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With winter upon us and Christmas just around the corner, it is important to remember those most vulnerable. Although not many people like the cold weather, this is more of a worrying time for older people and especially people who suffer from Dementia.

Actions that come naturally, such as turning up the central heating or putting on a extra layer of clothing, can be overlooked by someone with Dementia and that’s why it is important to take steps to ensure your loved ones with Dementia are safe and warm in the colder months.

At Murrays we supply the full range of Dementia Products and understand the most common issues. So we’ve put together some helpful tips on how to be prepared for the winter months.

Preparing the House
It is recommended getting heating systems serviced in advance of the winter chills. Many boiler and heating system breakdowns happen at the start of winter due to inaction during the summer. This will ensure the heating/boiler are in proper working order and minimise the risk of a breakdown. It is also advisable to get extra bedding and blankets available for colder nights.

Keeping Warm:

Clothing/Outdoors
This is something someone with Dementia may need help with, as they can forget how to dress themselves. Try helping them dress, where possible, as well as leaving clothing in visible places, such as on the back of the chair or bed. Dressing beds with extra blankets and throws is also helpful. When heading outdoors it is also important that they have a good insulated coat for the winter as well as some sturdy boots with a good grip to minimise risk of falling. Being available to accompany them outdoors is a good idea for safety and ensuring no one gets lost in the cold, as well as having walking aids, like a walking stick or rollator, to help prevent slips and falls on icy grounds.

Central Heating
It is also helpful to increase the heating temperature for the winter months, as older people tend to feel colder as their circulation declines. It’s also worth considering setting the heating on a timer for certainty that it’s being utilised.

Food and Drink
Ensure the cupboards are well stocked so that they don’t have to keep making trips outside. Also encourage hot drinks as well as having at least one hot meal a day to ensure they’re eating properly. If your loved ones are unable to cook for themselves, leave some ready meals in the fridge/freezer which they can simply heat up.

Alarms
Providing a pendant, fall alarm is a good idea throughout the year if prone to falls, but particularly so during winter.

Snow
If there has been heavy snowfall or conditions outside are icy, you could provide assistance with clearing/gritting driveways so that they can safely leave the house.

As well as these helpful factors, it is also important that you make regular contact with the family member with dementia. This will help keep them safe, ensure they don’t become too lonely, as well as seeing difficulties that arise and recognising if a Doctor is needed.

Wheelchairs are wonderful at providing independence and freedom, providing that they’re used with safety in mind. The following tips will help increase awareness of how best to safely use your chair.

General Maintenance Checks:
You should service your wheelchair regularly to protect against problems that could result in injury. This can be done by professionals as well competent home DIY enthusiasts. A general check that it rolls straight, has no broken spokes, tyres are inflated, the chair opens/folds easily and also that the brakes, nuts and screws are not loose. Most chairs are supplied with a spanner/allen key set to allow all parts be adjusted. If parts are missing go to your supplier to get replacements. We provide a full service department that can service and repair all faults, beyond broken frames. Chairs can be cleaned with soapy water.

Understand the General Safety Precautions:

• Footplates are not designed to bear weight beyond when you’re seated. Never stand on the footplates when you are getting in/out, as the chair will topple forward, causing injury.
• Quality chairs should have a safety belt – always use it.
• Always engage the manual brakes when parked and you sit/stand in the chair. If you do not the chair can run away when you get in or out.
• Ensure all 4 wheels are in contact with the ground when operating the chair. It’s unsafe to move with the front small wheels elevated.
• Do not tip backwards when seated. Most quality chairs have anti-tippers to avoid upturning.
• Always use ramps or elevators when out and about. If you are going down a ramp, or step incline, have the carer go down before the chair to avoid the chair gaining momentum, and running away onto the road, and leaving the carer behind.
• Never reach for an item in front while seated in the chair as the chair will tip you out. Instead, position the chair to the side and reach down from the side.
• Only use bags intended for wheelchair use on the rear push handles and do not have too much weight in it to avoid tipping the chair.
• When assisting an occupant in-out always ensure the brakes are locked, the leg-rests are flipped out of the way and the castors are facing forward.
• If you are being transported in a taxi/van while in the chair, make sure the wheelchair is crash test passed and is secured properly to the anchor points.
• If you’re transferring from a seat/car to your wheelchair use a transfer board as an easy bridge from one surface to the other.

If you’re aware of these warning tips you can enjoy your freedom and independence without worry and ensure your travels are carefree and safe.

A pressure sore can be common for wheelchair users or those seated for long periods in chairs or bed. Staying in the same position for too long significantly increases the risk of sores. Specialised cushions, along with other measures, really help to prevent these painful sores in the first place. Prevention is better than cure.

People with limited mobility are at the highest risk category of developing pressure sores and it is vital that carers keep an eye out for the early symptoms of skin damage. This can be localised pain or reddening of the skin in one area, most commonly the bony parts of ones bottom. Pressure sores are explained in detail in the other blog in this section. Anyone experiencing pain or reddening should contact their healthcare professional immediately, as a sore can progress from stage 1 to stage 4 in days. A stage 4 wound is open and deep, sometimes down to the bone.

How Do Cushions Reduce the Risk?
Proper medical cushions seriously reduce the risk of getting a pressure sore. A standard home cushion provides little or no support to reduce the risk as they bottom out. Bottoming out means that they provide short term relief but when the body has settled on the cushion, it is no longer providing relief.
Medical grade cushions work by spreading the contact area evenly over the seat thereby removing the contact pressure from a few bony areas. They can be made from foam, gel or air and all are effective. These cushions are graded to help people at the various stages or risk levels. Grade 1-4 stages are recognised in terms of an existing pressure sore and are at risk, low risk, medium risk to high risk, very high risk for those assessed at risk without an existing pressure sore. Both direct you to the level of cushion you will need. There is no point in someone with a grade 4 pressure sore or high risk need, purchasing a low-medium risk cushion.

Foam Cushions (Click to View Product Range)
These are most popular for the lower levels of need, although there are high risk foam cushions. Your OT or one of our experts can inform you what level of the various cushions will work for.

Gel Cushions (Click to View Product Range)
These cushions often cover medium to high risk, the gel allows movement beneath the cushion without the effects of friction. Friction itself can cause a tear in risked skin, so it’s important to ensure the correct cushion is prescribed.

Air Cushions (Click to View Product Range)
Air cushions are mostly covering high to very high risk. They encourage the elevation of the body entirely from the seating surface and this encourages blood flow which reduces the chance of pressure damage. Again your OT or Murray’s experts can help advise in this regard. Repose cushions are inexpensive and cover all categories from at-risk to very-high risk.

How Do I Choose the Correct Cushion?
The best way to ensure that you’ve got the right cushion to match your needs is to firstly get advice off your OT, or healthcare professional. We can also pair your needs with the most suitable cushion by asking questions to get an understanding of your risk category.

Pressure sores, also called pressure ulcers and bedsores, usually develop gradually due to pressure against the body, moisture, friction and shearing when people are immobile and not giving sufficient relief to the area in contact with another surface. That can be a chair, bed or wheelchair. They can also develop in hours. Most carers and patients aren’t aware of the damage until it’s too late. Like everything in health, prevention is better than cure.

How to recognise the potential problem?
Early symptoms include reddening of the skin in the affected area, pain or itchiness in the reddened area and finally a localised patch of skin that feels warm, moist, spongy or sometimes hard. Medics refer to this stage as a category 1 pressure sore. If untreated, the pressure sore can get worse, from further reddening, to skin blisters, eventually degrading to an open wound. The deeper the wound the higher the category of pressure sore. Category 4 stage of pressure sores are very deep and can be down to the bone.

Pressure sores can trigger all sorts of other medical conditions if left untreated, causing immense pain for the patient that could result in life threatening complications. So they need to be taken very seriously. If you suspect a pressure sore, you should immediately go to your Doctor or HSE Primary Care unit. If you can’t travel it’s important you get a home visit from your Public Health Nurse, without delay. The start of a red area can progress rapidly to a full-blown open wound in days. Do not delay.

Patients who are prone to pressure sores, mostly elderly, immobile or wheelchair users, should be frequently monitored by healthcare professionals or carers. They should try to cease smoking, improve diet and most importantly regularly reposition themselves so the pressure load is redistributed to other areas. Think of a time you’re sitting in the same position for a long time and you shuffle your bottom – that’s redistributing the pressure load to another area. We do that without knowing why, just for comfort. An elderly, immobile or wheelchair user needs to do that frequently each day.

The treatment required to heal a pressure sore depends on how soon you react. The sooner the better, as it’s a lot easier to heal a category 1 than category 4 pressure sore. A category 4 pressure sore could take months to heal and leave the patient in pain for a long time as they try to avoid surface contact with the area in pain.

The common treatments are as follows:

• Dressings are applied by nurses to help stimulate faster healing. This can be a daily requirement.
• Frequent repositioning at regular intervals to alleviate pressure from the affected area.
• Using special medical foam or air cushions/mattresses to relieve pressure. These are supplied by the HSE or through our shops for those not covered by the medical card. Proper quality products are costly but worth the investment.
• 30 Degree rotational mattress underlay’s, like Toto, can stimulate healing in more difficult stages by constantly repositioning the client without human involvement.
• Nurses cleaning out the wound and removing necrotic tissue to allow healing. This is mostly for category 3 and 4 stages, which are very difficult to heal and require constant supervision and treatment.
• Improvement in diet and intake of supplements, including vitamin C. Studies have shown that patients who look after their diet and take Vitamin C can considerably reduce their susceptibility to pressure sores.
• Maintain dry skin. If there’s incontinence, it’s important to ensure the patient is not left in wet pads for a long time as this can exacerbate the progression of pressure sores.

Studies show that the economic cost of pressure sores cost Governments in the EU billions. The cost of healing one single pressure sore has been estimated to cost the HSE as much as €30,000. It’s not impossible to eliminate pressure sores, but with early intervention, it’s possible to reduce the impact, heal more quickly and most importantly spare the patient a lot of pain.

Why the cheapest option may not always the best option in the long run!
In 2021 all businesses, in every industry are trying to reduce costs, save money and provide better value for money. This includes the medical/healthcare industry and all this activity is occurring against a backdrop of worldwide pricing increases from manufacturing shortages and increased international shipping, all resulting from the knock on effects of Covid-19. The question that needs asking is, is the cheapest option the best options for our loved ones and patients?

When it comes to delivering value for money, especially in healthcare, there are many factors to take into account including product price. The questions that need answering when coming to an overall value decision, should include the following:

Have the products been tried and tested for comfort?
It’s important for many products to feel and try, before you buy. If you buy a costly item like a bed, scooter or chair, it’s very important to ask questions and understand exactly what it does in advance. It’s too late after you’ve used the product to then find that some of the functions you need are not available.

Is the product or brand recognised for quality?
In the current global community there are more suppliers than ever with many being of dubious quality. That’s why we welcome visits to our shops where you can talk with our friendly and expert staff, as well as knowing that we only represent quality-approved suppliers. A better manufactured product will mostly last years longer than a more basic one. The reasons savings are often made with unrecognised brands is that they save with lower quality materials or components.

Is the product CE certified?
If a product is CE marked this means it’s been quality passed for sale within the EU. Many products that are sold without CE certification have not passed the more stringent EU quality testing.

Is the supplier based in Ireland and can they be trusted?
With the explosion of internet purchases, more than ever suppliers position themselves as being Irish whilst shipping from abroad. That causes after-sales and servicing difficulties. We have traded in Ireland since 1974 and we take our service and reputation very seriously.

Have you understood the after-sales service capability of web-based suppliers?
We, as an Irish web-based and bricks & mortar business with two Dublin shops, have often been asked to help service a product that has been purchased over the internet that’s covered by warranty, but the scooter or chair needs to be returned to the UK or beyond. The end result is often that the cost of returning the product for a service in the UK, and subsequent return, costs £100’s more than the apparent saving when comparing prices over the internet.

Have you checked dimensions or components for shrinkflation?
We’ve often noticed similar looking products are sold for lower prices and while nothing was misleading, the actual product is inferior for a few possible reasons. Here’s a frequent example: A standard wheelchair made form aluminium is lighter than one made from steel, but cost more. It looks the exact same when viewed on a website. Steel is cheaper but often weighs too much for an elderly person to lift into a car.

Oftentimes the difference in price between a trusted supplier and an unknown internet supplier can be 5-10% and for many of the reasons above it may not actually provide better value for money. At Murrays we stand over the quality and after sales service of all our products and you can be confident that we provide competitive prices with outstanding after-sales service – to allow you to buy with confidence.

Fair Deal Scheme Explained
The Nursing Home Support Scheme, known as the Fair Deal Scheme, is operated by the HSE and provides financial support for people that need long-term nursing home care. The HSE covers the cost of nursing home care while you make a contribution after your financial situation is assessed. Assets, including savings and property are taken into account when assessing your financial situation to decide how much you will have to contribute.

The scheme is open to anyone living in the State for at least a year and requires approval of your application before you can decide on the desired nursing home.

Care Needs Assessment
The application includes a “care needs assessment” to confirm that long-term care is necessary. This is carried out by healthcare professionals appointed by the HSE covering your ability to carry our daily independence tasks, like dressing, shopping and self-care. It also takes into account personal social services provided, family, or community, support available to you as well as your wishes and preferences. The report is prepared, shared with you and informs you whether you have been deemed eligible for State support for long-term nursing home care under the Fair Deal scheme.

Financial Assessment
This assessments looks at all your income and assets, including savings, property, pensions and social welfare benefits. The assessment does not take into account the income of children or supporting relatives. The assessment then works out what your contribution will be and the HSE will then cover the balance of the cost of your care. EG: If your weekly cost is €1000.00 and your contribution is €250.00, the HSE will pay the balance of €750.00 for as long as you need care.

Nursing Home Loan/Your Contribution to Long-Term Care
In order to avail of the Nursing Home Loan you must provide written consent to a charging order registered against your asset (home) and if you’re a couple your spouse must also provide written consent.
You will contribute 80% of your income.
7.5% of the value of assets per year of care, with a 3 Year Cap. After 3 years of long-term nursing care you will not be required to pay any further contribution based on your principal residence.
The first €36,000.00 of your assets are not counted in the financial assessment.
If your assets are property the 7.5% contribution will be deferred and paid to Revenue after your death. This is known as the Nursing Home Loan.
If your spouse is still living in the principal residence the repayment can be deferred for their lifetime.
If you no longer have the capacity to make decisions your representative/enduring power of attorney will make these decisions on your behalf.

Successful Application
Once the HSE confirm your eligibility and acceptance you then choose your preferred nursing home from a qualifying list. You then pay the level of agreed contribution and the State/HSE covers the rest.

This is solely a broad overview of the Fair Deal Scheme and does not constitute legal advice.

Use Technology
Smart devices like Amazon Echo, Google Home AND Apple Home Pod can all help you live better with dementia at home. Using Skype, Zoom and other forms of remote contact can be very helpful, especially if family are not near.

Good Lighting
Good lighting helps you to see more clearly and make sense of where you are. Dementia can make it harder to keep track of time and having your windows clear allows natural light in, informing you whether is is day or night. Better internal lighting reduces shadows and dark areas that can be confusing. Night time light sensors will help you safely move around if you need to get up.

Bathroom Safety
Remove items that aren’t frequently used as a crowded bathroom can be distracting. If you need assistive toilet, bath or showering equipment such as toilet frames, raisers, grabrails, tap turners get them in contrasting colours designed specifically for dementia. It makes them a lot easier to use than white ones that blend in with the surroundings.

Furniture and Furnishings
Dementia can make you disorientated and confused about what you are seeing. Use colour and pattern to help you identify and see things more clearly. Avoid stripes and strong patters as they can be disorientating. As dementia progresses reduce and avoid clutter, whilst keeping the original format of rooms the same. It may be necessary to remove mirrors and paintings as they can be confusing.

Knowing Where Things Are
Memory problems will mean that you forget where things are stored. If you put pictures and labels outside cupboards and wardrobes it will help greatly. Reorganise cupboards so the items most frequently used are to the front and easier to find. Consider removing cupboard doors that may hide white goods like washing machines etc.

Keeping Safe
Remaining safe and confident in you own home is important. Fit out your home with the necessary safety equipment like, grab rails, alarms, sensors, smoke alarms. Help is readily available from OT’s, fire and safety services as well as our customer care team. We’re all here to help. There’s also plenty of HSE and dementia support advice available.

Remain Active
It’s important to remain active and engaged so that you can live more easily with dementia. Try to continue with favourite hobbies and maintain in contact with family and friends. There are plenty of items like reminiscence/nostalgia items, toy pets and dolls, arts and crafts  boxes and these all help keep the mind engaged. There are also specialised clocks, calendars and watches to help keep on top of events and appointments with reminders.

Get Outdoors
It’s also important to keep fit and active and outdoor activities can be really helpful when possible. Gardening, exercise and enjoying outdoors should be encouraged. If you’ve lost confidence or may feel you can’t find your way home do these pursuits with a family member, friend or carer.

The Dementia Care section of our website covers all these items and we hope you found this blog helpful.

Why Buy a Crash Tested Wheelchair?

The first point to state regarding crash testing is that a wheelchair that’s passed a crash test is evidently superior in build quality than one the manufacturers have not sought to test. In the EU all quality wheelchairs have been crash test passed. The only reason to purchase a non-crash tested chair would be when you’d buy an occasional use chair solely for your locality and that you’d never anticipate using it in a car, taxi, van or ambulance. There’s not much difference in price so it’s best to always go with the quality of the crash tested wheelchair for confidence and security.

If you are a wheelchair user and wish to travel in any wheelchair accessible vehicle, the safest option is to transfer out of your wheelchair and into one of the cars seats. This may not always be practical, or possible. If you need to travel sitting in your wheelchair it’s important that the vehicle is equipped with the correct wheelchair tie-down and occupant restraints. The wheelchair itself must have passed a simulated crash test, to confirm that they are capable of withstanding the force of a crash without crumpling or disintegrating, causing danger to all occupants of the vehicle. The certification for wheelchairs that have undergone, and passed, a crash test is covered under EU ISO 7176:19-2001.

Wheelchair accessible vehicles cannot carry an occupied wheelchair user in a wheelchair that has not passed the above crash testing. Wheelchairs that have passed this requirement will have stickers on the base frame illustrating that the wheelchair has met the requirements as well as directing where the tie-downs should be attached.

If you are a travelling in an occupied wheelchair it can also be worthwhile to use a headrest that can be attached as an additional part to the back of the wheelchair. This is not compulsory but will give additional security and safety, minimising the risk of whiplash in the event of an accident.

VAT Refunds on Medical Equipment

In Ireland everyone can claim a full refund of the VAT included on all medical or disability equipment purchased privately. That amount’s to 23% of the purchase price. So if you buy a €400.00 product you can get €92.00 refunded directly to your bank, within weeks of submitting your claim.

You don’t need to be a business, or registered for VAT, to claim your refund and it’s been made to be a very simple and straightforward process. All that’s required is your PPSN number and a copy of the paid invoice to complete your refund.

It can be reclaimed on-line or by post using the following Revenue links,  https://revenue.ie/en/vat/documents/form-vat61a.pdf

The refund applies only to VAT on products purchased. Medical services or equipment rentals are not covered by these refunds.

Dementia is a disease of the brain that negatively effects brain functions regarding memory, behaviour and the ability to complete, previously mastered, everyday tasks. The good news is that with a diagnosis, there’s now plenty you can do to continue to live a full and rewarding life with dementia. More of that later..

There are many different types of dementia, the most common are:

Alzheimers
Here the most obvious symptoms are loss of memory, difficulty in recalling the right words, delays in problem solving and decision making as well as reduced vision and perception.

Vascular Dementia
Symptoms most frequently occur following a stroke or series of mini strokes, when damage has occurred to blood vessels in the brain. Symptoms are similar to Alzheimers with the addition of pronounced difficulties in concentration allied to general confusion.

Early Onset Dementia
This mostly occurs to younger people in their 40’s – 60’s and is often missed and difficult to diagnose as medics don’t think of dementia due to the age of the presenting patient. There’s usually a genetic history of dementia. Symptoms are the same as above but spread over longer periods and many patients can remain independent for a long time with this diagnosis.

Dementia generally progresses through three stages
Early; Where symptoms are mild, frequently missed or put down to getting older. Memory loss, forgetfulness are the most common signs and most people are still functioning independently.

Middle: The longest stage, where the early symptoms progress to confusion, moodiness and depression. Increased help is now needed to manage daily tasks.

Late; At this stage sufferers are increasingly frail, may no longer talk and are often lost in a world of their own. Full time 24 hour or nursing home specialist care are needed at this stage.

Post diagnosis
Receiving a diagnosis can be overwhelming but it also provides answers to past frustrations and most importantly, allows you to proactively and positively plan for the future.

The Positive News of Living with Dementia
Nowadays there’s a much greater understanding of dementia with better accessibility to advice, help and services. There are so many practical steps and products available to allow you to positively plan for the future. It’s now possible, with the right help from the HSE, national or local dementia support groups and charities, to reduce anxiety and more than ever before live active, rewarding and fulfilling lives with dementia.

The products in our Dementia Care Range can help you in this regard.