Day to day life

Managing finances

The impaired judgement caused by dementia can be a risk if the person has use of cheque books and cards. A joint account that requires two signatures for bank withdrawals and cheques, may offer a solution. However, a couple that doesn't already have a joint account should take advice before setting one up if it is possible that, at some stage, either party may have their assets assessed for the costs of residential care.

If possible, the options below might help:

• get affairs organised before the dementia progresses too far
• gather important papers together in one place (ie bank statements, bills, wills, insurance, pension details)
• arrange for regular bills to be paid by direct debit or sent to a relative or carer
• contact utility companies to explain the situation so they are not suddenly cut off
• encourage the person to set up a lasting power of attorney and consider what decisions they would like to be made on their behalf
• you should seek advice and can locate a local solicitor, by visiting www.lawsociety.org.uk

Benefits

You should check that the person with dementia, and you as a carer, are receiving all the benefits you're entitled to. Always check whether a benefit affects any others you are receiving.

There are three benefits you should certainly check.

• Attendance allowance or disability living allowance
  These are designed to help with practical needs of someone with a disability and are not dependent on your income or savings. People over 65 should claim attendance allowance for help with personal care only. People under 65 should claim disability living allowance, which covers personal care and mobility.
  
  Contact the Benefits Enquiry Line 0800 88 22 00 for more information.

• Care allowance
  This is for carers who spend at least 35 hours a week looking after someone receiving either of the above benefits. The carer doesn't have to be related to or living with the person they provide care for. We suggest advice be sought for this benefit as eligibility is dependant on income and other benefits.
  
  Contact the Benefits Enquiry Line 0800 88 22 00 for more information.

• Pension credit
  Pension credit is for people aged 60 and over and has two parts; guarantee credit and savings credit. Some people are entitled to both, but others only one. Guarantee credit tops up a person's income to a set minimum level. Savings credit is extra money for over 65's that have income above the basic retirement pension level. It is based on total income including pensions.
  
  The Pensions Service claim line can offer more help. Call 0800 99 12 34.

Eating and drinking

In the early stages of dementia, the individual may be able to cope with providing their own food, with some help with shopping and a few prompts around the kitchen, or perhaps a meal delivery service. As the dementia progresses it may require someone to be present for at least one meal a day to ensure that they are eating enough. They may forget to eat or how to cook food properly.

Older people often have reduced appetites and inevitably lose weight, particularly in the early stages of dementia. Not eating or drinking enough can worsen the symptoms of dementia and affect their general health. While a balanced diet is to be encouraged, the key is to eat and drink plenty and regularly.

Here are some tips for helping someone with dementia to eat and drink enough:

• leave snacks such as biscuits or fruit around the house - perhaps next to the person's favourite chair, on the kitchen table, or by the bed
• put pictures on cupboard doors or even remove the doors completely, to help the person find the food they want
• a 'bar style' fridge with a glass door may be helpful
• if the person has a favourite food, better for them to eat it frequently than not to eat enough
• people with dementia may not check 'use by' dates or realise food is unsuitable for consumption - regular checks of their food supply may be needed
• offering finger foods that don't need cutlery may make it easier for the person to continue to feed them self
• encourage use of adapted cutlery which is easier to hold
• serve food on plates with raised edges

People's tastes may also change as their dementia develops. They may suddenly start - or go back to - having sugar in their tea or go off their favourite food, or revert to particular dislikes. Ask what they really fancy for dinner or as a treat. It may seem like extra work but could be worth a stress-free mealtime.

In the later stages of dementia, you may need to feed the person you care for. If so:

• try to be at eye level when helping - maintaining eye contact helps to keep them engaged
• try to make sure you have plenty of time so the mealtime isn't rushed
• try to feed the person slowly, attracting their attention before placing the food into their mouth
• a tip from our own care staff is to ask someone to feed you so you can see how it feels and how to do it well

Personal care

Dressing
Maintaining a person's choice and involvement in their clothes for as long as possible can help to keep a sense of identity and dignity. Here are some tips on helping the person with dementia to dress themselves for as long as possible:

• try to leave enough time to avoid feeling rushed and stressed
• offer simple choices such as 'would you like the red or blue jumper' rather than 'what would you like to wear today'
• if they get it wrong, keep it in perspective - does it matter if buttons are not fastened correctly?
• lay clothes out in the order they should be put on, or hand each item to the person in the correct order
• if instructions are needed, keep them simple. Demonstrating may also be useful
• change fastenings from buttons and zips to Velcro to help dressing easier
• it may be useful to label drawers and cupboards where different clothing is kept

Washing and bathing
Personal hygiene routines are a common source of anxiety for people with dementia and their carers, so this needs to be handled sensitively. The individual will have been carrying out their own personal hygiene activities since they were a child, so requiring help or becoming dependent on others can be embarrassing and awkward, both for the individual and you as their carer. This is a key area where prolonging independence for as long as possible and offering unobtrusive help is important.

Some tips you may find useful:

• encourage the individual to continue with their own routines for as long as possible
• the person may need some prompting, such as handing them a hairbrush to brush their own hair
• encourage involvement and choice, such as 'which bubble bath would you like?' or even 'do you want a bath?'
• thorough drying is important. This can be made easier by allowing the individual to sit for a while in a clean towel or bath robe
• if the person spends a long time sitting or in bed, check for red areas or sores on their skin whilst they are undressed. These can be the first sign of 'bed sores'.
• allowing the person some privacy to undress or to bathe if they desire will make things easier for you both
• you could leave the room while they undress and get into a dressing gown before walking them to the bathroom
• run the bath for them and allow them to step into it with a towel round them
• have a thermostatic valve fitted so they can't scald themselves if they run the bath themselves

Using the toilet
Continence problems can be very distressing for both the individual and carer. Controlling urges to go to the toilet is taught at an early age and losing this ability can make an individual feel they are losing control of their dignity and life. Many people find it hard to accept help with such an intimate area and they may try to hide their continence problems. Treating the issue in a matter of fact way, or using humour, may help prevent blowing it up into a bigger problem.

Some practical tips to make using the toilet easier:

• remind the person where the toilet is - a picture of a toilet on the door may help or even signs or arrows to direct them to it
• installing hand rails will make getting on and off easier and may reduce the fear of falling
• try to ensure clothes are easy to undo
  
• moist toilet tissue can help wiping easier (available from most supermarkets)
• make sure the bathroom is well lit, warm and comfortable
• if the toilet is difficult to get to, for example upstairs, then a commode may be useful
• regularly remind the person to go to the toilet
  
• watch out for signs of needing to go, such as fidgeting or pulling at clothes
• try to establish a routine of going to the toilet before getting dressed

Activities

Activities can really help improve the quality of life for the individual with dementia, as well as providing stimulation and helping them to express themselves.

In the early stages of dementia, encourage the person to continue any outside activities they already enjoy, if possible. This will help to maintain a sense of self-identity and purpose. You might want to find some activities that the person finds calming, or that enables you to spend quiet, peaceful time together. For example, knitting, painting, watching cricket or listening to music together. You may want to recapture fun and enjoyment, so think about dancing or singing, a game of darts or a trip to a beauty salon.

The symptoms and capabilities of the person may change from day to day and people with dementia often have a short concentration span. To avoid frustration by inappropriate or ambitious tasks, here are some key points that may help:

• give plenty of encouragement to increase confidence
• be patient - don't step in and take over
• give instructions and guidance in short, clear sentences
• avoid giving too many choices or challenges as people with dementia find it hard to process multiple options
• keep tasks short to allow for reduced concentration span
• keep your sense of humour and try to enjoy spending quality time together.

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Living alone

In the early stages of dementia the person may be able to cope relatively well on their own, supported by some adaptations around the home and regular visits to check on them. This may continue to be the best option for anything from a few months to a few years. However, dementia is a progressive condition and symptoms and abilities will worsen. During the early stages, preparing and planning for their increased dependency can give you some time to consider the best option for all concerned.

If the person wishes to remain in their own home, there are obvious concerns about their safety and ability to cope. People with dementia can place themselves in danger due to their reduced concentration and impaired judgement. They may:

• forget to lock or close windows and doors before going out or to bed
• if they have trouble recognising people, they may welcome strangers into their home
  
• leave cooking food unattended
• leave ovens and gas hobs or heaters switched on.

Some points on safety which may be useful:

• replace the telephone for one with bigger buttons and leave a large-typed list of important numbers by the telephone for use by the person with dementia or a neighbour in an emergency
• check whether your local police offer free home security checks
• use 'we don't buy at the door' stickers to put off opportunistic callers
• speak to gas, electricity and water companies about services offered for customers with disabilities. They may be able to install safety devices or adapted controls.
• consider replacing gas cookers or fires with electric ones
• make sure boilers and water heaters are regularly serviced
• install smoke and carbon monoxide detectors
• adapt taps to only let out a certain amount of water to prevent flooding
• remove locks from bathroom doors.

Driving

By law, a person with a diagnosis of dementia must inform the DVLA and their insurance company. It doesn't automatically mean they must stop driving immediately but safety must be the overriding factor and it is likely that, as their dementia progresses, they will lose the ability to drive safely.

Further information can be found on the DVLA website: www.dvla.gov.uk.