Caring for those with Dementia

1. Caring for those with Dementia Sheryl Bagshaw, MBA, SSW, CVW Certified Dementia Practitioner Cognitive Interventionist

3. Dementia questions most often asked: • How do I deal with his/her behavior? • How do I get through to him/her? • What is the trick to understanding dementia?

4. In other words: • How do I communicatewith someone with dementia? • How do I deal with behaviors?

5. Let’s start by talking about BEHAVIORS

6. Behavior Management and why it does NOT work: • Managing negative behavior using a learning behavior model that includes triggers, behaviors, and consequences (reinforcement or punishment) • Relies on manipulating triggers, setting boundaries, and providing reinforcements • May affect identity and self-esteem • Assumes specific cognitive abilities such as awareness, judgment and reasoning

7. Questions to ask ourselves: • Is the demented person aware of his/her behaviors? • Can the person with dementia manipulate his/her own behaviors? • How disruptive is the behavior? • Is it ok to allow the individual to be demented? • And, most importantly…

8. Whose Behavior Needs to be Managed? OURS!!!

9. Primary External Cause of Agitation: Caregiver Approach • Not listening • Impatience – the more you hurry, the more time it’s going to take • Arguing – Join their journey • Not explaining • Expecting them to act/behave a certain way (Allow them to be demented) (They are not in our world – we are in THEIRS) • Trying to get them to do something that is not their idea

10. So what approaches to behaviors DO work? Need-Driven Behavior Approach And Validation

11. Need-Driven Behavior Approach • Normal needs + abnormal conditions = disruptive behavior • Uses the environment and individual strengths/preferences to meet and prevent unmet needs • Assumes that behaviors are not abnormal, deliberate, or good/bad • Behaviors do not need to be resolved, needs do and then behaviors will cease BASICALLY…

12. ALL Behavior = Communication NEEDS! Look for the NEED and you will know how to respond to the behavior!

13. Maslow’s Hierarchy of Needs:

14. Medical Needs: Care Needs: • PAIN • Constipation • Infection • Oxygen • Blood Sugars • Sleep Disturbances • Med Interactions • Hot/Cold • Hungry/ • Thirsty • Continence • Tired • Over/Under- Stimulation • Movement

15. Safety/Security Needs: • Looking for a family member • Thinking they are being poisoned • Thinking people are stealing • Want to go home • Hiding things • Feeling unsafe/paranoid • Unsure of others • Locking/barring doors • Elopement risk

16. Love/Belonging Needs: • Space invaders • Use a lot of physical touch • Sexually inappropriate • In the middle of everything

17. Esteem Needs: • Looking for something to do • Ask if they can help • Pick up familiar items • In the middle of everything • Negative self-statements

18. Self Actualization Needs: • Looking for something to do • Ask if they can help • Pick up familiar items • In the middle of everything • Negative self-statements

19. Bridging the Behavior/Communication Gap: Validation Empathy Reminiscence

20. Validation:- Is a method for communicating with those with dementia- Uses listening skills, empathy, reminiscing- Helps individuals with dementia to feel heard and validated- Gives demented individuals a sense of esteem/worth- Shows that another’s feelings/ communications are acknowledged and respected- Sees behavior as a form of communication of needs

21. Validation Method:- Ask questions – who, what, when, where (stay away from why)- Reflective listening – repeat back what they say in the form of a statement or a question- Ask the extremes – “what’s the worst thing about ______”- Ask the opposite – “what if (the opposite) were true”- Use ambiguity – s/he, they, it- Empathize – “that must be _____” (name that emotion)- Reminisce – “has there ever been a time when ____”- Match/mirror emotions/actions (non-verbal)- Use eye contact/touch

22. The best way to explain VALIDATION is by using examples of some of our communication failures with demented individuals and showing how we can use validation to improve them.

23. 1. Arguing with themExample: Day of the weekValidation: Don’t Argue!“WE are in THEIR world” – it only frustrates them when we try to bring them back to ours. Method: Ask questions

24. 2. We approach them wrong and/or don’t communicateExample: Moving a residentValidation: Approach is everything.“Be on their level.” Method: Eye contact, Empathy

25. 3. Reassure them/don’t let them express emotions (sympathy vs. empathy)Example: Patient wanting to leave (blocking the entryway)Validation: Allow them to safely express emotions. “The cat ignored becomes the tiger.” Method: Empathy, Need

26. 4. We assume we know the problem and how to fix itExample: Resident angry about his money.Validation: Look deeper“Look for the need.” Method: Reflective listening, Ask the extremes

27. 5. We fail to see the world from their view.Example: Patient who needs a brief change.Validation: Perception is reality.“It has to be his/her idea.” Method: Look for the need

28. 6. We lie to them Example: “Where is my husband?”Validation: Therapeutic Lies are harmful“Demented individuals have it within themselves to solve their own issues.” Method: Ask ?’s, Reminisce

29. 7. We bombard them with informationExample: Doctor’s appointmentValidation: Keep it simple, overstimulation is not good“Overstimulation, like boredom, causes anxiety.” Method: Matching, ambiguity

30. 8. We expect them to remember thingsExample: “You remember…”Validation: Keep self-esteem intact.“Has there ever been a time when...” Method: Reminisce

31. 9. We don’t stimulate themExample: HenryValidation: All individuals have worth and deserve our attention.“Music is to the soul what words are to the mind.” Method: Reminisce, music

32. Henry

33. 10. We don’t listen to the non-verbalExample: GladysValidation: Communication is 70% non-verbal.“Please hear what I’m not saying.” Method: empathy, music, touch, eye contact

34. Gladys

35. Communicating with someone with dementia is about:1. Accepting their realities2. Listening3. Validating their experiences4. Sharing their emotions5. Simplifying your communications6. Looking for the need7. Asking for their input8. Providing appropriate stimulation9. Reminiscing10. Being honest/truthful with them

36. If you want to learn more about communication, Validation, and other dementia issues, you can access my website:www.dementiaassist.com(You can also find dementia assist on Facebook)