Part 1 of this series reviewed the first two of eight steps to integrating effective speaking practices with other essential aspects of communication in order to provide quality care to residents with dementia, highlighting the importance of preparation. Part 2 will discuss steps three and four from Serving Residents With Dementia: Transforming Care Strategies for Assisted Living Providers, written by dementia expert Kerry C. Mills, MPA.
3. Approach residents intentionally
Be mindful and present when talking with a resident who has dementia. Approach the person from the front to ensure he or she is able to see you coming and avoid startling him or her. Once the interaction is underway, and the resident is attuned to your presence, adjust your position as necessary to avoid obstructing his or her view.
Make eye contact with residents. Eye contact often conveys, “I respect you,” or “I am listening to you.”
Align your body to be at their general height. In doing so, you create equality in the relationship. If you stand over the person (such as while he or she is eating or lying in bed), you create a power differential. Once you sit in a chair next to him or her or kneel on the floor next to his or her bed, you are sharing the authority or control, and the resident will be able to relax.
Touch the person, perhaps on her hand or his back, in order to get his or her attention. Touching someone is often an affectionate means to communicate. If, however, residents do not like to be touched, respect their wishes and avoid doing so. Very often, a person with dementia is overly affectionate, and the staff should use this as a cue that the person is comfortable with touch. If staff are not sure about a particular resident’s stance on the approach, they should ask the resident whether it is okay to touch him or her and then respond accordingly.
Evidence from the real world
I was doing some work in an ALFPD in Canada, when I began hitting it off with one of the residents. We had met only moments before, but we were already chatting it up and laughing. Eventually, I started to go in for a hug, but caught myself quickly and asked, “Would you mind if I hug you?” In the same cheerful tone, she replied, “Yes, I would mind very much!” I was so glad that I had asked!
By approaching residents in this respectful and deliberate manner, you empower them to relax and be themselves around you, and this in turn will make the interaction more enriching—not to mention peaceful—for you both.
4. Ask questions to engage, not to test
Let’s face it: It is hard to watch someone struggle, especially someone whom you care for. When we see a person with dementia fighting to get his words out, or someone who is crying as she talks about her husband who is always late for his visit (but who in reality has died), we want to help. We want to have the answer that will make the resident happy and carefree. For this reason, we tend to jump in and respond before we know all of the facts necessary to provide an appropriate answer. When Mary Joe is crying because she misses her husband, staff sometimes say, “Don’t worry, he’ll be back.”
Instead, staff should ask questions—not to test residents, but to engage them and learn more about how to help them. For instance, when Mary Joe is talking about her husband, the staff can respond by asking, “Why are you crying, Mary Joe?” Perhaps she will say she misses her husband, or that she is worried about him, or that she is worried that she doesn’t have their home in order for him. All three of these responses would warrant different responses. “He’ll be back” might be the very last thing Mary Joe needs to hear if she is worried that she still needs to tidy up.
If a staff member wants to reminisce about a resident’s trip last week to the zoo, rather than probe, “Remember when we went to the zoo?” staff can say, “So, last week we went to the zoo. Ilene, I remember you told me that the polar bears were your favorite animal. Will you tell us why?” In this way, you are giving the residents information so that they can form their answer, reply, or opinion. Staff are likely not focused on whether the residents remember going to the zoo—they just want to talk about the fact that they went. Supplying residents with the background information they need to share their thoughts allows the staff to accomplish this goal while engaging the residents.
It is important to educate staff and families alike, not to test residents. Often people will ask residents, “Do you remember my name?” This can be discouraging and embarrassing for residents. Many times, especially with their children, they will say, “Of course I do, honey,” which is their way of improvising.
Evidence from the real world
Lisa flew across the country twice a year to visit her parents. Her dad, John, had Alzheimer’s disease. For eight years, while he progressed in this disease, each visit was different, but he was always happy to see Lisa. For the past three years, John was in an ALFPD. Each time Lisa would visit, she would start her visits the same exact way: “Hi, Dad! It’s your daughter. Do you know my name?’ Unfortunately, John’s ability to answer accurately—which fluctuated a great deal—would set the tone for the visit. What an ill-fated series of events.
During Lisa’s last visit with her father, John was on hospice. She arrived and asked her dad the same question as always. In full clarity of mind, he responded, “I know that I love you.” Lisa has been looking in all the wrong places to connect with her dad, but fortunately for her, John was able to direct her to what was important: that, emotionally, he was still very much cognizant.
It is a good thing to ask residents questions—just make sure they are the right ones. Staff shouldn’t ask questions to test the residents but rather to engage them. The worst-case scenario is that the resident asks, “Why all the questions?” When that happens, staff should pull back. Sometimes a resident will become suspicious, and we want to avoid that as well.
Check in next week for Part 3 of “Increasing Communication With Your Residents Who Have Dementia,” which will provide tips for when communicating with actions, rather than words, is more effective, and how to manage unwanted behaviors without constantly reprimanding the resident.