Today's BLOG ~ UNIT 6 Where To Look For Resources, Ch. 5 future Challenges, APPENDIX I Nurse Tips, APPENDIX J Adult Guardianship Revoked.

Dear Readers, 
 
Many of the UNIT Chapters in my book, KNOW AUTISM, KNOW YOUR CHILD with < My Thoughts > by Sara Luker, have an added APPENDIX with more pertinent information for you. Therefore, the next few BLOGS will introduce you to them.

UNIT 6 – Where to Look for Resources? CHAPTER 5 – FUTURE CHALLENGES, APPENDIX I –
Nurse Tips, APPENDIX J – Adult Guardianship Revoked.      

CHAPTER 5  FUTURE CHALLENGES 

APPENDIX I - Nurse Tips

8 Nurse Tips for Dealing with Autistic Patients (Part 2) –

1. Follow the autistic patient’s routine at home
People with autism cooperate best within structured routines. Changes in their routines make autistic patients anxious and less cooperative.

< My Thoughts >    "...anxious and less cooperative."

With our Sonny, it does not take much in a new setting, or with new people to make him anxious and less cooperative.
 
2. Provide simple and straight-to-the-point instructions
Autistic patients have difficulty in reading between the lines. They often misunderstood complex instructions. They may ask questions, so make your answers direct to the point as well.

< My Thoughts >      "Provide simple and straight-to-the-point instructions."

This may be a good time for Visual Schedule Supports. Even more effective if the person can help create them.

Note: For further information on ‘Visual Supports’ go to MENU – Know Autism, Know Your Child with < My Thoughts > by Sara Luker. Read under UNIT #3C – Concerning ASD Behaviors; Visual Support, Social Stories.
 
3. Be slow with physical contact
Do not touch autistic patients without warning. They get easily stressed with unanticipated physical contact. To gain their trust, start first by sitting close to them. Eventually ask, “Can I hug you?” so he will not be surprised with your actions.

< My Thoughts >        “Can I hug you?”

In a new and / or strange medical setting, dressed in medical garb, for a stranger to ask to 'hug' a person with autism is very risky and will most likely be met with rejection.
 
4. Maintain a calm environment
Patient placement is critical for nursing and autism care. Since autistic patients are highly sensitive to sound, they should be placed in a room with minimal distractions and equipment.

< My Thoughts >    "..minimal distractions and equipment..."

This is true, especially if therapists and caregivers tend to use 'distractions' to keep the autistic person from performing purposeless or unwanted behavior.
 
5. Treat them as equal
Lack of socialization skills doesn’t mean that autistic adults also lack empathy or emotion. They recognize negative behavior. To gain their trust and cooperation, treat them like the other patients you have.

< My Thoughts >    "...negative behavior."

Studies show that highly sensitive children see 'negative behavior' through the ‘auras’ , energy fields which surround that person. Your neurotypical child may say, “The teacher doesn’t like me.” What the autistic child cannot always express is that they may feel unwanted because when their teacher approaches, her aura turns brown. Brown is a ‘yucky’ color, like dirt and other unpleasant things.
 
6. Encourage to bring their comforting item
Advice the guardian to let the autistic patient bring his favorite comforting item like a stuffed animal or a book. This reduces anxiety and helps in building trust.

< My Thoughts >    "...favorite comforting item..."
 
Besides favorite comforting items, it may help to bring his or her favorite comforting music.

7. Be transparent with your promises
When you say you will be back within five minutes, an autistic patient will expect you in no more than five minutes. Any delay or failure with your promise may lead to anxiety and tantrum attacks. To avoid this, be specific and realistic with your statements. Say “I will be back by 4:00 PM” and, “This will hurt like your first flu shot”.

< My Thoughts >    "...be specific and realistic..."

The concept of time for the person with autism may be too abstract and futuristic. Most are 'concrete' thinkers and do not understand "I'll be back in a minute." "Or, we will go later."
 
8. Pay attention to nonverbal cues
Autistic adults have difficulty in transcribing their feelings to verbal expressions. For this reason, they are likely to keep their health complaints until they can no longer hold it. To prevent this, pay attention to nonverbal cues when doing physical assessment to them. Abdominal guarding, facial grimace and constant shifting in bed are some nonverbal cues.

< My Thoughts >    "...nonverbal cues."

Nonverbal cues may also be, frantic 'stimming', sudden or extended irritability, withdrawal, even an unexplained meltdown or tantrum.
 
Just remember that whenever you are having a hard time in dealing with autistic adults, seek the help of your senior nurses. With their years of expertise in nursing care, they have their own strategies in providing nursing care to adult patients with autism.

Collingsworth, T. (2015) defines the elderly with autism –

Autism is a cognitive impairment of the brain. Symptoms include deficiencies in social interaction, communicative abilities, and/or creativity or imagination; with a “spectrum” of the disorder that encompasses various types of autism (referred to as ASD or Autism Spectrum Disorder).
 
How Autism Affects the Elderly

The US National Institutes of Health say that there is a lack of research regarding senior citizens who have autism; most likely because it has only been within the last 30 years that autism was not viewed as an immediate cause for institutionalizing a person. Institutionalization reduces the likelihood of a person ever being functional in society and often resulted in premature death.
 
Caregiving Needs for the Elderly with Autism – Combining both typical aging and special needs that include their autism creates a different set of caregiving needs for the elderly with autism.
 
Calm Surroundings – In some senior care situations the autistic seniors are highly medicated in order keep them calm, when in actuality it is their surroundings that are agitating them. Many times, those with various forms of autism do not like loud sounds, excessive noise or over stimulating surroundings.
 
Minimal Changes – Changes can cause confusion, aggression, and a feeling of being lost when things aren’t “the way they usually are.” It is one of the benefits of keeping the senior in their home for as long as possible to help maintain quality of life.
 
Comfortable Socialization – While socialization is important to quality of life, in can often mean loud forms of entertainment & large groups of people. It is important to socialize the senior with minimal intrusion & loudness, keeping in mind what entertains them specifically.
 
Limit New Faces – It seems that a very small group of the same caregivers work better than having a multitude of faces for the senior to deal with on a regular basis.
 
Conversing – It becomes difficult for the elderly with autism to converse; with one of the issues being the inability to connect with such things as irony, recognizing expressions and focusing on during conversations.
 
Points to Remember When Providing Caregiving for the Elderly with Autism –
 
When caring for the elderly with autism, the lack of prior diagnosis and understanding is basically creating an entire generation that we will be learning from as they age. However, some things are very clear when it comes to caregiving for the elderly with autism.

• It’s not good to continuously change caregivers & everyday faces.
• There is a learning curve with each individual that may be overlooked without one-on-one care.
• Socialization is important; however, understanding how the person socializes best is more important than providing socialization just for the sake of socialization.
• Overstimulation can trigger outbursts and confusion.
• Calm, quiet and serene surroundings work best.
•  Utilizing prescription medication to calm and desensitize elderly people with autism is not providing quality of life for them; in most cases it is an easy way to keep them from being troublesome to an understaffed caregiver situation.
•  Limited changes in surroundings cause less confusion & agitation.

 
Unfortunately providing caregiving for those with dementia is difficult enough; but adding the issues associated with autism creates an even more difficult and new frontier to the world of caregiving. We now focus on quality of life as we age, so it is important to learn how to deal with a multitude of mental and physical issues that are now recognized and better understood; including the elderly with autism.
 
It is important to understand that autism itself provides each patient with different troubles as they progress through life. Some may become quite functional in most categories of society, while others may find certain inabilities to full function.

The NIH article states, in part –
 
“Cognitive changes are common when people age, but what happens with aging if one has a psychiatric disorder like autism, that is, what if one already has cognitive deficits? Will everything deteriorate faster, or do efficient compensatory mechanisms develop?
 
At present, it is unknown what happens when people with autism age. The impairments are thought to last a lifetime… Even though some autism symptoms seem to decrease with increasing age, elderly with autism will not reach normal levels of social functioning.”
 
Today we realize that many have functioned with autism throughout their life, without ever being diagnosed, and are now elderly. Caregiving needs of the elderly with autism often encompass other mental issues such as dementia as they have aged. 

< My Thoughts >      "...elderly with autism..."

Added to the typical aging infirmities, like arthritis, heart disease, dementia, hearing and eyesight,  losses, there may be the loss of his or her lifelong caregivers. Many otherwise healthy persons with autism can outlive their parents.
 
End of APPENDIX I - Nurse Tips

​REFERENCE:

​Collingsworth, T. (2015). Home Care Needs Of The Elderly With Autism. Retrieved online from – https://www.familyaffaires.com/home-care-needs-of-the-elderly-with-autism/
             
Staff Writer (2015). 8 Nurse Tips for Dealing with Autistic Patients (Part 2).Retrieved online from – www.nursebuff.com/nursing-and-autism//   

UNIT 6  FUTURE CHALLENGES 

APPENDIX J  –  Adult Guardianship Revoked

DISCLAIMER: Because this information is often difficult to obtain, this is an EXAMPLE (only) of what may be needed, regarding guardianship.
 
Terminating an Adult Guardianship

In most cases, a court hearing is required to terminate a guardianship over an adult.  Anyone - a guardian, a relative, or the subject of the guardianship - can file papers asking the judge to decide whether a guardianship is still needed.  Read this section for more information about why a guardianship may be terminated, and to find the forms needed to ask a judge to end the guardianship.
 
If the protected person passed away and all of the surviving heirs will agree to waive a final accounting, you may be able to close the case with following the steps on this page and without a hearing.  Follow the instructions and complete the forms in the Petition to Waive Accounting and Close Case (protected person  Deceased) packet.  If all of the heirs will not sign the included consent form, you must instead follow the instructions below to terminate the guardianship.
 
How to Terminate an Adult Guardianship 

1. File the Papers

You will need to complete a Petition to Terminate Guardianship, and a Citation or a Notice of Hearing.  You may also need to provide other documents depending on your situation.  
Fill out all of the forms in the packet below, and follow all of the included instructions. 

If the protected person has passed away: Complete the Notice of Hearing instead of the Citation that is included in the packet above. This lets any interested parties know of the court date if they want to attend and speak to the judge.
 
Other Documents You May Need:

Depending on the reason you want to close the guardianship, you may need to provide other documents to support your request.  Some common forms that must also be submitted to the court are:

• Final Accounting.  If you are the guardian over the protected person's estate, you must provide a final accounting to the court.  The following document can be attached as an "Exhibit" to your petition so the judge can approve of the final accounting at the same hearing. 
   
  Doctor's Letters.  If you want to close a guardianship over an adult who has regained competence, you must provide two letters from two doctors stating that the adult is competent.  Attach the letters as exhibits to your petition. 
• Other State's Guardianship Papers.  If you have moved to another state (with prior court permission) and opened a guardianship case there, attach proof of the other state's filing as an exhibit to your petition.  

 
2. Serve the Papers

Once you have filed all of the necessary papers, you will have to serve the papers on all required people. THIS STEP IS VERY IMPORTANT!  If you do not follow this step properly, the judge may cancel your hearing!

You will have to send the Petition to Terminate Guardianship along with the Citation (or Notice of Hearing if the protected person has passed away) to the protected person, the guardians, the protected person's relatives (the same ones who have been receiving notice of prior proceedings), and the protected person's attorney.  This is to make sure all of these people know about the hearing and have a chance to respond to your papers.
 
How to Serve the Papers:

• If the protected person is alive: Mail the petition and the citation to all of the required people by certified mail, return receipt requested.
• If the protected person has passed away: You can send the petition and the notice of hearing to all of the required people by regular mail. 

 
3. On the Day of the Hearing (and after):

Make sure to arrive at the courthouse early for your hearing so you have enough time to park, get through security, and find the courtroom.  Check in with the judge's marshal. 
When your hearing begins, the judge will ask some questions to you and anyone who is at the hearing for your case.  The judge may make a decision after hearing from everyone.

If the judge terminates the guardianship, the judge will sign the Order Terminating Guardianship.  This form is included in the packet above; bring it with you to court.  After the judge signs the Order Terminating Guardianship, you must make sure the order is filed at the Clerk's Office. You will then be responsible to send a copy of the order to all required people, and file a Notice of Entry of Order with the court so the judge knows that all required people have a copy. 

REFERENCE:
 
Staff Writer ( 2024). Terminating Guardianship; Family Law Self- Help Center. Retrieved from  –https://www.familylawselfhelpcenter.org/self-help/guardianship/terminating-a-guardianship/195-adult#:~:text=Anyone%20%2D%20a%20guardian%2C%20a%20relative,Final%20Accounting.

​End of APPENDIX J  –  Adult Guardianship Revoked

​Thank you so much for sharing, commenting, and 'liking' on Facebook!

Regards,

​Sara Luker
​
​
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