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COVID – 19 | Infection Control

COVID – 19 | Infection Control

March 21, 2020

Mary Gilliam, MBA, LNHA


Infection Control is important during flu season but especially now during a COVID-19 pandemic.  Infection control addresses factors related to the spread of infections including prevention, investigation of origin, infection monitoring, vaccination surveillance and management of outbreaks.  There things can be done to help prevent the spread of disease.

  1. Hand Hygiene

The United States Centers for Disease Control and Prevention (CDC) notes that hand hygiene is the most important measure for preventing the spread on pathogens is effective hand washing.  Good hand hygiene should be at minimum before, during and after preparing and eating food, after using the restroom, after blowing your nose, coughing or sneezing, after touching an animal, animal feed, or animal waste and after touching garbage.

Follow these five steps when washing hands:

  1. Wet your hands with clean, running water (warm) and apply soap.
  2. Lather your hands by rubbing them together with the soap. Lather the back of your hands, between fingers and under nails.
  3. Scrub your hands for at least 20-30 seconds. Need a timer?  Hum “Happy Birthday” song from beginning to end twice.
  4. Rinse your hands well under clean, running water.
  5. Dry your hands using a clean towel or air dry them.


  1. Clean & Disinfect

The World Health Organization notes that COVID – 19, as well as other viruses can stay on surfaces for several hours to several days.  Keeping areas clean and sanitized is one of the best ways to keep bacteria and viruses away.

Common areas that should be disinfected include but are not limited to tables, doorknobs, light switches, desks, faucets, sinks, computers and cell phones.


  1. Use Personal Protective Equipment When Needed

Personal Protective Equipment, also known as PPE, is an important step in protecting one-self from germ exposure.  The most common PPE is gloves.  Wearing gloves does not mitigate the need to wash hands, but provides a barrier for our hands from exposure to bacteria.  Another form of PPE is facemasks.  Currently only N95 type of masks protect from COVID-19.  Texas Health and Human Services released a statement that facemasks were encouraged when working with the senior population.  Unfortunately, Medline, McKesson and other major medical supply providers currently do not have supplies readily available for purchase leaving caregivers to provide care without these supplies.


  1. Handle Food with Care

By handling food with care, we can limit the spread of bacteria and infection.  Many people think if something looks clean, it is safe.  Bacteria and other organisms cannot be seen with the naked eye and if not disinfected can cause contamination.

Always wash your hands before preparing food and wash hands in-between handling different types of food.  For example, wash hands after touching bacon, before handling the vegetables.  After prepping and cooking a meal, ensure utensils and plate ware are washed and sanitized properly and make sure the counter tops are disinfected as not to leave any residue from raw or other foods.


  1. Surveillance

Listen to your body and monitor for signs and symptoms of infection.  If you feel like you have a sore throat that does not get better with tea, listen.  If you feel hot, take your temperature.  If your chest is tight – let your physician know.  Surveillance starts with yourself.  No one knows your body as you do – so listen.

During a pandemic, it is easy to allow anxiety to cause fear of phantom symptoms.  This happened to me just the other day:  I was helping take multiple loads upstairs when I started sweating.  Was this a fever?  Was I sick?  No, I was just out of shape.


  1. Isolation & Quarantine

There are now COVID-19 tests available, however, they are not widely available.  Unless fever or respiratory issues require hospitalization, physicians are going to tell you to isolate and quarantine yourself for fourteen (14) days.

Isolation and quarantine is not to protect you, rather to protect the community around you that is vulnerable to the disease.  If you encounter anyone that has been diagnosed, it is recommended a 14 day self-quarantine to stop the spread of disease.


  1. Stay Informed

The CDC has web-pages and constant updates to the status of COVID-19 diagnosis, spread, precautions and prevention and treatment among other items.  Only listen to trusted, authentic sources such as the CDC and Texas Health and Human Resources.  Call Monarch Senior Home Care with any questions that come up.  Social media can easily spread propaganda creating anxiety and fear.  Do your homework, stay informed, heed precautions and stay safe.



Mary Gilliam’s passion for serving seniors has become a lifelong mission.  She is the founder of Monarch Senior Home Care and Monarch Care Source.  

Mary holds a Master’s Degree of Business Administration with an emphasis on Health Care Administration and is a multi-state Licensed Nursing Home Administrator.  She has been in long term care operations since 2002 serving those in home care, assisted living, memory care and skilled nursing. 

How to get an advanced directive or living will in Dallas TX

Monarch Senior Solutions helps seniors and their families living in the Dallas-area. We’re partnered with the highest-quality elder law firms to ensure all of our clients have the opportunity to get an advanced directive or living will in place if they need it.

An advance directive can establish what the holder wants done for their medical care if they find themselves in a situation where they are determined to be unfit to make their own decisions. This usually happens due to deteriorating mental capacity, terminal illness, or an extended state of unconsciousness. Having a living will in place ensures the holder gets the treatment they want rather than leaving the decision making to family members. Likewise, the same document can be used to appoint a proxy who can make those decisions on the holder’s behalf.

There are checks in place to determine when advance directives can and should be acted upon so that someone is not taken advantage of. Two physicians must assess the holder is no longer able to make their own medical decisions or that they suffer from a qualifying illness or condition. These same requirements must also be made before medical power of attorney (as laid out in the living will) can be acted on.

Advance directives are legal documents and as such followed when they are finalized and signed by the relevant parties in the presence of witnesses. While a lawyer isn’t needed to draw up a living will, their help is invaluable. The caring team at Monarch Senior Solutions, alongside our partners, will ensure these final wishes are correctly documented, and made as clear as possible to avoid any future confusion. There can be a lot of considerations that need to be made with living wills so be aware of those issues.

As you travel the path to graceful senior aging, don’t overlook the importance of having a living will in place. You want to be aware of it for your own piece of mind and for those of your family and loved ones. One simple document can help minimize the stress and impact that an end-of-life situation can bring. To learn more about how Monarch Senior Solutions, please reach out to us today for more information.

Caregiver Time – The Power of Our Time


Mary Gilliam, MBA, LNHA, Certified Dementia Practitioner


The dawn of a new year is a good time for us to reflect on something extremely important.  Time – or in our case caregiver time.  This upcoming year has the same maximum amount of time for each one of us.  The same 24 hours in each   day.  The same 7 days each week.  The same 12 months in the year.  We each get to decide how we will use our time and when the day is over, the time we had is forever gone. The decisions on how we prioritize this time determine many things such as how we will perform at work and how our personal relationship will develop.  Time is the most valuable resource we have.

It seems like many people live life with the attitude that the busier one’s schedule is, the more significant their life. The ability to multi-task has become glorified to the point that focusing on one task at a time can be misinterpreted as laziness or unproductive.  As a culture, caregiving is a great opportunity to reconsider the way we place value on what we spend our time doing, in making choices and setting our priorities.

Cheryl Beaver, Director of Community Relations at Monarch Senior Solutions, recently spoke on the power of time.  She highlighted a plaque she had given her daughter hanging prominently in her room stating; “do something that fuels your soul.”

For millions of Americans, caregiving is what fuels a passion of purpose, empathy and love.  These moments of joy can come in the simplest of caregiving tasks.  Cheryl told a story of a recent client she had gone to visit late morning during her off time.  Upon entering the room, Cheryl noticed the client was still in bed, wet and weak.  She immediately helped her to a sitting position, gave her a bear hug to help stand her up when all the sudden the client started passing a large amount of gas.

“Did you hear that?” said the client and she was cradled between the arms of Cheryl.

“No, no, didn’t hear a thing,” responded Cheryl allowing her to maintain her dignity during this transfer.  A moment passed as they slowly transferred to the wheelchair.

Her client looked up, caught Cheryl’s eye and said, “Well, I hope your sense of smell is as bad as your hearing.”

The two of them burst out in a belly laugh and a normal caregiving moment was instantly turned into a lifelong memory.

Time well spent and inspiration looks different to different people.   For Cheryl, that moment where she allowed herself to slow down and make the client in front of her the most important person in the world.  Cheryl said that “E-Mails, phone calls, meetings, life stops in that moment for a short period of time to serve the person in front of me.”  That is the time that it well spent.  It is not scrolling through FaceBook, rather it is laughing with the person in front of you.  It is these moments, transferring a sweet, wet, thankful client to a chair and laughing until your stomach hurts over flatulence, these are the moments that matter.  These are the moments that allow us to create hope, be a blessing, be an inspiration and share our love wherever we go.


Mary Gilliam’s passion for serving seniors has become a lifelong mission.  She is the founder of Monarch Senior Solutions and responsible for leading the in-home care partners and senior advisors.

Mary holds a Master’s Degree of Business Administration with an emphasis on Health Care Administration and is a multi-state Licensed Nursing Home Administrator.  She has been in long term care operations since 2002 serving those in assisted living, memory care and skilled nursing. 

Improvisation Techniques to help Dementia Care Communication

Loved One Suffering From Alzheimer’s? 

7 Ways Improvisation Techniques Can Help With Communication

Mary Gilliam, MBA, LNHA, Certified Dementia Practitioner


Communicating with someone with Dementia can be challenging.  Such as any skill mastery, it can take time and practice to learn the nuances of keeping a conversation engaging.  While improving communication skills might not make being a caregiver less stressful, it can make the moments you have more meaningful.  Oddly enough, the principles of improvisation can be implemented to help create a positive dialog for you and your loved one.

  1. “Yes, And”

In improvisation, “Yes, And” is one of the most important rules.  This is the rule of agreement, where under no circumstance should you discredit your partner.  No’s stop the flow of conversation.  Someone suffering from Alzheimer’s receives a lot of “no’s” throughout any given day. “You can’t go outside.”  “You can’t get up and walk.”  “Your room isn’t that way.”  “No.  No.  No.”  By agreeing using “yes, and” you can give validation.  You can continue conversation in a positive way.  “Yes, we are going to go home right after we eat.”  “Yes, your Mom is on her way here.” “Yes.  Yes.  Yes.”

  1. Listen & Respond

During conversation, it is important to actively listen to your partner and respond appropriately.  Sometimes with Alzheimer’s or other forms of dementia, we have to read between the lines in our listening.  For example, if someone is looking down at their bare feet saying, “I’ve lost my monkey’s.”  They might mean, “I need to find my shoes.”  We as caregivers, must listen and respond to what is said but also to what is meant.

  1. Commit 100% to the Moment

In both improvisation and dementia, things can get weird fast.  It’s important to fully commit to the conversation in whatever direction it may go.  If your loved one lives in an assisted living but they are talking about how fun the cruise activities are – re-focus to the moment, you are on a cruise.  Each moment is a little different and it’s important to commit to whatever moment your loved one is experiencing.

  1. Go with the Flow

During improvisation, you can’t always control the direction of the scene.  Similarly, we can’t control dementia.  Sometimes, a caregiver might approach a loved one and start being yelled at.  The next visit could be mean an embrace.  It is vitally important to go with the flow with your loved one and where they are at in the moment.  If the visit is going in the wrong direction, make it short and try again at a later time.  If the visit is positive and productive – stay longer and take advantage of making a moment.

5.  Accept offers and gifts

During acting scenes, imaginary items add a new dimension to the scene.  Someone can pretend to be shooting a basketball through a hoop and our minds help us imagine what they are doing.    If someone suffers from hallucinations commonly associated with Parkinson’s or Lewy Body Dementia, a third party might witness a similar scene of a person handing an invisible item to someone else or perhaps picking up something from the floor.  Just as you would be participating in a scene – take the invisible item from them and go with it.  It’s not real to you, but it is very real to the person you are connecting with.

  1. Silence can be powerful

                Both on stage and during conversation, silence can be powerful.  There is nothing wrong with taking your time to answer a question to direct conversation.  Don’t be afraid to take several moments of silence to figure out where the conversation is going and the best strategy to keep it going in a positive direction.  Moreover, remember that it is not always necessary to fill the air with words, sometimes a gesture such as holding hands is the most powerful thing we can do with a loved one.

  1. Accept the reality given to you

When communicating with someone who has dementia it’s so easy to say, “no Mom, we aren’t at home” or “No Dad, your wallet wasn’t stolen.”  It’s easy to want to draw someone back into your world instead of attempting to jump in theirs.  With improvisation acting, the whole goal is to understand the story your partner is laying out and to jump in that reality and roll with it.

Both with improvisation and with communicating with someone with dementia, there are no rules and you can’t rehearse set scenes.  It is a learning process to grow and develop techniques of productive communication.  The guidelines established in improvisation acting transcend the stage and can be highly effective in guided communication with someone suffering from dementia.    Next time you are communicating with someone with Alzheimer’s or other form of dementia keep these principles in mind and see how it can help make more moments into memories.

Mary Gilliam presents Improv Principles to North Texas Area Gerontological Society, McKinney, Texas

Mary Gilliam’s passion for serving seniors has become a lifelong mission.  She is the founder of Monarch Senior Solutions and responsible for leading the in-home care partners and senior advisors.

Mary holds a Master’s Degree of Business Administration with an emphasis on Health Care Administration and is a multi-state Licensed Nursing Home Administrator.  She has been in long term care operations since 2002 serving those in assisted living, memory care and skilled nursing. 

Life After Diagnosis | The New Normal

Life After Diagnosis | The New Normal

Mary Gilliam, MBA, LNHA

The New Normal

Receiving the diagnosis of a degenerative disease for yourself or a loved one instantly changes everything.  In the moment, fear and thoughts of what the future holds are consuming.  Denial.  Anger.  Guilt.   Hope?

Slowly over time, the normalcy of life without diagnosis transitions to a “new normal.”  Perhaps for someone with Alzheimer’s, that means repeating forty-three times in a ten-minute period that a loved one is at work.  Or, for someone that was diagnosed with ALS, transitioning from walking to a motorized wheelchair.  Maybe it is removing imaginary snakes from the ground because a loved one suffering from Lewy Body Dementia has the disturbing hallucinations each night.

After diagnosis, there are many changes that happen over time and respective idiosyncrasies, but it is still a life to be had.  It’s what I call the new normal.

The new normal changes throughout the disease process.  At first, the new normal is static; perhaps a reflection of the past with apprehension of the future.  Then the disease can turn from subtle to drastic, creating new norms for everyone in the path.

This new normal should be one that is embraced and cherished.  Each day is a blessing and although someone might excessively repeat something because they forget, it doesn’t mean they have forgotten love.  Just because someone with ALS is losing muscle mass and to transition to a wheelchair, doesn’t mean they can’t embrace a moment.  And just because someone with Lewy Body Dementia has disturbing hallucinations doesn’t mean they can’t have moments of a beautiful reality.

Tips to embrace The New Normal:

  • Be flexible to change

Use the principles Dr. Spencer Johnson illustrated in “Who Moved My Cheese” to help with family members.  Know that change is inevitable, anticipate it, monitor it and adapt to it.  Don’t be surprised if the mother you knew to hate fish wakes up loving it one day or a priest and family man start swearing like a sailor.  To accept the new normal, you have to be flexible to the changes that come with it.

  • Savor the good, get over the bad

There are good days and bad days when it comes to degenerative diseases.  When your loved one is having a good day, spend the extra time enjoying the moments.  If it is a bad day, cut the time short and re-approach.  Often, just an hour and a new approach can create a different response.

  • Stay educated and objective

Staying objective is harder said than done when it comes to the care of a loved one.  Heed the advice of professionals.  For example, if multiple professionals are telling you it is time to make some changes; listen.

  • Learn different realities

When a loved one has a diagnosis of dementia, it is especially important to live in their moment.  While it is very easy to correct and criticize, it is impossible to rationalize with an irrational disease process.  Learn the other person’s reality and get in it.

  • Take care of yourself

Finally, as a caregiver of someone with a degenerative disease, it is most important to take care of yourself.  Give yourself space and rest so that emotionally you can be present.  Take care of yourself physically so you have the strength and the stamina to pursue your labor of love.




“DNR” VS. “OOH-DNR” – What to know about Do Not Resuscitate

What to know about Texas Do Not Resuscitate Orders

Navigating Advanced Directives can be a confusing endeavor.  One of many advanced directives is commonly known as a Do Not Resuscitate or “DNR.”  A DNR is an election as well as a medical order that instructs health care professionals not to conduct cardiopulmonary resuscitation “CPR” should a person’s heart stop beating or breathing stops.

What most people do not know is that there are two kinds of DNR’s.  There is an in-hospital DNR and an out of hospital DNR.

When entering a hospital, if a patient is terminally ill, overall physical condition is severely or permanently compromised, they may elect and physician agreed to be a DNR.  This signed document will be maintained in the patient’s chart and would be respected by hospital personnel.

However, this form is only applicable inside the hospital.  If the patient or responsible party wants the DNR to continue, an out of hospital do not resuscitate “OOH-DNR” would need to be filled out and signed by a physician.

This document would stay with the person whether that is at home, in an assisted living or even taking a road trip.  In the event of an emergency, paramedics could review the form to help best assist someone to maintain their wishes.

OOH-DNR’s are state specific.  Therefore, if a client has an OOH-DNR from California and moves to Texas, a new OOH-DNR would have to be executed.  More information on OOH-DNR’s for Texas can be found at the Department of Texas Health and Human Services.

Call today for questions – 469-300-2288

Choice or Chance: Controlling End of Life Chaos

In a world of uncertainty, we often attempt to control everything we can within our lives; what food we eat, what clothes we wear, who we choose as our spouse, and so on.  We work hard to do the things we want, the way we want them.

If we feel like we are in control of our own destiny, than why do we, as a nation, leave the end of our legacy completely in chance’s hands?  Less than thirty percent of the population addresses advanced directives.  Even fewer seem to have the difficult conversation with a family member.

Specifically after the age of 65, we are playing a game of risk with what happens to us if we have a stroke, fall, or develop Alzheimer’s disease.   We are no longer in control of our fate which can place the burden on a spouse or a child.  Often, the family member designated to make decisions is too emotionally distressed to be offering guidance on another’s life saving measures or lack thereof.

Being proactive and taking control over end of life decisions can reduce stress in an already traumatic situation, reduce family member’s fear of making the “proper” decisions and ensure your final wishes are carried out.  Not sure where to start?  Here are a couple of helpful hints in dealing with advanced directives.

  • Start thinking about advance directives early and give yourself plenty of time to make decisions. Often, people change their mind of what they would want over a period of time so spend time to make a decision you are comfortable with.
  • Initiate the conversation with family. Although it might be a difficult to start, put it into perspective; it’s not more awkward than having the birds and bees conversation with your child.
  • Use a worksheet such as “Five Wishes” to help family members best understand what you would want during end of life care.
  • Fill out advance directives forms such as power of attorney and living will with details of how you would want your end of life care to proceed. Include directives such as if you would want a g-tube if you were aspirating, if you would want CPR, etc.

“I am the master of my fate; I am the captain of my soul.” – William Ernest Henley