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Organizing the Bedroom

Their body will remember the rote tasks associated with independent functioning long after they are unable to understand or follow directions.   
However rote memory is also in the process of eroding.   During this stage it is your task to enhance their rote memory as much as possible.    This is why dressing patterns, such as which arm goes into which sleeve first and which sock goes on first is important.    It is their routine that you are preserving and it is the routine that allows them to function as long as possible.    If you get help through a home-aide or volunteer or family member it is important that you teach them your person's routine.   Knowing the routine and implementing it preserves their sense of themselves and their environment.   To deviate is to feed into their mounting fears and confusion.   The end result is too often a catastrophic reaction.   

The good news is that with proper precautions there is no need to worry about ruined mattresses and bed clothes and carpets.

Basics to consider:

Keep blankets, sheets, bedspreads, down to a minimum.   As stated above, the more bed clothes you have on the bed, the more chance of your family member has of getting tangled up and falling out and getting hurt.   I used different weight goose down/fiber fill  comforters both summer and winter.   

Use a duvet cover which can be removed and washed instead of an additional top sheet during this period and make sure it is 100% cotton.   The less you have on top of the bed, the better.   The less complicated the bed, the less likely they will become entangled in the layers and wake up.   The longer they sleep, the less likely they are to get up and feel the need to urinate.

Getting in and out of bed at night also becomes a real problem.    To be very honest there is little you can do to keep them in bed if they are nocturnal pacers.   What you need is for them to be able to get out of bed safely, otherwise you can be faced with getting them up off the floor and dealing with injuries.   Tuck one side of the down comforter in under the mattress so they can just slide out of bed without having to fight the covers.    As for getting them back in bed, it is simply easier to shake a comforter out over them in one motion than it is to try to get sheets and blankets and bed spreads smooth.    And trust me on this, having a smooth warm cover is as important to them as it is to us.   However, they can't navigate straightening it out on their own. 

You might want to place one side of the bed up against a wall during this period, preferably in a corner.    Note which side of the bed your person uses to get in and out of and put the other side up against the wall.   This gives more space for maneuvering and the solid wall can be a source of stabilization for the family member.   It might even lessen an unarticulated fear of falling out of bed. 

You will want to purchase bed rails at this point.   Towards the end of this stage they lose balance and are in danger of falling each and every time they get in or out of bed.    Their awareness has diminished to the point where bed-rails are sufficient to deter some of this activity.   For more docile family members it will curtail it, thus giving you, the caregiver more control over when you take them to the bathroom.    Bed rails are adjustable, and adaptable to normal beds.   The main rails pass under the mattress and the side rails are easily adjusted for height and can be easily removed to enable you to reach over the bed to help your person sit or stand.   I bought mine through Sear's Medical Supply Catalogue.    They were the best price at the time.   They are also available through other medical supply catalogues and home health care companies.    They are a valuable tool at this stage of care.

Setting up the mattress: 

Numbers 1 -3 below

Number 4 - 6 below

Tom on his sea green cloud

   1.   Cover the mattress with a fabric water resistant or water proof cover rather than a rubber sheet or plastic cover.   Rubber sheets are expensive and unwieldy to handle and wash.   They also make the skin sweat.   As your person begins to spend more and more time in bed this can be devastating to their skin quality.   The water resistant fabric covers, on the other hand are washable, the fabric still breaths and it cuts down on sweating.   I bought my covers (you will always want to have a spare or two) at K-Mart.   Target, Marshall's, Ross, Wal-Mart, every major department store and catalogues all carry these.   Some covers also come with a 'memory foam'  which will conform to the shape of the body.   There are a multitude of varieties of this product.   They are fitted to any mattress size.   Cover this mattress with a 100% cotton fitted sheet unless you use a feather/fiber fill bed or egg crate mattress on top. 

2.   I purchased a down feather bed and placed that on top of the mattress.   This can also be covered with a water resistant or water proof cover.   Amazingly a regular fitted sheet will work just as well on a feather bed as on a regular mattress.   The knitted sheets should present no problem in slipping at all.   If you consider this step, make sure your feather bed has baffles in it.   They come with square baffles or length-wise baffles.   The baffles are important because they hold the filling in place.    There are feather beds available without baffles and they are less expensive, however they are useless for this purpose.   The filling spreads and separates from the weight of the body thus defeating their purpose which is to give loft under the body.

3.  Another option is the use of an egg crate mattress.    This can be used alone or with the feather-bed.   The egg crates are made of foam and they increase air circulation under the body.   Good air circulation lessens the chance of bed-sores forming.   I actually used my egg crate on top of my feather-bed and covered both with the same fitted sheet.    Egg crates are a science all their own these days.   They come molded to conform to body type and weight and range from very inexpensive to quite pricey.   They are highly recommended for any long-term bed-bound care.

4.  A fitted flannel  percale sheet will cover the feather bed and the egg crate mattress and will hold in place until changed.  I recommend 100% cotton.  By the time the mid stage of care ends I'd use flannel primarily.  Their brain is not longer able to regulate body temperature normally and the added warmth of flannel even in the summer is a good thing.

5.    Place a baby's doubled sided flannel covered rubber crib pad on top of the sheet across the bed in the torso area.    Make sure both sides are flannel.   One-sided products are available but they slip and slide and don't stay in place.   The flannel backing will keep the pad in place no matter how restless your person is.   Many of these products are designed with a quilted affect which softens the feel on the body.   I discovered that some Medical Supply Companies offer this padding by the yard.    You might buy a length and cut it to suit your individual needs.    In any event, buy the longest pad you can find.   Some are as much as 50" in length.    There are also lap pads which are smaller and are handy for chairs and car seats.    This is the primary protection for your bed and your furniture.   

• There are also pads designed specifically for adult incontinence available through medical supply companies, home health care products catalogues and medical supply sections in drug stores.   Many department stores are also carrying these items.   They work very well and serve the same purpose as the crib pads.   They are also more expensive than the baby crib pads which do the job just as well.

• Packaged disposable pads are in my opinion useless.   They slide, slip, bunch up, twist and move with every move of your person.    Over the long haul they are expensive as compared to buying the permanent pads described above and they are one more piece of trash for land fill to deal with.   The only purpose I found for them was when I had to sit Tom down while I pulled off trousers, underpants and socks after an episode with diarrhea in order to spare the seat or the bed from ruin.   The pad was then bunched up and tossed.   For what it is worth, seating Tom on a plastic kitchen trash bag served the same purpose and was a cheaper alternative.   

6.    Place a full size cotton terry towel on top of this pad .   Match the color with the sheet if possible.   We are looking at continuity and we are looking at keeping the visual field clear of clutter.   The fewer lines and breaks in the visual field of the person with advancing Alzheimer's the easier it is for them to continue to navigate their world.    The towel serves several purposes.

• It serves the purpose of a draw sheet and absorbs any spill over of urine and poop.    

• It is easier to wash than sheets and mattress covers.

• It is soft and because it is cotton it absorbs sweat without endangering the skin quality of your person.   This is even more important when they become bed-ridden.

• The towel also gives you leverage in rolling the person on to their side safely when they become bed-ridden for hygiene care in bed.     

• Because the pad and the towel are going to be noted by your person who is very possibly going to be insulted or saddened by the obvious reason for its placement, you might want to use a draw sheet for a while.   Take a top sheet, fold it into three segments length wise, place it over the crib pad and tuck the ends under the mattress on each side of the bed.   This might make your feel a little more secure as you approach this level of care while your person is still cognizant of what is happening to them.    I have always been concerned with how my energy is expended.   Dealing with a draw sheet was a bigger item to wash and set in place.   The towel took less time and energy.   your person's adjustment will take a shorter time then you expect, but take the route you feel most comfortable with.   Learning to read their needs while conserving your energy is the magic you perform.      

While your person is dealing with "Sundowning" behaviors such as pacing and wandering, it is important to simplify their environment as much as possible.   This is the time to turn this room into a "Safe Room."   See the link to the description of the "Safe Room." 

The 'Safe Room   A room of solitude where Tom could rant and pace without getting in trouble or hurt and a place that gave me a few minutes respite away from the madness.

The Supervision Stage of Care

The In-Charge Stage of Care

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