphal, J. (2018). Namaste Care™: A Person-Centered Care Approach for Alzheimer's and Advanced Dementia. West J Nurs Res, 40, 37-51.

Soliman, A. & Hirst, S. (2015). Using sensory activities to improve dementia care. Nursing Times, 111, 12-15.

Stacpoole, M., Hockley, J., Thomsell, A., Simard, J., & Volicer, L. (2015). The Namaste Care programme can reduce behavioural symptoms in care home residents with advanced dementia. Int J Geriatr Psychiatry, 30, 702-709.

Trueland, J. (2012). Soothing the senses. Nurs Stand, 26, 20-22.