Part 2 of this series taken from Serving Residents With Dementia: Transforming Care Strategies for Assisted Living Providers, written by dementia expert Kerry C. Mills, MPA, discussed how to approach residents who have dementia to ensure your presence is welcomed, as well as tips for asking questions to engage, rather than test. Part 3 reviews how to use actions, rather than words, to communicate and how to manage behaviors without constantly reprimanding the resident.
- Use Charades and minimal words
As has been discussed, often the words we use to best communicate with others are inadequate when communicating with a person who has dementia, which means we have to adjust our approach to foster mutual understanding.
Incorporating Charades into regular interactions is an excellent way to communicate. Residents often look to see what others are doing to guide their actions. If the staff member asks a resident to put the toothbrush in his mouth and he doesn’t, the staff can put her finger in her mouth and pretend that she is brushing her teeth. This action will demonstrate to the resident what the staff member is asking him to do. As in Charades, acting out actions in the ALFPD is a two-way street; if you establish this as an appropriate communication method, residents who are not very verbal may feel encouraged to express their needs in this vein.
Secondly, limit your words to an essential few. At times, the more we say, the more we may confuse residents with dementia or make them feel that we are trying to control them.
Evidence from the real world
Cheryl was helping Wayne get dressed. They were standing together in his bathroom. Wayne was putting on a belt and looping it through the belt loops. At each loop, Cheryl repeated, “Put it through the loop.” She said this roughly six times, and as Wayne began to buckle his belt, he said, in what seemed like slow motion, “Do you think that I have never put on a belt before in my life?”
I asked Cheryl why she kept telling him what to do. Her response was, “He gets confused,” and I said, “But he was doing it well. It is best to let him have success without saying anything and then jump in and cue him when he is having trouble.”
Giving someone direction when he or she is confused can be helpful. However, care partners should wait until the person actually demonstrates a need for assistance before jumping in, rather than basing responses on past patterns of behavior. Otherwise, you may hamper a person’s ability to be independent in that moment.
- Avoid saying “NO”
There are many times when a person with dementia might be engaged in an activity that you would prefer he or she refrain from, and your gut reaction is to say, “No, don’t touch that,” “no, don’t do that,” “no, don’t sit there,” or the like. In all of these situations, your goal is clearly to inspire the residents to behave differently. However, giving people commands often has the opposite effect, making them a little bit more wary, defensive, or defiant. It is important to remember that we are not training young people who are not yet familiar with the norms of society, nor are we teaching life skills. We are working with older people who have lived their whole lives, most of them very independently, doing what they wanted, when they wanted. This experience doesn’t mean residents always make the best decisions, or ones that you agree with, but the freedom to set the general course of our actions is a privilege that most of us enjoy each day as adults—and one that we should avoid withdrawing from our residents.
Beyond the implications for personal liberties, care partners should avoid telling residents what to do simply because it is doesn’t work most of the time. Because many people with dementia are more visual than verbal, prompting them with a physical indicator of what you want them to do may help them to understand the action and carry it out on an ongoing basis. For this reason, instead of telling Susan to not get up without her walker, staff should bring her the walker when they see her start to get up. She might be very happy to use it when offered instead of commanded to do so and cued in how.
Finally, depending on the specific behavior, staff may have more luck changing their approach to accommodate the resident.
Evidence from the real world
Ann, an ALFPD resident, always watched the staff as they cleared the tables, and each day, she would stand up and bring her dishes to the sink. The staff always responded by saying, “Oh no, Ann, we will get your dishes. You stay seated.” Ann started each of these encounters with a bright smile on her face, and after the staff rejected her help, she seemed sad. One day, Sonia caught herself as she took Ann’s dishes and instead said, “Thank you, Ann, you are also so helpful. I will take them.” Ann was beaming!
For months, the staff had told Ann she couldn’t help, and yet it didn’t change her behavior. On this particular afternoon, Sonia instead made Ann happy by appreciating her clearing her dishes. Ann continued to get up with her dishes, and the staff were now able to make her happy instead of discouraging her. Notice that Ann’s behavior never changed—she still brought her dishes to the sink. The change in the staff’s response is what made a difference in Ann’s happiness. The added bonus was that Ann’s behavior was also useful, and she was given the opportunity to be independent.